Do you really need to get an electric toothbrush? -

Is using a powered brush better or more effective than a manual one? - What does research show?  |  Applications where electric brushes may offer an edge.

Manual vs. Power toothbrush - Is using an electric really better?

Pro.

Effective tooth brushing isn't all that easy. It takes time, effort and skill. And for many people, using a powered toothbrush is a valuable aid in helping them to meet these requirements more easily.

Con.

But don't buy an electric because you think it will accomplish something for you that you couldn't ultimately learn how to do on your own (given an interest in putting in the time and effort to do so), because the scientific evidence supporting this point of view is probably less overwhelming than you think.

What you should do is think of a powered brush simply as a tool whose features may help you rectify whatever brushing deficiencies you have. And if you determine that it can, then getting one makes a good idea.

How to decide.

Toward helping you figure out if using a powered brush makes sense for your situation, this page discusses the following topics:

  • Are electric toothbrushes really superior to manual ones? - What does research say? (This is our very next section.)
  • Reasons / applications where the use of an electric brush make good sense.

Electric vs. manual toothbrushes.

What does dental research say?

This isn't such an easy question to answer. And we'd be short changing you if we answered it by citing a few handpicked studies (the standard marketing tactic of toothbrush manufacturers).

Instead we are going to present information from a dental literature review published by the Cochrane Collaboration. (A respected non-profit organization recognized for its work of conducting systematic reviews of health-related literature on numerous topics, in an attempt to identify appropriate clinical methodologies founded on valid research.)

The paper itself is titled: "Powered versus manual tooth brushing for oral health." (Yaacob 2014).

And although it carries a 2014 publication date, it is actually an update of a Cochrane Collaboration review of this subject originally published in 2003, and updated in 2005. That makes this the third incarnation of this study, spanning a period of over a decade.

Evaluation criteria.

The types of studies sought for this review were as follows:

  • Those that had compared manual vs. powered toothbrushes, as used in everyday life by people of any age ...
  • ... that had reported findings about each type of brush's ability to remove dental plaque, aid in gum health, minimize tooth staining and/or tartar formation ...
  • ... and the study ran for at least 4 weeks of unsupervised use (like subjects using their brushes on their own at home).
How many publications were evaluated?

The reviewers identified 432 studies that were potentially on target. This included:

  • Published toothbrush trials, some of which could be considered "sponsored" research in the sense that there was some level of affiliation with a manufacturer.
  • Unpublished trials obtained directly from manufacturers, likely including the "data on file" type of research often used to substantiate advertising claims.
Evaluating study bias.

Beyond determining that each of the 51 studies met the inclusion criteria, each was also assessed for risk of bias (high, low or unclear).

Bias in a study can take various forms.

  • One is "selective reporting," such as the situation where a factor clearly investigated was omitted in a study's report of findings.

    The reviewers found this to be a minor issue with the group of trials evaluated, with only one, involving just a single factor (gingivitis measurement), demonstrating high bias.

  • A more common source of bias involves ineffective blinding. For example, an investigator responsible for judging plaque removal effectiveness being aware of which type of brush (powered or manual) had been used.
  • Evidence of randomization and allocation bias were also found in the 51 studies evaluated. This could include issues such as how, why or to whom different types of brushes (manual vs. electric) were assigned.

The review presented a color-coded table showing what type and level of bias was determined for each of the 51 studies.

  • Only 5, involving only one type of bias each, were judged to be at the "high" level.
  • Our estimate from viewing the table was that 2/3rds of the studies were judged to have "low" bias.
  • Our estimation was that the remaining, roughly 1/3rd of studies, were classified as having "unknown" bias.
Our conjecture about study bias.

With much of the available data about powered toothbrushes coming from (manufacturer) sponsored research or (manufacturer) "data on file" sources, we don't wonder that in cases where the level of study bias is "unclear" that possibly those results couldn't at least be suspected of documenting the use of electric brushes in a comparatively more-favorable light.

And if that's true, that could suggest that the inclusion of these types of studies in this review's findings might overestimate the benefit of using a powered brush over a manual one.

An example from this review.

The authors of this paper noted that a large amount of the data documenting the benefit of using electric brushes came from studies involving "rotation oscillation powered toothbrushes" (Oral-b products).

Yet of the 27 trials involved, only three were determined to be at low risk of bias, one at high risk and 23 at unknown risk.

It's important to say that just because their level of bias can't be estimated doesn't mean that these studies are poor quality ones. But if so, it's obvious how including this large number of "unknowns" could skew this review's conclusions.

We won't pretend that we know that our concerns constitute a significant issue. But we're so jaded by how far manufacturers seem to go to have any claim that their brush is superior, we're wary of sponsored research in general, especially when an issue like its bias can't be quantified.

Manual vs. Powered toothbrush - What did this review determine?

After evaluating the data collected from the 51 studies, the reviewers concluded that:

  • "Powered toothbrushes reduce plaque and gingivitis more than manual tooth brushing in the short and long term."

So yes, this study did determined that using an electric toothbrush was more effective than a manual one. They considered the short term to be 1 to 3 months, and long term periods those greater than 3 months in duration.

Statistics for individual oral hygiene categories.

In regard to the subject of powered toothbrushes (all styles and designs*) versus manual ones, this review came to the following conclusions for the following oral health categories.

* Types of toothbrushes included in the evaluated studies: side to side (Sonicare), counter oscillation, rotation oscillation (Oral-b), circular, ultrasonic and ionic.

a) Plaque reduction.

The reviewers concluded that there was:

  • moderate quality evidence that powered toothbrushes provide a statistically significant benefit as compared to manual ones, over both short term (3 months or less) and long term (greater than 3 months) time frames.

Per the data in the studies evaluated, and as compared to the use of a manual toothbrush:

  • Electric brushes produced an 11% reduction in plaque over the short term and a 21% reduction over the long term.
Our conjecture.

We find it interesting and positive that a greater reduction in plaque is associated with the long-term use of a powered brush versus a manual one.

  • Possibly this suggests that maintaining the needed level of diligence required for effective manual brushing tends to fade over time ...
  • ... and in comparison, since it's the powered brush that creates the brushing action, it's easier for the user to maintain brushing effectiveness as their interest in performing their duties fades.

b) Gingivitis reduction.

As compared to the use of a manual toothbrush, the reviewers concluded that:

  • There was a greater reduction in gingivitis when powered toothbrushes were used, both short term (1-3 months) and long term (>3 months).
  • A 6% reduction was seen over the short term, and 11% over the long term.
Discussion.

The presence of dental plaque and gingivitis generally go hand in hand, so these conclusions aren't all that surprising. And as with the plaque reduction category above, note that using a powered brush provided a greater benefit (vs. a manual one) when the comparison period involved a greater time frame.


So what's the answer? Is using an electric brush really better than a manual one?

Considering the marketing claims you see stated in electric toothbrush ads, we can see how someone might be surprised that the statistics associated with using one (as stated above) aren't more impressive.

Having said that, any tool that can help increase your brushing effectiveness offers value. And if using an electric appeals to you, we think the information on this page makes the case that getting one can be expected to be beneficial.

But don't feel that you have to buy a powered brush.

We'd be surprised if any dental professional wouldn't say that a person couldn't be just as effective using a manual toothbrush vs. an electric one, given the time and motivation to use it properly.

Of course it's the latter portion of that statement that's the key. But if you're the type of person who would do so, then getting an electric has little to offer you.

When does getting a powered brush make sense?

If you're still on the fence about whether to get an electric toothbrush or not, here are some points and situations to consider.

a) Using an electric tends to be 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:

 

(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.

Animation showing how white-spot lesions may form where plaque is allowed to accumulate around dental braces.

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.)

Collectively, these findings make a good case for using an electric toothbrush over the course of orthodontic treatment.

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 independently. - Since electrics create an effective brushing motion on their own, using one requires much less dexterity than a manual toothbrush. This can make them ideal for elderly persons or those who are physically disabled.
  • It can assist their caregiver. - People who take care for individuals who are unable to brush on their own can certainly benefit from using an electric when performing the oral aspect of their duties.

    It will tend to make their task easier, help them in providing more consistent results and will likely prove to be 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 may seem quite unwieldy to some people. 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 powered toothbrush, you might purchase either a low-end or even disposable electric. Not necessarily for long-term use but as a test, to see if the potential for even using this type of unit exists.

Brushes with high and low settings.

We'll also point out that higher-end electrics frequently have a standard and lower-power setting. The performance of the low-power brushing action will generally be substandard to the higher one. But choosing it may make using the brush tolerable, where as in full-power mode the brush's motion is too vigorous to be accepted. (These lists of Sonicare and Oral-b models contain information about brush settings.)

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.

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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.

That suggests that buying a powered toothbrush is usually money well spent.

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.

Using an electric toothbrush should be able to keep this type of stain from forming.

Picture of tooth surface staining.

It may also be able to remove some of this type of staining too.

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).


Don't bother buying an electric toothbrush for these purposes.

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.

You'll do far more to improve the quality of your breath by using a tongue scraper and dental floss than by just improving your tooth brushing effectiveness.

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
peroxide compound).

[Philips and Sonicare are registered trademarks of Koninklijke Philips Electronics N.V.]


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Topic Menu ▶  Powered Toothbrushes

  • Sonicare Toothbrushes Pages -
    • All Sonicare models - A comprehensive review of the features/prices of all of the current models of the Sonicare lineup. Some comparisons between each of the individual product lines are made.
    • The best Sonicare models - A narrative that outlines how to determine which Sonicare model makes the best choice for you. It discusses Sonicare features, which of these features we think are important to have, and which models seem to offer a reasonable manifestation of them.
    • How sonic toothbrushes work. / Effectiveness. - If you're wondering how sonic toothbrushes work and what's special about the brushing action they create, this page explains.
  • Sonicare Features Pages -
    • Brush Heads - Information about Sonicare brush heads, including: What styles of heads are available, in which sizes? Which heads can be used with which models? Comparative cleaning efficiency. How long does a brush head last? Screw-on vs. Click-on design. Standard vs. Compact sizes.
    • Sonicare brushing features - An outline of the various brushing modes different Sonicare models have, and what we think of each of them. It explains the importance of having the 31,000 strokes-per-minute brushing action.
      We also explain details about the Easy-start, Smartimer, KidTimer, QuadPacer, BrushPacer and Smartphone App functions (how they work, what we think of them).
    • Additional Sonicare features - We discuss Sonicare's UV brush head sanitizer in this section. We also explain features and issues associated with Sonicare battery types, charging units, working voltages, battery replacement and travel features.
  • Oral-b Toothbrushes Pages -
    • All Oral-B rechargeable models - A comprehensive review of the features/prices of all of the current Oral-b rechargeable models. Some comparisons between each of the individual toothbrush lines are made.
    • The best Oral-B models - Our narrative outlining how to figure out which model makes the best choice for you. It covers Oral-b features, which of them we think are important to have, and which models seem to offer a reasonable manifestation of them.
  • Oral-b Features Pages -
    • Brush heads - Details about Oral-B replacement brush heads: styles, options, differences. Which are the best ones?
    • Brushing modes - An explanation of the different Oral-B brushing modes found on various models. The importance of 3D vs. 2D brushing action.
    • Additional Oral-b features - Information about the Oral-b Bluetooth/Smartphone app and the wireless Smartguide, as well as what we think of them. Also details about Oral-b brushing timers, quadrant timers and brushing pressure indicators, as well as charging units, operating voltages and battery types.
  • More about electric toothbrushes Pages -
    • Powered vs. Manual toothbrushes - Do you really need an electric toothbrush? This page can help you to decide. Advantages and potential benefits of electrics. What does research say?
    • Rotary electric toothbrushes - Types and brands of rotary-brush head powered toothbrushes (Rota-dent, Interplak, Braun Oral B). Pros and cons of their design differences.
    • The best electric toothbrushes for Senior Citizens. - Elder persons in different age groups, with differing situations, need different features. This page discusses the pros and cons of various models in meeting those needs.
  • Page reference sources.
 
 
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