Title

Effectiveness Of Electric Toothbrushes In Orthodontic Patients

Clinical Question

In patients undergoing orthodontic treatment, are power toothbrushes more effective than manual toothbrushes in reducing the incidence and prevalence of gingivitis?

Clinical Bottom Line

At this time there is insufficient evidence to conclude whether power toothbrushes are more effective than manual toothbrushes in reducing the incidence and prevalence of gingivitis in orthodontic patients. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
19571055	Huang/2011	Patients undergoing orthodontic treatment	Systematic Review
Key results	Of the 59 studies identified as potentially relevant, only five met the inclusion criteria and were included in this systematic review. These five studies investigated various types of power toothbrushes. Among the studies reviewed, only one demonstrated that side-to-side power toothbrushes were significantly more effective than manual toothbrushes in reducing gingivitis in patients undergoing orthodontic treatment. However, the reduction in gingivitis associated with the use of side-to-side power toothbrushes was modest, as shown by the 0.5 point reduction in the Loe and Silness gingival index.
18249278	Kaklamanos/2008	301 patients undergoing orthodontic treatment	Meta-Analysis
Key results	Five trials were considered appropriate for the meta-analysis. Based on quality assessment and the short experimental period of these trials, current evidence is insufficient to support the comparative efficacy of powered toothbrushes in reducing gingivitis in patients undergoing ﬁxed orthodontic appliance therapy.

Evidence Search

"Toothbrushing"[Mesh] "Orthodontics"[Mesh]

Comments on
The Evidence

The paper by Huang is a systematic review of randomized controlled clinical trials. This systematic review included 5 trials with an unknown number of patients. There was a comprehensive, detailed search for relevant trials and the individual trials were assessed for validity. A meta-analysis was not performed. The Kaklamanos article was a systematic review of randomized control trials with a comprehensive, detailed search for relevant trials. Five trials included in this systematic review included a total of 301 patients. Each of the individual trials was assessed for validity and a meta-analysis was performed.

Applicability

The patients included in these trials are representative of the patients likely to be seen in orthodontic practices. There were no harms associated to the used of power and manual toothbrush. Moreover, both toothbrushes were efficient in promoting plaque removal and control of gingivitis in orthodontic patients. Patients are likely to expect that the power toothbrush will provide more beneficial results than manual toothbrush, however, no real conclusions can be drawn based on the current evidence.

Specialty

(Orthodontics) (Periodontics) (Dental Hygiene)

Keywords

Power toothbrush, Oral Hygiene, Orthodontics

ID#

749

Date of submission

03/07/2011

E-mail

martineze15@livemail.uthscsa.edu

Author

Esperanza R. Martinez

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Cristina Villar, DDS

Faculty mentor e-mail

Villar@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
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Jessica Xia, John Luke Covalt, Marjan Malakouti (San Antonio, Texas) on 01/06/2014
The present CAT examines a meta-analysis and a review, both indicating that further evidence is needed. The Huang review date is incorrect on the Cat; listed as 2011 when it is actually 2009. A recent (2013) RCT of 46 subjects, found that powered toothbrushes significantly reduced plaque compared to manual, although it has the same limitations as the CAT found; short duration. [Erbe, 2013, PMID: 23726325 ]