Comparison of the Effect of Sonic and Manual Toothbrushes on Dental Plaque and Gingivitis Control

Introduction

Although dental plaque control using a properly used manual toothbrush is effective, there is still significant room for improvement in this area. With this goal in mind, the sonic toothbrush was developed to optimize daily mechanical plaque control at home, thus helping to prevent inflammation in the gingiva and periodontium.

Methodology and Study Course

A randomized single-blind study with parallel groups included 144 adults aged 18–70 years (mean age 42.1 years). The study generally included healthy non-smokers who, at the beginning of the study, had mild to moderate gingivitis. Individuals with severe gingivitis or periodontal disease did not meet the entry criteria. The minimum modified plaque index score according to Lobene and Soparkar was > 1.8 after 3–6 hours of plaque accumulation. Participants underwent an oral examination at study entry and were then randomized into 2 groups.

The first group was assigned to brushing with the Philips Sonicare DiamondClean (SDC) electric toothbrush with a standard-sized brush head, while the second group was assigned to brushing with a reference manual toothbrush approved by the American Dental Association (ADA). Both groups were instructed to use the toothbrush twice daily. Both groups also received standard fluoride toothpaste and were instructed not to use any additional oral hygiene tools or products during the study. The total study duration was 4 weeks. Interim efficacy and safety evaluations were conducted at 2 weeks, with final evaluations and study termination at 4 weeks. A total of 142 participants completed the study. 

Results

For the parameter of gingival inflammation assessed by the modified gingival index (MGI), the least squares mean MGI score at study onset was 2.08 (standard error 0.05) in the sonic toothbrush group and 2.14 (0.05; p = 0.3660) in the manual toothbrush group. After 2 weeks, the sonic toothbrush group showed a 24.5% reduction in MGI score compared to a 13.7% reduction in the manual toothbrush group (p < 0.0001). At the end of the 4-week study, there was a further reduction in MGI scores, with a 25.5% reduction in the sonic toothbrush group compared to a 19.1% reduction in the manual toothbrush group (p < 0.0106).

For the parameter of gingival bleeding assessed by the gingival bleeding index (GBI), the least squares mean GBI score at study onset was 28.5 (1.13) in the sonic toothbrush group and 29.7 in the manual toothbrush group (1.12; p = 0.4232). After 2 weeks, there was a significant GBI score reduction in the sonic toothbrush group compared to the manual toothbrush group (52.2% vs. 17%; p < 0.0001), with a similar reduction observed after 4 weeks of therapy (57.4% vs. 31.4%; p < 0.0001).

For the parameter of plaque amount assessed by the modified plaque index (MPI), the least squares mean MPI score at study onset was 2.77 (0.05) in the sonic toothbrush group and 2.85 in the manual toothbrush group (0.05; p = 0.2481). After 2 weeks, there was a significant reduction in MPI score in the sonic toothbrush group compared to the manual toothbrush group (31.4% vs. 3.8%; p < 0.0001), with a similar reduction observed after 4 weeks of therapy (34.9% vs. 8%; p < 0.0001).

Regarding safety, a total of 8 adverse events were reported by 3 study participants, none of which were serious. No adverse effects of either method on restoration materials, including crowns, composites, or veneers, were observed during the study.

Conclusion

The clinical study on healthy volunteers with mild to moderate gingivitis demonstrated that the sonic toothbrush was statistically more effective after 4 weeks of use compared to the manual toothbrush in all study parameters, in terms of reducing gingival inflammation and bleeding as well as the amount of supragingival plaque.

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Source: Delaurenti M., Ward M., Souza S. et al. The effect of use of a sonic power toothbrush and a manual toothbrush control on plaque and gingivitis. J Clin Dent 2017; 28 (1 Spec No A): A1–A6.