Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control

Table 1

Studies that compared the effectiveness of manual and powered toothbrushes on microbial biofilm.

Study (author, year)	Study design	Test group (toothbrush model, mechanism of action	Control group (toothbrush model, n male, n female, n smokers, mean age)	Brushing time	Outcomes of interest (clinical indexes)	Main results	Conclusion
Schmidt et al. [9]	3-species biofilm was formed in vitro on protein-coated titanium disks. Subsequently, biofilm-coated substrates were exposed to 4 different powered toothbrushes with side-to-side action for noncontact biofilm removal.	4 different powered toothbrushes with side-to-side action (A, B, C, D)	Brushing (bristle-to-disk)	2, 4, and 6 seconds	Biofilm volume as measured using a confocal laser scanning microscope.	Two powered toothbrushes with side-to-side action (C and D) promoted increased in vitro biofilm removal without bristle contact.	It is possible to reduce a three-species in vitro biofilm by noncontact brushing with two out of four side-to-side toothbrushes.
Schmidt et al. [10]	3-species biofilm was formed in vitro on protein-coated disks in an adjustable interdental space model. Subsequently, biofilm-coated substrates were exposed to three side-to-side powered toothbrushes with different oscillation frequencies for noncontact biofilm removal.	Oscillation frequencies of three commercial side-to-side toothbrushes were progressively reduced (100, 85, 70, 55, and 40%).	???	???	Biofilm volume as measured using a confocal laser scanning microscope.	The oscillation frequency of the tested side-to-side toothbrushes affected the biofilm reduction in an interdental space model.	Powered toothbrushes with side-to-side action set at higher oscillation frequencies may promote increased interdental biofilm removal.
Hope et al. [11]	Oral biofilms were grown in vitro on hydroxyapatite (HA) discs in an interdental space model. Next, biofilm-coated substrates were exposed to powered toothbrushes.	Sonicare Elite beyond the bristles and Braun Oral-B 3D	Nonoperating Sonicare Elite beyond the bristles and Braun Oral-B 3D	5 seconds	Biofilm volume as measured by reduction in bacterial counts.	Both brushes removed a significantly higher percentage of plaque bacteria compared to the inactive brushes (Braun, ; Sonicare, ). Percentage of plaque bacteria removed by the Sonicare Elite beyond the bristles (32.23%) was significantly greater () than that removed by the Braun Oral-B 3D (9.48%) in this model system.	Powered toothbrushes removed a significantly higher percentage of plaque bacteria compared to the inactive brushes