SUMMARY REVIEW/PREVENTION

Long term impact of powered toothbrush on

oral health
Wayne Richards,1 Anne-Marie Coll1 and Teresa Filipponi1

A commentary on
Pitchika V, Pink C, Völzke H, Welk A, Kocher T, Holtfreter B.
Long-term impact of powered toothbrush on oral health: 11-year
cohort study. J Clin Periodontol 2019; 46: 713–722.
Practice point
Plaque control is fundamental to good oral health and powered
toothbrushes are beneficial. However, any means to improve
plaque control that is evidence based should be supported.
Appropriate use of manual tools can be effective in plaque control
and this should be considered for those individuals who may not
have the financial means to fund power based toothbrushes.

Abstract
Data sources The Study of Health in Pomerania (SHIP).
Data extraction and synthesis Data were taken from SHIP1 to
SHIP3 over an 11 year period. Mixed-effects linear regression models
were constructed between the exposure (manual versus powered
toothbrush) and outcome variables (probing depths [PD], clinical
attachment loss [CAL], caries status DMFS and DFS, tooth loss)
adjusting for potential baseline covariates.
© SCIENCE PHOTO LIBRARY/Getty Images Plus

Results Power toothbrush usage was found to be significantly

associated with reduced mean PD and CAL progression scores, for
example after 11 years the entire sample showed MTB users to have
0.41 mm PD mean progression while PTB users had 0.09 mm mean
PD progression. This demonstrates PTB users having 0.32 mm less PD
progression. Similar trends were shown for CAL mean scores.
Conclusions There are benefits of power toothbrush usage and long
term protective effects on oral health in terms of reduced probing
depths, clinical attachments and number of teeth lost.
Commentary
The question ‘are powered toothbrushes better than manual
toothbrushes?’ is often asked by patients. The answer is difficult in
the absence of conclusive evidence. While there is evidence that the
powered toothbrush (PTB) reduces plaque and gingivitis in the short
and long term, whether this has an impact on clinical outcomes is
unclear.1 This longitudinal study aimed to establish the effects of PTBs
on periodontal health, caries, and tooth loss in an adult population.
The Study of Health in Pomerania (SHIP) provided the authors
with a study sample. SHIP is an ongoing prospective cohort study
which was initiated in 1997–2001. This study’s baseline data were
taken from SHIP1 at five years as there were no PTB data included
in the original cohort data collection. The cohort was followed
through SHIP2 at 11 years and SHIP3 at 16 years. SHIP1, 2 and 3
included 3,300, 2333 and 1718 participants, respectively.
Dental examinations were performed by calibrated dentists;
probing depths (PD), clinical attachment loss (CAL), decayed
missing filled surfaces (DMFS), decayed filled surfaces (DS) and
number of teeth present were established.
GRADE rating
Interviews and medical examinations provided further
information regarding use of PTBs or manual toothbrushes (MTB).
Also data regarding age, sex, toothbrushing frequency, education
status, smoking status, dental visit in last 12 months, periodontal
treatment in last five years, diabetes, HbA1c, BMI, physical activity
and periodontal state.
Comprehensive statistical analysis were undertaken, these
considered the time-varying outcomes: mean PD, mean CAL,
DMFS, DFS and number of teeth. Continuous and categorical
variables were compared using students’ t test and chi-square
test, respectively. Mixed-effects linear regression models over
three time points were used to assess the effects of PTB usage on
different outcomes. All models were adjusted for baseline (SHIP1)
covariates. Analysis included associations between PTB usage and
periodontal health (PD, CAL), caries (DMFS, DFS) and number
of teeth present within the entire sample and subsets including
regular brushers, younger subjects and younger regular brushers.
Further stratification into participants with no/mild periodontitis,
moderate periodontitis and severe periodontitis were undertaken
for analysis.
The results showed PTB usage to be significantly associated
with reduced mean PD and CAL progression scores, for example
after 11 years the entire sample showed MTB users to have 0.41
mm PD mean progression while PTB users had 0.09 mm mean PD

14 © EBD 2020:21.1

© The Author(s), under exclusive licence to British Dental Association 2020

progression. This demonstrates PTB users having 0.32 mm less PD
progression. Similar trends were shown for CAL mean scores.
On stratifying the population on periodontal disease severity,
PTB usage for participants with no/mild periodontitis showed less
mean PD progression for the entire sample and the sub-set that
brushed regularly, however, no differences were observed in mean
CAL scores. Also no differences were observed for PD mean scores
for young subjects and young regular brushers.
Subjects considered with moderate periodontitis showed less
mean PD and mean CAL progression scores for the entire sample
and the sub-set that brushed regularly. No differences were
observed in younger subjects and young regular brushers.
Subjects with severe periodontitis did not benefit from the usage
of PTB.
As for caries the only significant progression was observed in
DMFS for the entire sample and regular brushers sub-set. The
difference was 1.32 surfaces less DMFS progression. This was not
observed in any other sub-set. PTB usage had no influence on the
DFS scores.
With regard to tooth loss, PTB users retained on average 0.36 teeth
more than their counterparts in the entire sample and 0.39 teeth in
the regularly brushing sub-set. No differences were observed in the
younger sub set and younger regular brushing sub-set.
The fact that this study is a longitudinal study is its main
strength. The authors recognise the limitations of the study
© EBD 2020:21.1
© The Author(s), under exclusive licence to British Dental Association 2020
SUMMARY REVIEW/PREVENTION
in that the PTB users were younger in age and that residual
confounding factors cannot be excluded. Also the authors
recognise that subjects were only asked whether they used a PTB
or MTB and no record of the type of PTB used was ascertained.
Finally, the authors recognise a greater awareness of the German
population towards oral health and the role of plaque control
with the use of inter-dental cleaning aids.
While the results of this study show benefits in terms of
measurable clinical outcomes, whether these improvements
impact on the health of patients in a broader sense when using
definitions of health based on the social model of health may
be debatable. This is a good start to show the benefits of PTB
usage and long term protective effects on oral health in terms
of reduced probing depths, clinical attachments and number of
teeth lost.
Reference
1. Yaacob M, Worthington H V, Deacon S A, Deery C, Walmsley A D, Robinson P
G, Glenny A M. Powered versus manual toothbrushing for oral health. Cochrane
Database Syst Rev 2014; CD002281. DOI: 10.1002/14651,858.CD002281. pub3.
Author affiliation
1
University of South Wales
Evidence-Based Dentistry (2020) 21, 14-15.
https://doi.org/10.1038/s41432-020-0076-8
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