sonic toothbrushes / electric toothbrushes

• Safety concerns related to the usage of sonic toothbrushes.
• Applications for the use of electric toothbrushes.

About sonic toothbrushes and their potential to cause damage to oral tissues or dental restorations.

As you know, sonic toothbrushes create over 30,000 brush strokes per minute. There has been conjecture that this vigorous brushing action could cause tooth wear or else cause damage to existing dental work. Related to these safety concerns here are some conclusions drawn from two different studies that evaluated sonic toothbrushes.

About electric toothbrushes and brushing forces.

Our Bowen reference evaluated several electric toothbrush clinical studies that had been published between the years 1989 and 2002. From their review the authors of this study determined that on average users of electric toothbrushes applied 128 grams of force when brushing. The typical manual toothbrush user applied over twice this amount of pressure. On average they used 285 grams of force.

Applications for the use of electric toothbrushes.

There can be circumstances or special situations where an electric toothbrush can prove to be a valuable aid in helping a person maintain their oral health. Many of the examples we provide may seem to be simple common sense applications but we mention them anyway in an attempt to be thorough.

• Electric toothbrushes can help to motivate a person to brush.
  
  
• An electric toothbrush can be an effective aid in the fight against gum disease.
  
  
• Electric toothbrushes can help to remove or minimize tooth staining.
  
  
• Some oral conditions make brushing with a manual toothbrush difficult.
  
  
• Information about the use of electric toothbrushes by orthodontic patients.
  
  
• An electric toothbrush can be a valuable tool for those people who have limited manual dexterity.

Electric toothbrushes can help to motivate a person to brush their teeth.

You may have someone in your household who is not a good brusher. One possible reason for this might be that they simply lack the motivation to brush. There can be an aspect of using an electric toothbrush that is fun or different and because of this a person will sometimes brush longer, more frequently, or both. One study (our Biesbrock et al reference) 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.

Electric toothbrushes can also provide motivation in another way. A person might take a greater interest in brushing because they see evidence that their electric toothbrush is cleaning their teeth much more effectively than when they brush with a manual toothbrush. A person's 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.

Somewhat related to this topic of motivation, and so to provide some reinforcement for those who are hesitant to spend their hard earned money on an electric toothbrush, we can report on a study (our Stainacke reference) that evaluated responses from 120 persons who had purchased an electric toothbrush at some point during the previous three years. At the extremes, 62% of these brush owners reported that they used their electric toothbrush daily whereas only 3% of the respondents stated that they had ceased to use their brush totally. Buying an electric toothbrush is usually money well spent.

The use of electric toothbrushes in fighting gum disease.

The use of an electric toothbrush, either high-end rotary or sonic, has been shown to improve the oral health of those persons who have periodontal disease (gum disease). One study (our Robinson et al reference) conducted a six-month evaluation of dental patients who had periodontitis (an advanced form of gum disease which involves not just a person's gums but also the bone that lies underneath them). Two electric toothbrushes were chosen for this study, one a sonic toothbrush 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 electric toothbrush produced significant reductions in the amount of dental plaque found on the surfaces of the participant's teeth. At the 6-month evaluation however it was determined that the sonic toothbrush had provided better interproximal cleaning (cleaning in those areas where a person's teeth touch up against each other) than the conventional electric toothbrush.

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). The evaluations performed at the 4 and 6-month time periods however showed a statistically greater oral health improvement in those patients who had used the sonic toothbrush.

It seems fair to make 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). And that the use of a sonic toothbrush can possibly produce a greater improvement than the typical electric toothbrush.

Using electric toothbrushes so to minimize tooth staining.

Teeth whitening seems to be on everyone's mind now days. And because of this just about every dental product you see advertised (including electric toothbrushes) tries to make some claim about having a whitening effect on the user's teeth.

Actually, when you discuss a tooth's shade there are two different aspects you need to take note of and evaluate separately. The first is the intrinsic color of the tooth. This is the color the tooth would be if its surface was perfectly clean. The act of brushing one's teeth, in the sense of bristles scrubbing the surface of teeth, will have no effect on a tooth's intrinsic color.

The other influence on the color of a tooth is extrinsic staining, also known as "surface stain." Extrinsic staining is the type of discoloration that you discover has been removed after you have had a professional dental cleaning. Extrinsic staining lies on the surface of a tooth. The abrasive effect of the dentist's or hygienist's hand tools and cleaning pastes can scrub this surface stain off. In many cases a person will be able to correlate the presence of this type of staining to the consumption of coffee, tea, colas, red wine, or else the use of tobacco products.

The scrubbing effect of an electric toothbrush, over time and with continued use, can dislodge some or possibly even all of the surface stain found on a tooth and therefore have a whitening effect. As a means of maximizing this phenomenon allow your electric toothbrush to scrub for a few extra seconds each time you brush in those areas where staining tends to accumulate.

You may find that in some areas the staining that has formed is too heavy or tenacious to be completely removed by your electric toothbrush and can only be removed by having a professional dental cleaning. However, once removed it would be expected that the use of an electric toothbrush would be able to eliminate or at least significantly minimize the gradual return of staining to these areas.

Oral conditions that make effective tooth brushing difficult.

A person may have various physical characteristics that make it difficult for them to remove dental plaque effectively. As an example, crooked teeth can provide an obstacle to effective tooth brushing, and an electric toothbrush may provide just the added help a person needs in this type of situation.

Other oral home care obstacles can be less obvious. In regards to tooth anatomy, a tooth's surface often contains pits, fissures, or concavities that can be difficult to clean. This situation is often compounded in those cases when a person's gums have receded, as either a result of periodontal disease (gum disease) or else its treatment. Dental restorations, such as bridgework and dental implants, can also have surfaces that prove to be a challenge to clean effectively with a manual toothbrush.

Electric toothbrush use by orthodontic patients.

It would be an understatement to say that the presence of orthodontic bands, brackets, and wires makes it extremely difficult for a person to brush their teeth effectively. In those situations where adequate brushing has not been achieved it is common that the person's gums will be inflamed. Some of the signs of this inflammation, which is typically termed "gingivitis," are gum redness and tenderness, the gums themselves may look enlarged or swollen, and they may bleed when the person brushes their teeth.

Another type of dental problem that can occur when thorough dental plaque removal is not achieved is the formation of "white spot" lesions. If dental plaque lies on the surface of a tooth it will attempt to form a cavity. The first stage of this cavity formation process is termed a "white spot" lesion because the surface of the tooth enamel in the region where the cavity is beginning to form takes on an opaque whitish coloration.

Even if a white spot lesion doesn't progress and subsequently transform into a full-fledged cavity its presence, especially if it's in the center of a front tooth in that area where an orthodontic bracket is bonded, can spoil the appearance of a person's smile after their braces have been taken off. (White spot lesions are discussed in more detail in our Tooth Decay topic.)

A way of preventing both the presence of gingivitis and the development of white spot lesions is effective plaque removal. A study was created (our Ho et al reference) where orthodontic patients with existing gum inflammation (gingivitis) were broken into two groups. One group continued to brush with manual toothbrushes and the other group was given sonic toothbrushes to use.

Evidently participating in the study motivated the manual toothbrush group to improve their brushing habits. The health of their gum tissue did improve over the 4 weeks of the study, however very minimally.

The group brushing with sonic toothbrushes 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 is the same location for dental plaque accumulation that would be associated with the presence of white spot lesions.)
  
  
• A reduction in the total gram-negative bacteria found in subgingival (below the gum line) plaque samples. (Gram-negative bacteria are typically the types of bacteria that are 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 the health of gums. Any bleeding which occurs during probing indicates the presence of gum inflammation.).

Electric toothbrushes can be valuable aids to those who have limited manual dexterity.

Since electric toothbrushes create an effective brushing motion on their own their use requires much less dexterity than a manual toothbrush. This makes them ideal for those persons who have decreased dexterity such as the elderly or persons who are physically disabled.

Caretakers of those persons who are totally unable to brush on their own will benefit from the use of an electric toothbrush when performing their duties. Using an electric toothbrush will make their task easier but also more effective.