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and manual toothbrushes in everyday use, principally in relation to plaque removal and gingival health. [6] In this review, five electronic databases were searched to iden- tify randomised controlled trials that com- pared powered and manual toothbrush- es (up to the middle of 2002) in which the participants were members of the pub- lic with uncompromised manual dexterity who brushed unsupervised for at least four weeks. The review was first updated by Robinson et al. (2005) and the most recent update of this review was published by Ya- coob et al. (2011). [7,8] In total, 50 eligible trials involving 4,326 participants, with no evidence of publication bias, were included in the review. Oscillating-rotating powered toothbrush- es resulted in greater plaque and gingivi- tis reduction compared with manual tooth- brushes, with standard mean differenc- es (SMD) for plaque and gingivitis reduc- tion of 0.53 (95 per cent CI: -0.74 to -0.31) and 0.49 (95 per cent CI: -0.73 to -0.26), re- spectively, in the short term (one to three months). Significantly greater plaque and gingivitis reduction was also found in the long term (i.e. beyond three months), with approximately 27 per cent fewer sites with bleeding on probing. The conclusion of this last systematic re- view was that only for oscillating-rotat- ing toothbrushes is there consistent evi- dence of their clinical superiority to man- ual toothbrushes and greater ability to re- duce plaque and gingivitis. These results confirm the findings and conclusions of the earlier reviews that compared powered and manual toothbrushes. Comparisonofdifferentpowered toothbrushes The most recent Cochrane review assessed the comparative efficacy of powered tooth- brushes with differing action and their ef- fect on oral health. [9] Five electronic da- tabases were searched for studies conduct- ed up to July 2010, resulting in a total of 17 eligible trials, with more than 1,300 total participants. The criteria for selection were that the studies were randomised, com- pared at least two powered toothbrushes with differing action and involved at least four weeks of unsupervised brushing, and that their participants had uncompromised manual dexterity. The action of the tooth- brushes in these trials was oscillating-rotat- ing, counter-oscillating, side-to-side, circu- lar, ultrasonic, multidimensional and ionic (electrically active). Based on seven trials of up to three months in duration, with no significant heterogene- ity, oscillating-rotating toothbrushes were found to result in statistically significantly greater plaque reduction in the short term (one to three months) compared with side- to-side powered toothbrushes. The SMD for plaque reduction was calculated as 0.24 (95 per cent CI: 0.02 to 0.46). Clinically, the relative superiority of the oscillating-rotat- ing action to the side-to-side action equat- ed to a 7 per cent reduction in the Turesky modified Quigley–Hein plaque score. The SMD for short-term gingivitis reduction of 0.35 (95 per cent CI: -0.04 to 0.74) was not statistically significant. As only one trial of more than three months in duration was available, and with only a limited number of participants, no firm long-term conclu- sions could be drawn. Thesafetyofpowered toothbrushes A systematic review was recently con- ducted on the safety of oscillating-rotating toothbrushes compared with manual tooth- Recommending Oral-B® Power toothbrushes can help your patients reach their long-term oral health goals. That’s because the unique small round brush head design and the oscillating- rotating cleaning action ensure a superior clean in hard-to-reach areas, versus a regular manual brush. brushes regarding hard and soft tissue. [10] After searching several electronic databas- es, 35 original papers were selected for in- clusion and grouped by research design (randomised controlled trials with safety as the primary outcome, trials in which safe- ty was a secondary outcome, studies that used a surrogate marker of safety, and lab- oratory-based studies). The review authors concluded that “this systematic review of a large body of pub- lished research in the preceding two de- cades consistently showed oscillating-ro- tating toothbrushes to be safe when com- pared with manual toothbrushes, and col- lectively indicated that they do not pose a clinically relevant concern to either hard or soft tissues”.The outcome is consistent with the observations of the Robinson et al. (2005) and Yacoob et al. (2011) reviews, supporting the safety of oscillating-rotat- ing powered toothbrushes. [7,8] There are at present no systematic reviews on safety for any other powered toothbrush. Otherconsiderations Evidence-based dentistry is important for decision-making; however, it has to be not- ed that clinical outcome may not be the only decisive factor. For instance, while a pow- ered toothbrush may offer ease of use and improve patient compliance with brushing, the increased cost of powered toothbrush- es may affect a patient’s toothbrush choice. It is the manner in which the user brushes that determines the efficacy of plaque re- moval. The role of the dental professional is to coach and motivate the patient. Fea- tures such as a timer and visual signals on a toothbrush help to increase engagement of the user while brushing, and have been found to result in improved brushing and patient compliance. Conclusion Based on the available evidence, oscillat- ing-rotating toothbrushes have been shown to result in greater plaque and gingivitis reduction compared with manual tooth- brushes. Additionally, based on short- term data, oscillating-rotating toothbrush- es compare favourably to powered tooth- brushes with a side-to-side action, while insufficient evidence is available for other powered toothbrushes. Systematic reviews also provide evidence of the safety of oscil- lating-rotating toothbrushes. Summary of findings: The bristle tuft con- figuration is an important parameter for manual toothbrushes. Oscillating-rotating powered toothbrushes are more effective than manual toothbrushes. The safety and efficacy of oscillating-rotating toothbrush- es have been established. A complete list of references is available from the publisher. 21DENTAL TRIBUNE Middle East & Africa Edition | Jan-Feb 2013 ORAL HYGIENE