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Get the power!?

This is a review of powered toothbrushes looking at the science behind the use of clinical trials in this area.

Damien Walmsley

on 6 March 2015

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Transcript of Get the power!?

Get the power!?
Damien Walmsley
297 studies

but 245 were excluded
Many reasons
Less than 28 days
not RCTs
split mouth designs
42 trials accepted

but many had flaws

Difficult to add everything
Trials are wanting to prove new brush
so maybe not interested in all aspects
Some examples

Different indices
Brushing timing before arrival
Professional brushing
Drop out rates
Intention to treat
Priori power calculations
Compliance data
Adverse events
Cochrane reviews aim to provide a robust summary of the effectiveness of healthcare interventions

Quality is needed and many trials rejected could have been improved

Short term good but not representative of everyday use
Checklist and diagram
Research is a compromise ...

ADA mild to moderate gingivitis
Range of patient groups

This was good
Movements open to debate
From Original Article

Side-to-side action
Counter oscillation
Rotation oscillation
Ultrasonic (above 20kHz)
But changes in movement from different manufacturers

Varied OH practices
Abstain before recording
Brush on arrival
Under supervision no plaque but gingivitis
Plaque index
Turesky modification of Quigley Hein

Gingival index
Loe & Silness
Automatic methods?
Periodontal attachment?
Secondary data
Mechanical data
Sample size

Priori calculation
ADA guidelines 30 participants
What should be reduction that provides a change?
10% or 20%
Statistical methods
Baseline data
Numbers analysed
ITT, dropouts
Numbers analysed
ITT, dropouts

Adverse events

Duration of trials
Only 13 trials greater than 3 months

Registration of trials
Registration of trials
My own personal view
Scientific writing and presentation of results!
Powered vs Powered brushes
17 trials with 1369 participants
Brushes with a rotation oscillation action reduced plaque and gingivitis more than those with a side to side action in the short term

Difference was small and
clinical importance unclear
Technology is changing
Newer brushes
More efficient movement
Different movements
More trials needed and long term

Powered toothbrushes work

Patient motivation is high

It is important people know how to use them
Manaul and Powered toothbrushes

Review on existing technologies
incl. clinical benefits and limitations - Cochrane review
the ideal and the possible
Oral B
Different bristle
Remains side-to-side
New movements based on orientation
Next update is imminent
Thank you for listening
and ready for questions
New Research on Powered toothbrushes
Toothbrush Noise
elmex ProClinical A1500
Courtesy of: Natan Morar, Vladimir Akopyan, Manish Parekh and Chris Baber
Full transcript