The efficacy of manual toothbrushes following a brushing exercise: a systematic review

To cite this article:
Int J Dent Hygiene 10 , 2012; 187–197 
DOI: 10.1111/j.1601‐5037.2012.00546.x 
Slot DE, Wiggelinkhuizen L, Rosema NAM, Van der Weijden GA. The efficacy of manual toothbrushes following a brushing exercise: a systematic review. Abstract:  Aim:  To determine the efficacy of manual tooth brushing with respect to toothbrush design and brushing duration. Material and Methods:  The PubMed–MEDLINE and Cochrane CENTRAL were searched through October 2010 to identify appropriate studies. The outcome measurement was dental plaque removal following subject brushing. Results:  The search yielded 2119 titles and abstracts. Ultimately, 59 papers with 212 brushing exercises as separate legs of the experiments and meeting the eligibility criteria were selected. Overall, a brushing exercise provides a 42% (21) plaque score reduction (95% CI: 41.23; 42.03). Of the brushing studies providing data as assessed according to the Quigley and Hein plaque index, the weighted mean reduction from baseline in plaque scores was 30% (95% CI: 26.79; 33.21). A weighted mean plaque score reduction of 53% (95% CI: 49.51; 56.49) was observed in the experiments using the Navy plaque index. Subanalysis between the different bristle tuft configurations illustrated variation in plaque removal ability (24–61%). The angled bristle design numerically showed the highest mean plaque reduction with either index. A subanalysis of brushing duration revealed after 1 min, a mean reduction of 27% and after 2 min, 41%. Conclusion:  The efficacy in plaque removal following a brushing exercise is a reduction from baseline plaque scores of 42% on average, with a variation of 30–53% dependent on the plaque index used. The available evidence indicates that bristle tuft arrangement (flat trim, multilevel, angled) and brushing duration are factors that contribute to the variation in observed efficacy. [Correction added on 5 July 2012, after first online publication: In Table 1a, the overall effect of a brushing exercise was estimated at 50% (33) plaque score reduction (95% CI: 46.54; 55.40). This was corrected to 42% (21) plaque score reduction (95% CI 41.23; 42.03) in the abstract and throughout the manuscript] 1 Summary of the efficacy following brushing exercises ordered by plaque index and presented as a weighted mean percentage reduction in plaque index scores (standard deviations of the weighted mean in parentheses)(a) Total Plaque index No. of studies No. of experiments No. of participants WM (SD) 95% CI*Q&H (12–14) 32 121 5478 30% (18) 26.79; 33.21 Navy (15, 16) 29 91 5328 53% (17) 49.51; 56.49 S&L (17) NA NA NA NA NA Overall effect 59 212 10806 42% (21) 41.23; 42.03 (b) Subanalysis of brush head design Plaque index Bristle tuft configuration No. of studies No. of experiments No. of participants WM (SD) 95% CI* Q&H (12–14) Flat trim 23 74 3464 24% (11) 21.49; 26.51 Multilevel 10 23 1020 33% (19) 25.23; 40.77 Angled 7 11 599 39% (22) 26.00; 52.00 Navy (15, 16) Flat trim 16 27 1764 47% (12) 42.47; 51.53 Multilevel 19 33 2050 54% (15) 48.88; 59.12Angled 11 26 1489 61% (20) 53.31; 68.69 (c) Subanalysis of brushing duration Plaque index Minutes No. of studies No. of experiments No. of participants WM (SD) 95% CI* Q&H (12–14) 1 20 83 4039 27% (17) 25.78; 26.80 2  6 11  349 41% (13) 39.45; 42.26NA, not applicable; WM, weighted mean; SD, standard deviation; Q&H, Quigley and Hein plaque index 1962 (12), Turesky modification of the Quigley and Hein plaque index 1970 (13), Lobene modification of the Quigley and Hein plaque index 1982 (14); Navy, Navy plaque index 1972 (15), Rustogi modified Navy plaque index 1992 (16); S&L, Silness and Löe plaque index 1964 (17); CI, confidence interval. *As a measure of precision, the standard error of the weighted mean (which is a reflection of the variation among studies) was used relative to the number of experiments available to calculate the lower and upper limits of the 95% confidence interval of the weighted mean difference.