Clinical Efficacy Evidence: Reducing Plaque, Gingivitis, Staining and Calculus

While patient preference is an important factor in toothbrush selection, equally integral is the ability of a given toothbrush – manual or power – to improve oral health through efficient plaque removal and reduce signs of gum disease such as inflammation and gingival bleeding. Many patients are also interested in a brush’s capacity to target cosmetic concerns, such as stain removal and whitening, and unsightly supragingival calculus.

Dental professionals examine patients every day who exhibit gingivitis and/or periodontal disease, as an estimated four-fifths of adults are afflicted.10 Many factors, such as family predisposition, smoking habits, systemic disease and host defense mechanisms, determine how patients respond to the bacterial plaque existing in their oral cavities. Dental professionals cannot control or change most of these risk factors; therefore, the focus should be on the one evidence-based etiologic factor that is modifiable: the removal of bacterial plaque.11 It is well-documented that effective plaque removal is central to the prevention of gingivitis and periodontitis.12-14 Daily plaque removal by the patient accompanied by professional care should focus on the elimination of dental plaque and its pathogenic products. Studies have shown that the removal of supragingival plaque affects the subgingival plaque biofilm; therefore, it reduces the clinical signs of inflammation (Figure 8).11

Figure 8. Power Brush Bristles Disrupting Plaque.
Photo showing power bristles disrupting plaque
Image presented with permission from Dr. John Thomas and Oral-B.

Diligent, frequent use of a manual toothbrush together with an interdental cleaning device (e.g. floss) has been shown to be sufficient for thorough plaque debridement and therefore control of gingivitis.15 Unfortunately, research has shown that many individuals do not achieve thorough plaque removal solely with use of a manual toothbrush and do not floss regularly, whether due to lack of ability or motivation.10,16,17 Conversely, studies and surveys have found power toothbrushes can motivate patients to brush more regularly and for longer durations,8,18,19 and because a skilled brushing technique is less critical as the power brush head does the work, plaque removal (both overall and approximally) can be greater with use of certain power toothbrushes. Power toothbrushes differ in their effectiveness, however, and well-controlled clinical research is essential when comparing the abilities of various brush technologies.