Insufficient evidence to conclude that orthodontic patients derive benefits from using power toothbrushes

Abstract

Clinical question. Are power toothbrushes more effective than manual toothbrushes in reducing gingival inflammation in orthodontic patients? Review methods. The authors performed a comprehensive, all- language literature search of multiple databases from 1950 through 2007, including those used for dissertations, conference proceedings and research registries (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, CochraneReviews, Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, TrialsCentral and meiaRegister of Controlled Trials). They included all randomized trials involving patients undergoing orthodontic treatment. The authors excluded all trials that combined toothbrushing with the use of antimicrobial mouthrinses, irrigation devices or interdental cleaning appliances. In addition, they excluded studies of less than four weeks' duration. They also excluded trials with split-mouth designs and crossovertrials with washout periods of less than one month. The authors used quantitative measurements of gingival inflammation (either gingival index scores or gingival bleeding scores) as outcome measures. Main results. Of 59 studies identified as potentially relevant, five met the inclusion criteria. The authors of these five studies investigated various types of power brushes. Only investigators in the trial that examined the side-to-side power toothbrush found a significant reduction in gingival scores. On the basis of the Loe and Sil- ness gingival index,1 the reduction was approximately 0.5 point. Conclusion. The evidence is insufficient regarding whether power toothbrushes are more effective than manual toothbrushes for orthodontic patients.