The safety of oscillating-rotating powered toothbrushes

PubMed-Medline, the Cochrane Central Register of Controlled Trials (Cochrane-CENTRAL), Embase, together with the reference lists of selected studies were searched. Both in vitro and in vivo studies were included with selection being undertaken by two reviewers with a third as arbiter if required. Human randomised clinical trials (RCT) or controlled clinical trials conducted in healthy subjects were included where, the intervention included a rechargeable, oscillating-rotating power toothbrush compared with a manual toothbrush control and a safety assessment was included. Similar criteria were used for in vitro studies. Two independent reviewers extracted the data with any discrepancies being decided by a third reviewer. Missing data were calculated and designated accordingly. Meta-analysis was performed where possible using a random-effects model. Thirty-five publications met the criteria. The mean change in gingival recession was not significantly different among toothbrush groups in the two selected trials with safety as a primary outcome (weighted mean difference: 0.03). A meta-analysis of the five trials that evaluated safety with a surrogate parameter was not possible; however, there were no significant between-group differences at the study end in any trial. A descriptive analysis of the 24 selected studies assessing safety as a secondary outcome revealed few brushing-related adverse events. The heterogeneity in objectives and methodology of the four in vitro trials that met the eligibility criteria precluded generalisation of the results. A large body of published research in the preceding two decades has consistently shown oscillating-rotating toothbrushes to be safe compared to manual toothbrushes, demonstrating that these power toothbrushes do not pose a clinically relevant concern to hard or soft tissues.