Power Toothbrush Safety Data

Most leading power toothbrushes have been tested extensively both in the laboratory and in clinical trials for gentleness to the dentition and gingivae, including assessments for some brushes of applied pressure (force), incidence of abrasions, and measurement of any associated gingival recession. A study evaluating the brushing force of individuals using a manual toothbrush and three electric toothbrushes with distinct modes of action showed that considerably more force was used by those patients using the manual brush, while less force was used with the electric brushes.38

Dentino, et al. and Danser, et al. have demonstrated in independent clinical investigations that study participants brushing with a power toothbrush did not experience greater gingival recession or gingival abrasion, respectively, than those participants assigned to the manual toothbrush.39,40 Dörfer and colleagues observed the depth of tooth abrasion in a long-term (35 months) clinical trial of an oscillating-rotating-pulsating power toothbrush versus the American Dental Association (ADA) reference manual toothbrush and concluded that the power toothbrush did not show a higher risk of tooth abrasion compared to the manual brush.41 With respect to gingival recession, Dörfer et al studied recession changes in 109 subjects with at least two sites of at least 2 mm recession at baseline following 12 months’ clinical use of an oscillating-rotating power toothbrush (Oral-B Professional Care 7000) or an ADA reference manual toothbrush. The results demonstrated that while both brushes reduced recession on the buccal surfaces, there was a tendency towards a higher reduction in recession in the oscillating-rotating power toothbrush group, which was attributed by the authors to improved brushing technique.42 When reporting the 6-month results of this study, Dörfer and colleagues concluded, “Based on these six-month data, concern that power tooth brushing results in a higher risk for gingival recession is not warranted.” In both study groups, pre-existing gingival recession was significantly reduced, and no adverse effects on oral hard and soft tissues were observed.43 In 2016 Dörfer published the culmination of the above recession studies out to 36 months and concluded that subjects with pre-existing gingival recession had a statistically significant reduction in recession after three years of brushing with either an oscillating-rotating power or manual toothbrush. This 3-year randomized clinical trial corroborates and reinforces those findings, showing that daily brushing with either a power or a manual toothbrush does not adversely affect gingival recession.44

In 2011, a systematic review was published by Van der Weijden and colleagues examining the literature reporting soft and/or hard tissue safety outcomes with the use of oscillating-rotating power toothbrushes compared to manual toothbrushes.45 This review and meta-analysis evaluated 899 potential publications, ultimately including 31 in vivo clinical trials (encompassing over 2000 patients) and four in vitro studies meeting all of the eligibility criteria. Inclusion criteria for clinical studies required randomized or controlled clinical trials that included oscillating-rotating brushes with a control manual toothbrush; and a safety assessment as a primary or secondary outcome measure or as a surrogate outcome measure of gingival abrasion of toothbrushing force or excessive force. The authors concluded that this systematic review of a large body of published research in the preceding two decades consistently showed oscillating-rotating brushes to be safe when compared with manual brushes, and collectively indicated that they do not pose a clinically relevant concern to hard or soft tissues.45

Sonic toothbrushes have been found to be well-tolerated in clinical trials, and were noted in the 2004 Cochrane Review to be (along with the other reviewed power toothbrushes) not more injurious than manual toothbrushes.6 In several laboratory (in vitro) investigations assessing various Sonicare power toothbrushes, the Sonicare brush was found to be less abrasive and/or more gentle compared to a manual toothbrush.46