The proper and regular use of oral care products is essential to maintaining good dental health and preventing common oral health concerns, such as gingivitis and excessive plaque. Due to an increasing number of toothbrush models in the market, patients with gingivitis may lose their way in the abundance of advertisement information and find toothbrush selection challenging. While some individuals keep track of new offers in the toothbrush market and prefer powered options, such as oscillating-rotating toothbrushes, others might take advertisements with suspicion and continue using manual toothbrushes. To resolve the stated issue and provide a definitive answer regarding the toothbrush type that benefits gingivitis patients most of all, research and evidence systematization are important. This paper presents the results of a preliminary literature review aimed at explaining the selected research question’s importance.
Manual Toothbrushes in Modern Dental Care
As the studies highlight, manual toothbrushes are still considered the mainstay of oral hygiene, which might be due to several reasons. The introduction of the first easy-to-use brush with nylon bristles has cemented manual toothbrushes’ role as basic and universally accessible oral hygiene tools (Anas et al., 2018). Firstly, the number of marketed powered toothbrushes with innovative types of bristles, combinations of bristle types, or technical features, such as rechargeability or micro-vibrations, continues to expand on a regular basis (Ccahuana-Vasquez et al., 2019). Under these circumstances, the volume of published research regarding new designs’ effectiveness also increases (Elkerbout et al., 2020). It might confuse unprofessional consumers even more and make them stick to traditional variants. Secondly, manual tools’ simplicity and no need for any additional accessories contribute to their affordability and ease of maintenance (Elkerbout et al., 2020). These features and advantages could probably make non-powered tools an intuitively attractive choice for an average consumer.
Toothbrush Type as a Factor Influencing Plaque Removal and Gingival Health
In current literature, toothbrush type is considered an important factor that affects the outcomes of regular toothbrushing in terms of plaque removal. In their comparative study of manual, powered, and ultrasonic tools, Anas et al. (2018) define the regular use of toothbrushes as the fastest and most widespread way to remove dental plaque. However, as their review suggests, the parameters predicting the efficacy of toothbrushing include brushing techniques, the presence of adjuvant methods, for instance, mouth rinse products, timing, and toothbrush type (Anas et al., 2018). Similarly, Ccahuana-Vasquez et al. (2019) list toothbrush type and bristle configurations among the factors that facilitate or hinder access to hard-to-reach areas of the mouth. Thus, in general, the influences of tool type on toothbrushing efficacy are not called into question.
One difficulty that surrounds the provision of an unambiguous answer regarding whether electric oscillating-rotating brushes outperform manual tools in terms of gingivitis reduction is product design diversity in both groups. For instance, as of now, popular manual toothbrush models are far from being homogeneous in terms of bristle configurations, which should be considered in recommendations for gingivitis patients. The currently available manual toothbrushes can be with tapered-end or rounded bristles or use a combination of these bristle types, which has been shown to affect dental health gains from toothbrushing (Ccahuana-Vasquez et al., 2019). Particularly, as per in vitro studies, the degree of tapering in non-powered toothbrushes is positively related to bristle flexibility (Ccahuana-Vasquez et al., 2019). It results in the greater effectiveness of super-tapered bristles in reaching the subgingival area. Similarly, powered brushes with rotation-oscillation action can have varying characteristics when it comes to toothbrush head diameter and shape, rotation speed, or the type and length of bristles (Elkerbout et al., 2020). Despite this variety, not much research has been done to single out such toothbrushes’ technical features that are the most conducive to optimal dental health.
Electric Toothbrushes and Gingivitis Home Care
Electric toothbrushes are regarded as an important development in dental care. The first nylon-bristled toothbrush with a plastic handle appeared in the U.S. dental equipment market in the 1930s and became a critical technological advance of the time (Anas et al., 2018). However, the subsequent miniaturization of electric tools advanced the creation of the first electric toothbrush in the rotating systems family in the 1950s (Anas et al., 2018; Elkerbout et al., 2020). With the lapse of time and by trial and error, it became possible to present an electric brush model that would achieve the necessary frequency of oscillations. Modern powered or electric toothbrushes are subdivided into two large groups, including the rotating systems family (oscillo-rotary, oscillo-rotary with pulsation, and rotary brushing) and sonic technology (Anas et al., 2018). Finally, apart from being a promising decision for plaque removal, non-manual brushes can potentially improve dental care routine in individuals with arm mobility issues.
Gingivitis care requires effective plaque removal, but whether or not electric oscillating-rotating brushes are always better is not perfectly clear. As the first stage of periodontal disease, the condition in question is extremely common. As per the boldest estimates, gingivitis can be found in up to 90% of adult dental clients in the U.S., whereas around 50% of them develop periodontitis (Grender et al., 2020). Being caused by adverse reactions to bacteria in plaque, periodontal disease, and gingivitis cases should involve strict adherence to everyday plaque control measures, such as toothbrushing (Grender et al., 2020). However, general recommendations for gum disease prevention are more centered on the regularity of toothbrushing instead of recommending one toothbrush type as the best option (Grender et al., 2020). Due to product diversity in the market, gingivitis patients are welcome to choose between powered and manual tools.
Finally, the superiority of oscillating-rotating toothbrushes over manual toothbrushing for gingivitis management could be regarded as a controversial question. As per the Cochrane Collaboration, powered brushing is better at promoting gingival status improvement compared to manual tools (Elkerbout et al., 2020). However, these results do not distinguish between powered toothbrush types, such as sonic and oscillating-rotating devices, thus making it unclear which type contributed to that advantage most of all. Some previous studies conducted between 2009 and 2015 suggest that toothbrushes using oscillating-rotating technology outperform sonic models in promoting gingival health, which implies their great advantage over manual tools (Grender et al., 2020). Other authors report ultrasonic tools’ advantage over oscillating-rotating brushes and the latter’s statistically irrelevant advantage over traditional manual tools (Anas et al., 2018). Thus, the existence of conflicting findings may hinder the provision of patient education.
Gaps in the Literature and the Significance of the Proposed Research
In summary, based on the selected literature, multiple knowledge gaps surround the chosen research topic. The first gap that is worth discussing refers to the need for further studies that would consider manual and electric brushes’ long-term effects on gingivitis patients with reference to individual factors. To start with, to establish better control over subjects’ toothbrush use, the majority of topic-specific studies measure the outcomes of single-brushing exercises (Anas et al., 2018; Elkerbout et al., 2020). It leaves the question of whether electric toothbrushes’ advantage for gingivitis patients exists only in the short term open to discussion. Another gap, such as the inability to consider an average patient’s imperfect adherence, practices, and difficulties, follows from this preference over non-longitudinal studies. Particularly, even if oscillating-rotating toothbrushes are proven to be the most effective in studies where subjects’ dental routine is supervised, it does not guarantee the absence of real-life mistakes that would ruin its effectiveness.
The second gap, the limited generalizability of findings from modern literature, supports the significance of the proposed quantitative systematic review. Firstly, as the preliminary review indicates, there is an increasing diversity of product designs in both manual and oscillating-rotating tools (Ccahuana-Vasquez et al., 2019). Considering this, single RCTs that draw comparisons between very specific toothbrush models from these two groups do not necessarily shed light on general tendencies, which limits individual studies’ contributions to answering the stated research question. In itself, another single experimental study would also be ineffective in formulating toothbrush selection recommendations for gingivitis patients. In contrast, a systematic review of evidence from single studies, including those conducted within the last five years, would support such endeavors by allowing to consider the toothbrush model in such recommendations. Additionally, single studies focusing on those with gingivitis vary in terms of patient characteristics, which makes their results of unknown significance for those with dental implants or other subgroups (Grender et al., 2020). By considering multiple studies with diverse patient profiles, the systematic review would support the development of more accurate recommendations, including contraindications.
Finally, modern literature suggests that manual toothbrushes remain the mainstay of dental care at home despite some evidence in favor of oscillating-rotating brushes’ advantages for individuals with gingivitis. The presence of conflicting findings regarding such toothbrushes’ superiority over manual tools makes the selected question open to further exploration. The proposed study will be aimed at reviewing all relevant research systematically to improve patient education regarding home-based toothbrushing interventions for gingivitis reduction.
Anas, B., Merlem, E. M., Abdelhadi, M., Zahra, L. F., & Hamza, M. (2018). A single-brushing study to compare plaque removal efficacy of a manual toothbrush, an electric toothbrush and an ultrasonic toothbrush. Journal of Oral Hygiene and Health, 6(3), 1-7. Web.
Ccahuana-Vasquez, R. A., Adam, R., Conde, E., Grender, J. M., Cunningham, P., Goyal, C. R., & Qaqish, J. (2019). A 5-week randomized clinical evaluation of a novel electric toothbrush head with regular and tapered bristles versus a manual toothbrush for reduction of gingivitis and plaque. International Journal of Dental Hygiene, 17(2), 153-160. Web.
Elkerbout, T. A., Slot, D. E., Rosema, N. M., & Van der Weijden, G. A. (2020). How effective is a powered toothbrush as compared to a manual toothbrush? A systematic review and meta-analysis of single brushing exercises. International Journal of Dental Hygiene, 18(1), 17-26. Web.
Grender, J. M., Ram Goyal, C., Qaqish, J., & Adam, R. (2020). An 8-week randomized controlled trial comparing the effect of a novel oscillating-rotating toothbrush versus a manual toothbrush on plaque and gingivitis. International Dental Journal, 70, S7-S15. Web.