Abstract
Aim: To establish the effect of a single-brushing exercise on dental plaque removal using an oscillating-rotating power toothbrush (OR-PTB) as compared to a high-frequency sonic power toothbrush (HFS-PTB). Materials and Methods: The MEDLINE-PubMed and Cochrane-CENTRAL databases were searched up to September 2019. The inclusion criteria contained (randomized) controlled clinical trials involving healthy adult participants brushing with an OR-PTB as compared to an HFS-PTB. Plaque index (PI) scores were evaluated after a single-brushing exercise. Results: A total of 15 publications were included, representing 34 comparisons, of which 8 were professional brushing exercises and 26 participant brushing exercises. The potential risk of bias was estimated to be low. In the overall descriptive analysis of 34 comparisons, 19 comparisons showed a statistically significant difference in favour of the OR-PTB and 4 in favour of the HFS-PTB. The meta-analysis using the professional brushing study design showed a significant difference of means (DiffM) in favour of the OR-PTB (PI score) (DiffM 0.19; P <.0001) (95% CI [013; 0.25]). In those studies where the participants brushed themselves, the data were inconclusive. PI scores showed no difference between the two brushes (P =.15), while one plaque index (the Rustogi Modified Navy plaque index) indicated significant favour for the OR-PTB (DiffM 0.06; P =.002) (95% CI [0.02; 0.09]). Conclusion: Based on the estimated evidence profile, there is moderate certainty of evidence of a very small but significant beneficial effect on plaque removal after a single-brushing exercise with the OR-PTB over the HFS-PTB.
| Original language | English |
|---|---|
| Pages (from-to) | 78-92 |
| Number of pages | 15 |
| Journal | International Journal of Dental Hygiene |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb 2021 |
Funding
From the current descriptive analysis (Table 2A and B ), professional brushing showed a positive effect in favour of the OR‐PTB in 7 out of 8 (89%) comparisons, while for participant brushing this was 12 out of 26 (46%) in favour of the OR‐PTB. The difference is illustrated in the meta‐analysis of the MS&L plaque index, where for the professional brushers, there was a significant effect that was not confirmed in participant brushing (Table 3A ). All included professional brushing exercises, however, originate from the same research group and may therefore introduce performance bias with an overestimation of the results. Conversely, in the professional brushing study design, the variable of the subject participating in the study will be avoided. Therefore, the potential ability of each toothbrush regarding plaque removing effectiveness can be studied without being biased or influenced, for example, by manual dexterity or the brushing experience of the participant. The funnel plot of the meta‐analysis as presented in Appendix S6D is suggestive of publication bias, as included studies are spread mostly at the top of the funnel with a lack of studies located at the bottom. Also funding publication bias may play a role as 10 studies report either sponsorship, funding or involvement of authors related to industry. However, the effect of funding source on publication bias is not clear, when trials that are just financially supported the responsibility for the conduct and reporting of the trial lies primarily with the research group. When a study is performed in an academic setting, the researchers need to comply with the university and national codes of ethics for research. Besides, if a trial is supported by industry or sponsored by industry, this sponsorship has been defined in good practice guidelines. As discussed above, different plaque score indexes may result in a different effect sizes. As companies show a preference for a certain index, this may also introduce a reporting bias. Seven of the nine studies with involvement of the OR‐PTB Company used the Rustogi Modified Navy plaque index, whereas studies with involvement of the HFS‐PTB Company toothbrush evaluated the PTBs with the Modified Quigley and Hein plaque index (see Appendix S11 ). The impact of this preference for a specific index on the outcome of the present review could not be substantiated but meta‐analysis with the Modified Quigley and Hein plaque index does not show a difference between an OR‐PTB and the HFS‐PTB, whereas with the Rustogi Modified Navy plaque index a significant difference was observed. Therefore, a potential effect of the choice of plaque score index cannot be ruled out. 24‐26 47,48 75 75,76 7,72 30 27‐29 29 30 For this research, GA van der Weijden received an unrestricted educational grant from Procter & Gamble Worldwide Clinical Investigations?Oral Care. The authors have previously received either external advisor fees, lecturer fees or research grants from toothbrush manufacturers. Those manufacturers included Colgate, Dentaid, GABA, Lactona, Oral-B, Procter & Gamble, Philips, Sara Lee, Sunstar, Waterpik and Unilever. This study was sponsored by an unrestricted educational grant by Procter and Gamble Company Worldwide Clinical Investigations?Oral Care. This company had no say in the design or conduct of this review nor did they influence the reporting and publishing of the findings.
| Funders | Funder number |
|---|---|
| Procter & Gamble Worldwide Clinical Investigations?Oral Care | |
| Procter and Gamble Company Worldwide Clinical Investigations | |
| Philips | |
| Procter and Gamble |
