Title Clinical Trials Show Sonic Toothbrushes To Be More Efficacious Than Manual Toothbrushes in Overall Plaque Removal
Clinical Question In a patient that presents with plaque-induced gingivitis, is the use of an ultrasonic toothbrush more effective than a manual toothbrush in reducing plaque and inflammation?
Clinical Bottom Line Sonic toothbrushes in recent clinical trials were more efficacious than manual toothbrushes in reducing whole mouth plaque, gingival margin plaque, interproximal plaque, and gingival indices and scores. Older evidence from 50 years ago has insignificant results in comparison to a 2012 clinical research study.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
23448083Nathoo/201276 subjectsRandomized Controlled Trial
Key resultsSubjects were split into two groups and assigned either a manual flat head toothbrush or a new specially engineered sonic toothbrush. There were two additional assessment phases at 4 and 12 weeks after the initial pre- and post-brushing assessment. The study began with 82 enrolled subjects, but only 76 complied with their assignments and completed the entire study. This study evaluated whole mouth plaque index scores, gingival margin plaque index scores, interproximal plaque index scores and gingival index score. At each assessment, the new specially engineered sonic toothbrush provided statistically significant results when evaluating the reduction in gingivitis after four weeks. The sonic toothbrush exhibited results that were statistically significant (p < 0.05) resulting in a greater reduction in gingival index scores of 0.09 as compared to an increase in 0.01 for a manual toothbrush.
12787206Sicilia/200221 studies total-3 studies evaluating sonic toothbrushesSystematic review of randomized trials
Key resultsThis systematic review compares different powered toothbrushes to manual toothbrushes. However, focus for this CAT is to determine the efficacy of sonic toothbrushes to manual toothbrushes. Out of the 21 studies, 3 studies focused on this topic. When determining each sonic-to-manual toothbrush study’s results, the results all vary. Some studies utilized different models such as an over-the-counter model where the patient did not receive any instruction on how to properly use the brush, an oral hygiene instruction (OHI) approach with more education between clinician and subject, and then a prophy and OHI model with regular dental care and utilization of at home hygiene. Two sonic toothbrush studies were evaluated using the OHI model and both yielded no significant differences in gingival bleeding, and the third study actually favors the manual toothbrush.
Evidence Search ("gingivitis"[MeSH Terms] OR "gingivitis"[All Fields]) AND sonic[All Fields] AND toothbrush[All Fields] AND ("manuals as topic"[MeSH Terms] OR ("manuals"[All Fields] AND "topic"[All Fields]) OR "manuals as topic"[All Fields] OR "manual"[All Fields]) AND toothbrush[All Fields] ("inflammation"[MeSH Terms] OR "inflammation"[All Fields]) AND sonic[All Fields] AND toothbrush[All Fields] AND ("manuals as topic"[MeSH Terms] OR ("manuals"[All Fields] AND "topic"[All Fields]) OR "manuals as topic"[All Fields] OR "manual"[All Fields]) AND toothbrush[All Fields]
Comments on
The Evidence
The systematic review is the highest quality of research; however, it was published in 2002, and the studies that evaluated the efficacy of sonic toothbrushes took place in 1994 and 1996. Science has progressed significantly in the past 18-20 years. Since newer clinical studies have been done since this review was written, the more recent evidence shows to be significant. Even though the 2002 systematic review is contradicting the clinical trial’s findings it is important to note the systematic review is outdated and newer research shows that sonic brushes are more effective as technology has improved. In matters of personal opinion, the 2012 study has more significance than trials from 18-20 years ago and seems more applicable to the present day.
Applicability A comparison of products is important in the field of dentistry. Patients constantly ask clinicians if they are using the right products and the products’ efficacy. Sonic toothbrushes can often be sold in office as well, and this research is important to present to a patient when recommending a product. A previous CAT, #2402, compares the efficacy of plaque removal by a rotation-oscillation toothbrush to a sonic toothbrush. Research shows the rotation-oscillation toothbrush to be more effective in overall plaque removal. For best plaque removal results, a rotation-oscillation toothbrush would be the best choice for a patient wanting to reduce plaque scores.
Specialty (Public Health) (General Dentistry) (Periodontics) (Dental Hygiene)
Keywords sonic toothbrush, manual toothbrush, plaque, inflammation, gingivitis
ID# 2768
Date of submission 09/08/2014
E-mail hollandel@livemail.uthscsa.edu
Author Emily Holland
Co-author(s) Lindsey Nicholson
Co-author(s) e-mail
Faculty mentor Carol A. Nguyen, MPH, MS
Faculty mentor e-mail nguyenc@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available