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Which toothbrush?

Systematic review

Important things, toothbrushes. Together with toothpaste they are the stalwart of dental, and oral, health. So which should you use, the old-fashioned manual, or more expensive, but fun, powered toothbrush? A systematic review [1] tells us both are pretty much the same, but that perhaps rotational powered brushes have the edge.

Systematic review

This sought randomised trials comparing manual and powered toothbrushes. Several databases were searched including a Cochrane trials register for oral health. Outcomes were quantified levels of plaque or gingivitis.

Powered brushes were defined as those with:

  1. Side-to-side action
  2. Counter oscillation (where each tuft rotates in the opposite direction to its neighbour)
  3. Rotational oscillation (in which the brush head rotates in one direction and then the other)
  4. Circular (brush head rotates in one direction only)
  5. Ultrasonic (the bristles vibrate at ultrasonic frequencies)
  6. Unknown action.


There were 29 trials (2,630 subjects) of at least 28 days duration. Most evidence was available for rotational oscillation toothbrushes. For these there was a significant improvement compared with manual brushing in plaque and gingival scores over 1-3 months, and in studies longer than three months.

For no other comparison was there any convincing evidence, either in the number of trials or a statistically significant difference.


We know that using a toothbrush of any type with fluoride toothpaste will reduce tooth decay. Rotational oscillation powered brushes also reduce plaque and gingivitis, compared with manual brushing.

The trouble is that we don't, as yet, know quite whether this has any health benefits, but given the possibility that less plaque and better gums are probably good ends in themselves, the balance tilts in favour of powered toothbrushes.

In the meantime, those of us with a rotational oscillation brush can feel at least a little bit smug in the morning, at least if our toothbrush is charged up.


  1. C Deery et al. The effectiveness of manual versus powered toothbrushes for dental health: a systematic review. Journal of Dentistry 2004 32: 197-211.

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