Do you really need an electric toothbrush? -
Effective tooth brushing requires time and diligence. And if using a powered toothbrush can help you better meet these demands, then getting one can make a great choice.
But don't buy an electric just because you think it will accomplish something for you that can't be done on your own, because that's not really what dental research shows.
Toward helping you decide if getting a powered brush makes sense for you, this page discusses the following topics:
- Are electric toothbrushes really superior to manual ones?
- Reasons / applications where the use of an electric brush makes good sense.
Electric vs. manual toothbrushes.
What does dental research say?
One of the first things you'll find when digging into this subject is that the conclusions drawn by studies aren't always so clear cut.
For example, Bowen (2003) evaluated the question of electric toothbrush superiority over manual ones by reviewing 46 clinical studies published between 1989 and 2002. The findings of this evaluation were:
- 33 studies supported the superiority of electric over manual brushes.
- Two of the studies found that manual tooth brushing gave better results.
- The remainder (11) either found equal effectiveness for both methods, or determined that the results of their study were inconclusive.
Sometimes it's difficult to trust study findings.
When you look at the statistics above, it seems obvious that published research tends to support the use of electric toothbrushes on the order of about 3 to 1. But things aren't always what they seem.
That's because the quality of a large amount of the research related to this subject is quite open to debate.
Here's an example.
A landmark study (Heanue 2003) also investigated this same issue, once again by reviewing the findings of other researchers.
This study created a set of guidelines for what they considered appropriate methodology for clinical trials. Of the 354 published and unpublished trials they found to evaluate, only 29 met their inclusion criteria (Niederman 2003).
A more recent example.
In 2011, the Cochrane Collaboration (Deacon 2011) performed a literature review that evaluated the topic of the effectiveness of powered toothbrushes. Of the 332 studies identified and evaluated, only 17 met the standards needed for inclusion in the review.
The above really shouldn't come as much of a surprise to anyone, considering the amount of money involved with electric toothbrush sales.
So many of the studies investigating this subject are "sponsored" research. And it seems that sponsors (manufacturers) are frequently more interested in the hope of positive study findings for their products as opposed to stressing the need for stringent study design.
[These "sponsored" conclusions are most likely the same ones manufacturers spin to you in advertising claims, so take them for what they're probably worth.]
So what is the answer? Do you really need to get an electric brush?
As the authority for this topic, we'll cite another, more recent Cochrane Collaboration review of dental literature titled "Powered versus manual toothbrushing for oral health." (Yaacob 2014)
This paper pointed out the design problems associated with so many studies, but after evaluating the ones that met their criteria came to the conclusion that "Powered toothbrushes reduce plaque and gingivitis more than manual tooth brushing in the short and long term."
We will point out that this review also determined that "There was an 11% reduction in plaque at 1 to 3 months of use, and a 21% reduction in plaque when assessed after 3 months of use." Considering all of the hype associated with powered toothbrush advertising, we might have expected a reduction that was more dramatic.
When does getting a powered brush make sense?
a) Using an electric is more efficient than brushing by hand.
A study (van der Weijden 1993) compared the plaque removing efficiency of three different electric toothbrushes vs. brushing by hand over various time periods ranging from 30 seconds up to 6 minutes.
- This study found that the use of all three electrics was more effective than brushing manually, for all of the time periods evaluated.
- It also determined that more dental plaque was dislodged by an electric toothbrush in 2 minutes than a manual one used for 6.
That suggests that although you may be able to reach the same cleanliness end point with either method, when using an electric you'll get their sooner.
Certainly, if a person has a set habit regarding how long they will brush, they'll probably get more cleaning accomplished during this limited time frame when using an electric rather than a manual brush.
b) Electric brushes do a lot of the work for you.
You can think of an electric toothbrush as being a tool, which, on its own, creates an effective brushing action.
In a sense, all that's required from the user is the ability to move the brush around to various locations in their mouth (an activity that takes very little dexterity). Since the skill level that's needed to brush properly is minimal, all a person must do is focus on brushing long enough.
In comparison, using a manual toothbrush requires a fair amount of dexterity and some diligence. And if either are in short supply, the person's results will be subpar.
c) Using an electric may help you brush longer.
As you might guess, many humans simply aren't self-disciplined enough to brush properly when they use a manual toothbrush.
As a general rule, most people should brush their teeth at least twice a day with each brushing period lasting at least two to three minutes. The fact of the matter is that many of us routinely fail to meet these guidelines.
You may not be brushing for as long as you think.
Actually, the statement that most people aren't self-disciplined enough to brush properly is probably a little bit harsh. Research has found that there can be a major discrepancy between the amount of time that a person actually does brush verses the amount of time that they perceive they did.
- One study (our Saxer et al reference) found that their test subjects, on average, brushed their teeth for 78 seconds (a little longer than a minute) when they actually thought they were brushing for 141 seconds (over two minutes, an adequate amount of time).
That means the intention of these people was appropriate but their actions (actual brushing time) were lacking. (To help with this problem some powered brushes have built in timers that allow you to measure the length of time you have been brushing.)
Useful applications for powered toothbrushes.
There are several situations where the use of an electric toothbrush can make it substantially easier to accomplish your bushing goals. They include:
- A) Dental braces.
- B) Impaired dexterity.
- C) Brushing motivation.
- D) Fighting gum disease.
- E) Tooth staining.
- F) Hard to brush locations.
(There are also some situations where using one probably won't provide much benefit.)
a) Dental braces.
Clearly, having dental braces (orthodontic bands, brackets, and wires) makes it more difficult for a person to brush their teeth. And in those cases where proper oral home care isn't maintained, that person will be at greater risk for the formation of the following problems during their treatment.
Post-orthodontic treatment white-spot lesions.
1) Gingivitis - This is a form of gum disease (gum inflammation). When it's present, a person's gums may be red, tender, enlarged, swollen, and they may bleed when the person brushes.
2) "White spot" lesions - These are discolorations that form on tooth enamel. They are the first stage of tooth decay formation.
Even in those cases where these areas don't transform into full-fledged cavities, once they have formed they can spoil the appearance of teeth.
Research - How using an powered brush can benefit people wearing braces.
A study was set up (our Ho et al reference) where patients wearing dental braces who had gum inflammation (gingivitis) were broken into two groups. One group continued to brush with a manual toothbrush and the other was given a sonic brush to use.
The group that switched to a sonic toothbrush showed substantial improvement in the health of their gums, as evidenced by the following parameters:
- A reduction in the amount of supragingival (above the gum line) plaque. (This plaque in a location that could cause white-spot lesions.)
- A reduction in the total gram-negative bacteria found in subgingival (below the gum line) plaque samples. (Gram-negative bacteria are a type of bacteria that are typically associated with gum disease.)
- A reduction of pocket depth. (A pocket is the space between the gums and tooth where the bacteria that cause gingivitis can live undisturbed.)
- A reduction in the number of locations which bled on probing. (Probing is a way of measuring and evaluating gum tissue health. Any bleeding which occurs during probing indicates the presence of gum inflammation.)
b) Debilitated or impaired persons.
There can be good reasons why an elderly, medically compromised or physically handicapped person might make a good candidate for the use of an electric brush.
- It may allow them to brush themselves. - Since electric toothbrushes create an effective brushing motion on their own, their use requires much less dexterity than a manual one. This can make them ideal for elderly persons or those who are physically disabled.
- It can assist their caregiver. - People who take care of individuals who are unable to brush on their own will benefit from using an electric toothbrush when performing their duties. It will both make their task easier and more effective.
Testing with a 'trial' brush first is a good idea.
Before purchasing an electric brush for someone else, please beware that the (sometimes vigorous) brushing action of powered units can be quite unwieldy for some. This is especially true in situations where the person is at a point in their life where they are less adept to change or adapting to new situations.
Before you spend money on a high-end electric toothbrush, you might purchase either a low-end or even disposable one. Not necessarily for long-term use but as a test, to see if the potential for even using an electric exists.
c) Brushing motivation.
Some people simply lack the motivation to brush. If so, an electric might just be what they need.
1) Electrics can be fun to use.
There clearly is a novelty effect associated with using a powered brush. And we don't mean just for kids. There can be an aspect of using one that is fun or different. And because of this, a person will sometimes brush longer, more frequently, or both.
- Biesbrock et al reported that the introduction of an electric toothbrush into the oral hygiene routine of adolescents and adults alike produced brushing behavior that lasted 1/3 longer than when these same study participants brushed manually.
2) You can often just feel the difference.
Problem brushers may take a greater interest in brushing if they see evidence that using their electric is creating better results.
Their teeth may feel slicker and cleaner than ever before, an improvement in the health of their gums may be evident, or possibly they will notice a reduction in the amount of staining that they see on their teeth.
3) People tend to continue to use their electric brush.
A study (our Stainacke reference) evaluated responses from 120 persons who had purchased an electric toothbrush at some point during the previous three years.
- 62% of these owners reported that they used their brush daily.
- Only 3% of the respondents stated that they had ceased to use it totally.
d) Gum disease.
Another reason to consider getting an electric brush is because they've been shown to help improve the oral health of those persons who have periodontal disease (gum disease).
As an example, one study (our Robinson et al reference) conducted a six-month evaluation of dental patients who had periodontitis (an advanced form of gum disease).
Two electric brushes were chosen for this study, one a sonic and the other a conventional rotary type. The effectiveness of these brushes was evaluated at 2, 4 and 6-month intervals.
- Each of these evaluations determined that the use of either type of brush produced significant reductions in the amount of dental plaque found on the surfaces of the participant's teeth.
- The overall health of the participant's gums improved over the course of the study with the use of either brush (as measured by reduction in gingival inflammation, probing depth scores, probing attachment levels).
It seems fair to draw the conclusion that this study demonstrated that the long-term use of a good-quality electric toothbrush can improve the oral health of a person who has gum disease (periodontitis).
e) Tooth stain.
When you discuss a tooth's coloration, there are two different aspects you need to take note of and evaluate separately.
- Teeth have a base-line shade. - This is the color the tooth would be if its surface was perfectly clean. The mechanical action of brushing one's teeth will have no effect on a tooth's intrinsic color.
- Surface stain also affects the color. - Extrinsic stain lies on the surface of a tooth. This is the type of discoloration your dentist polishes off during cleanings.
Surface stain and debris.
Using an electric tooth brush may be able to remove and keep this type of stain from returning.
A powered toothbrush may be able to remove some surface stain.
The scrubbing effect of an electric toothbrush, over time and with continued use, may dislodge some, or possibly even all, of the surface stain found on a tooth. (This is the only type of "whitening" claim that a toothbrush manufacturer can legitimately make.)
If you have an area where staining tends to accumulate, allow your toothbrush to scrub for a few extra seconds in that region every time you brush.
Using an electric toothbrush may help to prevent surface stain from returning.
You may find that some of the stain that's formed on your teeth is so heavy and stubborn that it can only be removed via a professional dental cleaning.
However, once it has been removed, using your electric brush diligently should help to prevent, or at least minimize, its return. And just like above, if you have a problem area, make sure you brush for an additional few moments in that region every time you brush.
f) Oral conditions that make effective brushing difficult.
Some people have unique situations that make effective brushing a challenge. If so, a powered toothbrush may be able to provide the assistance they need.
As an example, having crooked teeth can make it more difficult to brush effectively. So can dimples, pits and fissures in the surfaces of teeth. Other difficulties include teeth with gum recession and some types of dental restorations (such as bridgework and dental implants).
Reasons not to buy an electric toothbrush.
a) Bad breath.
Using an electric toothbrush probably isn't going to cure your bad breath.
Yes, bad breath is cause by bacteria. And more effective tooth brushing will help to reduce the number of them in your mouth. But the vast majority of bacteria that cause bad breath live on a person's tongue, in between their teeth or below their gum line.
Also, electric toothbrushes have not been demonstrated to be more effective at tongue cleaning than manual toothbrushes, or the inexpensive tongue scrapers you see in your local store.
b) Teeth whitening.
As explained above, using an electric brush may be able to lighten your teeth by way of removing accumulated surface stain. But it will never be able to actually change the baseline color of your teeth. That can only be accomplished via the use of bleaching treatments (usually the application of some type of
c) Don't feel that you have to buy a powered brush.
There is no overwhelming body of evidence in dental literature that conclusively proves that using an electric toothbrush is better than just using a manual one (assuming that you take the time to use it properly).
So, bottom line, if the idea of using an electric doesn't appeal to you, then that's just fine. Use your manual one but be thorough.
[Philips and Sonicare are registered trademarks of Koninklijke Philips Electronics N.V.]
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