From the final review, the Cochrane group determined that “Power toothbrushes with a rotational oscillation action provided slightly better plaque removal and may provide better protection against gum inflammation than manual toothbrushes.”5
The researchers discussed the weaknesses of their review and noted:5
•“One possible weakness of this review was the grouping of toothbrushes by their modes of action.”
•“So many factors may influence the effectiveness of toothbrushes including filament arrangement, orienta- tion, size, shape and flexibility, brush head size and shape along with presence or absence and characteristics of a timer that not all of them could be analyzed.”
•“None of the trials compared durability, reliability, and cost of using manual versus powered brushes, it is presently not possible to make a clear recommendation on toothbrush superiority.”
In summary, the Cochrane review provides important information on power toothbrushes, but is not without flaws. Of consideration is that studies on older, obsolete products with outdated technology were included in the
brushes. 1,2,3,4,6,10,11,12
Individual Recommendations
Once clinical efficacy has been established, when recom- mending a power brush, individual preferences can play a significant role in product acceptance. In fact, studies have shown that when individuals play a more assertive role in healthcare decisions, compliance and satisfaction increase.6 Therefore, it is unlikely that all the individuals in a practice will like or benefit from the same type of power toothbrush. Importantly, the individual oral health needs along with personal preferences should influence the brush recommendation.1,3,6
There are a large number of power brushes on the market with a wide array of features, which can influence acceptance of the product. To help individuals find the product right for them, there are multiple features to consider.
• Timer: Essential for those who need to extend brushing time
•Handle size: Should be of adequate size and feel comfortable
•Brush head motion and configuration: Size is important as is dexterity
•Lifestyle: Frequent travelers may prefer a battery- operated unit
•Disposability: This generally means that neither the bat- tery nor the brush head can be replaced. Products gen- erally last around 3 months - the same as a manual toothbrush and often cost the same. May be a good gateway product
•Affordability: With multiple products in a wide range of prices, there is a power brush to fit anyone’s budget
Brushing Recommendations
Some individuals may think that once they use a power brush, they no longer have to make any effort when brushing. Therefore, it is important to continue empha- sizing how often and long to brush. Studies have shown that good biofilm removal takes time, and those who brush longer tend to remove more biofilm.8,9
Figure 1
It is important to explain to first time users that power brushes have a unique or different sound and sensation than manual brushes. It may take some time to get adjusted to a new product. Additionally, some products may enhance the foaming action of the toothpaste and this may initially be overwhelming. See Figure 1. Advise individuals not to use an excessive amount of toothpaste and not to turn the unit on until they have placed the brush head in their mouth.
3