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Power Toothbrushes: Hype or Science?

University of Kansas - Lawrence, West Campus, 2099 Constant Ave., Lawrence, KS 66047; hefferen{at}ukans.edu

KEY WORDS: Toothbrush • manual toothbrush • power toothbrush

The Workshop title suggests that reports of power toothbrush studies may include both hyperbole and science. Today we have two hours to review the science describing power toothbrushes and chart a future for scientific exchange, collaborative studies, and recommendations for future communication, use, and research relevant to power toothbrushes and their relationships to manual toothbrushes and dentifrices in oral hygiene programs.

The operative variables in defining toothbrush functionality include brush head size, bristle length and diameter, brush head motion, and brush head speed (Table). These characteristics are determined by the power toothbrush designer and are optimized to enhance the performance of the brush in the hands of the user. Brush head load and motion remain in the domain of the brush user. Timers incorporated into brush design encourage brush use for one to two minutes or longer, thereby providing a signal for optimal duration for each brushing. The general characteristics of manual and powered toothbrushes are listed in the Table.

Laboratory and clinical studies of toothbrushes can benefit from the use of available references that will facilitate comparison of data between studies. The American Dental Association has made available and encouraged the use of a soft bristle, flat profile manual toothbrush as a reference brush. The use of this brush in both laboratory and clinical studies will provide a point of reference. A special lot of calcium pyrophosphate (Hefferren, 1999) is available as a reference for both abrasivity (wear) (Hefferren, 1976; International Standard, 1995) and cleaning power (Stookey et al., 1982). While calcium pyrophosphate reference has been and continues to be used primarily in laboratory studies, it has been used in collaborative clinical studies to provide a reference for clinical cleaning (American Dental Association, 1984). The use of the soft manual toothbrush and calcium pyrophosphate as references in power toothbrush studies provides access to substantial laboratory and clinical multi-investigator, multi-site collaborative studies (Hefferren, 1976; Stookey et al., 1982; American Dental Association, 1984; Hefferren et al., 1984).

The American Dental Association has published Clinical Study Guidelines in 1996 and 1998 (Clinical Protocol Guidelines, 1996; Toothbrushes Acceptance Program Guidelines, 1998) for both manual and power toothbrushes. These Guidelines, among other things, define safety and efficacy, if brush claims are limited to cleanliness. Also included are guidelines for brush use superiority with implied health claims. The Guidelines include a general recommendation to avoid disparagement of other toothbrushes.

The functionality of toothbrushes shares with dentifrices the general overall aims of cleaning and polishing the tooth with minimal surface change per se. The bristles of the toothbrush have the added assignment of gaining access to the sheltered oral sites, such as the anterior and posterior proximal spaces. Assessment of bristle access is one measure of the functionality of a toothbrush (Ersen et al., 2001).

	Acknowledgments

 
This Workshop has been supported in part by the John O. Butler Co., Braun Oral-B, Interplak by Conair, Phillips Jordan, Sonex International Corp., and Teledyne WaterPik.

	Footnotes

 
Presented at a Symposium entitled "Powered Toothbrushes: Hype or Science?", sponsored by the IADR Oral Health Research Group and held during the 78th General Session of the International Association for Dental Research, April 5-8, 2000, Washington, DC

	References

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Clinical Protocol Guidelines (1996). Guidelines for toothbrushes. Chicago, IL: American Dental Association, January.

Ersen E, Coffman L, Berg ML, Li N, Hefferren JJ (2001). Tooth brush functionality measurements: access and cleaning (abstract). J Dent Res 80(Spec Iss):548.

Hefferren JJ (1976). A laboratory method for assessment of dentifrice abrasivity. J Dent Res 55:563–573.[Abstract/Free Full Text]

Hefferren JJ (1999). Calcium pyrophosphate, a reference for abrasion and cleaning studies. In: Proceedings of Task Force on Design and Analysis. Lawrenceville, NJ: Task Force on Design and Analysis, Inc., 2975 Princeton Pike, 08648-3297, chilforce{at}aol.com, pp.57-60.

Hefferren JJ, Kingman A, Stookey GK, Lehnhoff R, Muller T (1984). An international collaborative study of laboratory methods for assessing abrasivity to dentin. J Dent Res 63:1176–1179.[Abstract/Free Full Text]

International Standard ISO 11609. Dentistry–toothpastes– requirements. Test methods and marking. Geneva! ISO, 1995.

Stookey GK, Burkhard TA, Schemehorn BR (1982). In vitro removal of stain with dentifrices. J Dent Res 61:1236–1239.[Free Full Text]

Toothbrushes Acceptance Program Guidelines (1998). Council on Scientific Affairs, American Dental Association, May.

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