at

Continuing Education
Power Toothbrushes:
Everything You Need to Know To Make
Informed Recommendations for Your Patients
Ginger B. Mann, BSDH, MS
Continuing Education Units: 3 hours

The information found in this course will arm the dental professional with information and resources
needed to make effective power brush recommendations that motivate patients and boost brushing
compliance.

Overview
Power brushes are designed to facilitate the removal of bacterial plaque and food debris from the teeth
1
and gingiva and to reduce calculus and stain accumulation. The information found in this continuing
education course will arm the dental professional with information and resources needed to make effective
power brush recommendations that motivate patients and boost brushing compliance.

Learning Objectives
Upon the completion of this course, the dental professional will be able to:
Discuss the history of the power brush.
Compare and contrast the past designs and recommendations of power brushes to the current designs
and recommendations.
Describe the clinical significance of plaque.
Determine the role power toothbrushes play in the removal of plaque.
Discuss research presented on patient compliance with brushing recommendations.
Describe the power brushs effect on plaque, gingivitis, calculus and stain.
Identify various designs/mechanics of power toothbrushes on the market today.
Discuss the oral safety considerations of power toothbrushes.
Utilize product evidence based research, clinical experience, and patient values to select the best
power toothbrush for each individual patient.
Locate sources of information about dental products.
Utilize science to make recommendations for patients.
Instruct patients on the use of power brushes.

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

Course Contents

Gingivitis inflammation of the gingival

tissue with no apical migration of the junctional
epithelium beyond the cementoenamel junction.

Glossary
History of the Toothbrush
Purpose/Indications of Power Brushes
Designs/Mechanics
Safety
Selection Parameters
Using Science to Make Recommendations
Patient Instruction
Summary
Course Test
References
About the Author

Host defense a persons immune response to

invasion by pathogens or to treatment.
MEDLINE a comprehensive database of
life sciences and biomedical bibliographic
information.
Pathogenic products products that can
cause disease (such as specific bacteria).

Glossary

Periodontal disease inflammatory disease

of the periodontium that results from the
progression of gingivitis and is caused by specific
microorganisms.

Abrasivity describes a material of various

particle size and hardness.
CINAHL a database for nursing and allied
health literature.

Supragingival plaque plaque located above

the gingival margin.

Cochrane Collaboration an organization that

aims to help people make well-informed decisions
about healthcare by preparing, maintaining and
promoting the accessibility of systematic review of
the effects of healthcare interventions.

Subgingival plaque plaque located below the

gingival margin.
Systemic disease a disease that affects an
entire organism or bodily system.

Dentifrice another name for a tooth gel, paste

or powder.

Systematic review a rigorous method of

reviewing original research to synthesize results,
which results in a summary of the best evidence
on a specific topic.

Editorial boards a group of people who are

experts in their field who review articles prior to
publication.

Tongue cleaning the removal of debris and

bacteria from the tongue.

EMBASE a database providing rapid access to

the worlds biomedical and drug literature.

Toothbrush abrasion a pathologic wearing

down of the tooth as a result of improper
toothbrush use.

Evidence the data on which a conclusion or

judgment may be based; proof.

History of the Toothbrush

Gingival abrasion trauma to the gingival

tissue which frequently occurs on the facial
surfaces.

Tooth cleaning devices date back thousands of

years. Primitive configurations of the toothbrush,
called chewsticks are mentioned in Chinese
literature dating back to about 600 B.C. The
toothbrush itself dates back to around 1000 AD
in China. This brush is believed to have been
made of hogs bristles. When toothbrushes
began to surface in Europe in the late 18th and
19th centuries, they were too expensive for every
person to afford. These brushes, often made
of gold, ivory or ebony, had replaceable heads.

Gingival index used to assess the severity

of gingivitis based on color, consistency, and
bleeding on probing.
Gingival recession reduction of the height of
the marginal gingiva to a location apical to the
cementoenamel junction, resulting in root surface
exposure.

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

Figure 1. Early Mechanical Brushes

(Image presented with permission from Dr. Fridus van der Weijden)

Finally, in the 1930s, the affordable, plastic

handle, nylon filament toothbrushes became
available. Since then, synthetic materials have
been the industry standard.2, 3 Until the 1970s,
hard bristles were the norm due to a harder
you brush, the cleaner the teeth mindset. This
philosophy caused many cases of toothbrush
abrasion to the teeth and gingival recession to
surrounding tissues. The invention of the nylon
brush is probably the biggest breakthrough in the
history of oral hygiene products. In industrialized
countries, 80%-90% of people brush once or
twice a day.4

were recommended primarily for those who were

handicapped or had limited manual dexterity.
During the 1966 World Workshop in Periodontics,
the use of power brushes was examined.
Workshop participants stated: in persons who are
not highly motivated and those who have difficulty
with manual toothbrushing techniques, the use
of an electric brush with its standard movements
may result in more frequent and better cleansing
of the teeth.7 Since the 1960s, many new and
improved designs have surfaced, including the
oscillating or rotating brushes and brushes that
function at high frequencies. During the 1998
European Workshop on Mechanical Plaque
Control, Weijden concluded: Clinical trials over
the past 10 years show that in controlled trials
electric toothbrushes appear to be superior to
6
manual brushing. Due to these findings, one
can conclude that the recommendation for power
brushes during the 1966 workshop for those
with lack of motivation and limited dexterity has
broadened to include more of the patients dental
professionals see every day.

Mechanical toothbrushes were used in the 19th

century. (Figure 1) Oddly enough, the power
brush was not mass produced until the 1960s.
The push for power brushes was short-lived due
to the lack of evidence that the power brush
performed as well if not better than a manual
brush.5 The power market resurfaced in the
1980s along with evidence that the power
brushes had some superiority over manual
brushes.6

Purpose/Indications of Power Brushes

Although the manual brush is still the primary
mode of maintaining oral hygiene, most patients
do not brush well and/or for an adequate amount
of time. The power brushes were invented to
overcome these barriers to maintaining good
oral hygiene. In the 1960s, the power brushes

Dental professionals examine patients every day

who exhibit gingivitis and/or periodontal disease.
Many factors, such as family predisposition,
smoking habits, systemic disease and host
defense mechanisms, determine how patients
respond to the bacterial plaque existing in their

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

oral cavities. Dental professionals cannot control

or change most of these risk factors; therefore,
the focus is on the one evidence-based etiologic
factor: the removal of bacterial plaque.8 It is
well documented that effective plaque removal
prevents gingivitis and periodontitis. Daily
plaque removal by the patient accompanied
by professional care should focus on the
elimination of the pathogenic products in dental
plaque. Studies have shown that the removal
of supragingival plaque affects the subgingival
plaque biofilm; therefore, it reduces the clinical
signs of inflammation.9 (Figure 2) Supragingival
plaque removal can be accomplished by patients
in many ways.

brush, 62% were still using the brush on a daily

basis.10 Warren et al. studied the effectiveness
of the Oral-B Ultra Plaque Remover in reference
to effectiveness and dental professional and
patients attitudes toward the brush. Eighty-five
percent of the patients exhibited positive results,
including reduction in plaque and improved
gingival condition. One result of the study was
that dental professionals (70%) stated they would
be more likely to recommend the brush to their
patients due to the changes that were evident in
their patients oral health. Seventy-four percent of
the patients perceived their oral health to be better
than when they were using a manual brush. The
majority (88.9%) of the patients reported that they
11
would continue using the brush after the study.
A study conducted in 1998 had subjects compare
the Oral-B 3D power brush to a manual brush.
The subjects perceived that the Oral-B 3D was
more effective than the manual brush. They also
reported an increase in their brushing time and
effectiveness. It is well documented that patients
do not brush long enough; power toothbrushes
with timers may be an avenue for patients to
better assess their brushing time. It has been
proven that more plaque can be removed in
less time using power toothbrushes (Oral-B,
Interplak, Blend-a-dent).12 With the evidence
indicating patient preference and compliance with
power toothbrushes, dental professionals should
feel confident that power brushes can motivate
patients and boost brushing compliance.
When choosing a powered brush, the professional
should examine the brushs effect on:
1. plaque
2. gingivitis
3. calculus
4. stain

Figure 2. Power Brush Bristles Disrupting Plaque

(Image presented with permission from Dr. John Thomas and Oral-B
Laboratories)

Todays toothbrush market is overwhelming

for dental professionals as well as customers.
Many toothbrushes are available with different
actions and features. Dental professionals are
responsible for recommending brushes that
motivate patients, boost brushing compliance,
and are effective. It is understood that a patients
response to any oral hygiene recommendation
is based on their motivation and willingness to
comply. One study examined the compliance
level of patients using powered toothbrushes
unrelated to any social factors and found that
36 months after the purchase of the powered

A systematic review of 29 articles covering

2,547 subjects was done to compare manual
and powered toothbrushes in the removal of
plaque, the health of the gingiva, stain, calculus,
dependability, adverse effects and costs. The
review showed that power brushes that use a
rotation oscillation action (Braun Oral-B and
Phillips Jordan HP 735) removed more plaque
and reduced gingivitis more effectively than
13
manual brushes in the short and long term.
(Table 1) (Figure 3)

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

Figure 3. Rotation Oscillation Action

(Image presented with permission from Oral-B Laboratories)

Evidence suggests that power brushes can

reduce the amount of stain and calculus present
on teeth. A study compared the Braun Oral-B 3D
Excel, the Sonicare power brush and a manual
brush. The two power brushes were used with
conventional toothpaste, while the manual brush
was used with a tartar control toothpaste. All
three modalities were effective in reducing
calculus and stain formation; however, the Oral-B
3D Excel reduced calculus and stain more
1
effectively than the other methods. This finding
is amazing due to the fact that the manual brush
was being used with tartar control toothpaste
and the powered brush was not. The evidence
supports the assertion that power toothbrushes
that use a rotation oscillation (such as the Oral-B)
action are superior to manual brushes in plaque
removal, reduction in gingivitis, calculus and stain
formation.

this evidence available, power brushes can be

mainstreamed into the dental practice; however,
power brushes are not one size fits all.14 There
are various types of power brushes, categorized
by the manner in which the brush head moves.
(Table 2)
Brush head shapes are available for adults,
children, orthodontic patients as well as for
interdental spaces. The brush shapes may
be round, conical or similar to traditional brush
heads. Flat, bi-level, rippled or angled profiles
exist. (Figure 4)
The brush heads for children are smaller to
accommodate the small oral cavity as well as
the developing dentition. (Figure 5) Interdental
brushes are also available. (Figure 6)
The brush filaments are made of soft endrounded nylon in various diameters. The
diameters correlate with the amount of softness.
Power toothbrushes operate from a variety of
power sources. A direct power source is when
the brush connects to an electrical outlet. Some

Designs/Mechanics
As seen above, research supports the use
of power brushes to motivate patients, boost
compliance, reduce plaque, reduce gingivitis,
and reduce calculus and stain formation. With

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

Figure 4. Various Brush Heads

15

(Image presented with permission from Wilkins )

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

Figure 5. Childs Brush Head

Figure 6. Interdental Brush Head

15

(Image presented with permission from Wilkins )

Figure 7. Pressure Sensor (Oral-B Braun)

(Image presented with permission from Oral-B Laboratories)

brushes have replaceable batteries. As the

battery life is reduced, the brush speed also
reduces. Power brushes with batteries should
have a watertight handle to avoid corrosion
of the batteries. Disposable brushes are
available where the battery cannot be replaced
or recharged. Brushes with switches have
a button that remains on until the button is
pressed again. Other brushes have rechargeable
batteries, which are charged by sitting on a
stand that is connected to an electrical outlet.
The speed of a powered brush varies from low
to high. This variance is dependent on the
manufacturer and type of brush. For instance,
power brushes with replaceable batteries usually

move slower than those with rechargeable

5
batteries. Some brushes offer a pressure sensor,
which interrupts the brush movement to make
patients aware when too much pressure is being
applied to the tooth surface. (Figure 7)
It is well known that patients underestimate the
amount of time they brush. Power brushes with
timers enable patients to assess the time spent
on brushing.

Safety
Patients may use improper toothbrushing
techniques, abrasive toothpastes and hard bristle
filaments, which can damage the gingiva, dentin,

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

Figure 8. Toothbrush Abrasion

Figure 9. Gingival Recession

(Image presented with permission from Dr. Marty Spiller)

(Image presented with permission from www.perio.com/b.html)

and/or enamel. Two types of damage are called

toothbrush abrasion and gingival recession.
Toothbrush abrasion is defined as pathologic
tooth wear as a result of a foreign substance.
(Figure 8) This type of abrasion is most
commonly caused by traumatic toothbrushing.
The teeth appear to have notches worn into
the teeth just above the gumline. Gingival
recession is defined as reduction of the height
of the marginal gingiva to a location apical to the
cementoenamel junction, resulting in root surface
exposure. (Figure 9)

term studies, which used adults and children for

subjects, showed no evidence of soft or hard
tissue trauma when using the Braun Oral-B
plaque remover. Seven studies estimated
the effect of the powered brush in reducing
gingivitis. These studies made the correlation
between gingival bleeding, gingival index and soft
tissue trauma. In summary, if the gingiva was
bleeding and the gingival index had increased,
this would be indicative of soft tissue trauma.
These detrimental effects were not noted in
any of the seven studies reviewed.18 Dentino
evaluated gingival recession in 95 patients using
the Braun Oral-B plaque remover or a standard
manual toothbrush. The results showed that the
Oral-B plaque remover did not cause gingival
recession.19 Gingival abrasion can also occur
due to toothbrushing. A study compared the
incidence of gingival abrasion when 47 subjects
brushed with a manual brush and the Braun
Oral-B plaque remover. When comparing the
brushes, gingival abrasion was comparable
between the manual and electric toothbrush.
Clinical studies consistently report no evidence
of clinically significant gingival abrasion, and a
number of studies that investigated safety report
no difference in the incidence of minor gingival
abrasions associated with power and manual
toothbrush use.20 According to the review of
the literature above, the Oral-B powered brush
showed no evidence of harmful effects on the
gingival or the root structure of the tooth.

Gingival recession can be caused by many

factors. Toothbrushing technique, frequency,
duration, force of brushing, and the hardness of
toothbrush filaments can all contribute to gingival
recession.16 When making recommendations to
patients, the dental professional should be certain
of the safety of the product. Many studies have
been performed that assess the safety of electric
toothbrushes.
Both toothbrush abrasion and gingival recession
can be caused by excessive pressure while
brushing. A study evaluated the brushing force
of individuals using a manual toothbrush and
three electric toothbrushes (Rotadent, Interplak,
Braun D7). The results showed that considerably
more force was used by patients with the manual
brush; therefore less force was used with the
electric brushes.17 Some brushes, such as the
Braun Oral-B plaque remover offer a pressure
sensor, which makes patients aware when too
much pressure is applied to the tooth. Fishman
conducted a review of published safety data on
the Braun Oral-B plaque remover. Two short-

Selection Parameters
With so many dental products on the market
today, it is hard for dental professionals to stay
abreast of the newest and greatest. The dental

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

professional as well as the patient has a wealth of

information at their fingertips. Recommendations
should be based on the documented evidence
of a products effectiveness, the dental
professionals clinical experience, as well as the
patients attitude toward their oral health and
their willingness to try new products. The dental
professional should search for research articles
that assess the effectiveness of the product. The
research must be critically examined for bias
or flaws in design. Patient readiness must be
assessed to enhance the success of the new
recommendation:
1. Determine the patients perception of the
problem and their goals.
2. Make sure the patient understands why and
how the product might benefit them.
3. If the evidence is strong and the patient is
willing, make the recommendation.
4. Evaluate the result, with the dental
professional and the patient working as
partners.

and costs. Many databases were searched to

collect research on the topic. Some of these
databases included: MEDLINE, EMBASE, and
CINAHL. Companies were also contacted for
research results. Dental professionals have
access to all these resources as well. Ask
company representatives for published research
that supports their products. Organizations such
as the Cochrane Collaboration review all the
literature and make conclusions the public and
dental professionals can examine, apply and
evaluate. In the recent Cochrane Review on
powered toothbrushes, the reviewers found 29
trials that included 2,547 patients!22
The Internet is a wealth of information for dental
professionals and patients. However, not
everything found there is factualbe sure to check
the sources. Other resources include colleagues,
experts in the field, or continuing education
courses. Still, the dental professional must
evaluate the information, apply it and evaluate the
outcome. The web also offers many resources
for information on products or links to product
information. (Table 3).

Using Science to Make

Recommendations
So where do dental professionals find the
evidence of product effectiveness? There are
many literature resources available to dental
professionals. Many of these have editorial
boards who review the submitted manuscripts
for publication. A few of these titles include:
The American Journal of Dentistry, The Journal
of Clinical Dentistry, The Journal of EvidenceBased Dental Practice, The Journal of Clinical
Periodontology, The Journal of Dental Hygiene
and The Dental Assistant Journal. Journals
can be obtained through subscriptions, online or through a library affiliated with a dental,
dental hygiene, or dental assisting program.
Reviews of current literature are available
from many resources. Another source is
independent organizations such as the Cochrane
Collaboration. The Cochrane Collaboration is an
organization that aims to help people make well
informed decisions about healthcare by preparing,
maintaining and promoting the accessibility of
systematic reviews of the effects of healthcare
21
interventions. For instance, a Cochrane
Review recently compared manual and powered
toothbrushes in relation to the removal of plaque,
the health of the gingivae, amount of staining and
calculus, dependability and any adverse effects

Patient Instruction
When teaching any new oral hygiene skill, the
dental professional must assess the patients
knowledge, attitudes, values and psychomotor
skills. The patients particular situation, such as
their socio-economic status and stress levels
also should be assessed. Establishment of new
oral hygiene practices are dependent on active
participation of the patient. Patient to dental
professional instruction is the best because it
allows for immediate feedback. Self-instructional
materials can also be used by patients at home
in addition to face-to-face instruction. The patient
should be involved in the instructional process.23
One great way to facilitate patient involvement
and compliance is with self-evaluation. For
example: patients can use disclosing tablets
after brushing to show the areas that need more
attention.
The advantage of powered brushes is the
patient only has to focus on the placement of
the brush, not the brushing action; therefore the
powered brush works well for patients with limited
dexterity and those who are ineffective brushers
with a manual brush. It is imperative that the

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

dental professional review the manufacturers

instructions due to the vast number of designs
available. Review the manufacturers suggestions
for use and care of the brush.

Tongue cleaning can also be done with a

powered brush. Tongue cleaning is important
because it retards plaque formation and total
plaque accumulation. Some brushes have
specific brush heads designed for tongue
cleaning. With the tongue extruded, the brush
should be placed at a right angle to the midline
of the tongue with the bristles pointing toward
the throat. With light pressure, the sides of the
filaments are drawn forward toward the tip of the
tongue. This procedure should be repeated 3-4
times until the tongue surface is clean.15

General instructions for power brushes include

selecting a brush with soft end-rounded filaments
and a dentifrice with minimum abrasivity. Instruct
the patient to spread the dentifrice over several
teeth before starting to brush to prevent splashing
of the dentifrice when the brush is turned on. The
patient should vary the brush position to reach
each tooth surface, including the distal, facial,
mesial and lingual surfaces. The angulation may
need to be altered for access to malpositioned
teeth. For brushing the occlusal surfaces, place
the brush with filaments pointing into the occlusal
pits at a right angle. The patient can move
the brush in a slight circular motion while the
filaments are in the occlusal pits or can press
moderately (not bending the bristles) so the
filaments go straight into the pits and fissures.
The strokes for the occlusal surfaces are sharp
and quick. The brush should be lifted after each
stroke to dislodge any loosened debris.

Summary
Dental professionals today can be overwhelmed
by the number of products surfacing on the
market daily. Patients are more educated
and asking more questions about their
care. Technological advances oblige dental
professionals to seek information that will enable
them to make the best recommendations based
on proven product effectiveness, their own clinical
experience, and patient values.

10

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

To receive Continuing Education credit for this course, you must complete the online test. Please
go to www.dentalcare.com and find this course in the Continuing Education section.

Course Test Preview

1.

Power brushes were first seen in mass production in the:

a. 1930s
b. 1950s
c. 1960s
d. 1970s
e. 1980s

2.

Power brushes were invented to:

a. Overcome domination of the manual toothbrush market
b. Improve brushing
c. Encourage patients to brush longer
d. a, b, c
e. b, c

3.

In the early days of power brushes, they were primarily recommended for those who were
handicapped and had limited dexterity.
a. True
b. False

4.

Which of the following factors determine how patients respond to bacterial plaque?
a. Host defense mechanisms
b. Systemic disease
c. Family predisposition
d. Smoking habits
e. All of the above

5.

Powered brushes focus on the elimination of pathogenic products, therefore, reducing the
signs of inflammation.
a. True
b. False

6.

Thirty-six months after the purchase of a powered brush ___% were still using the brush on
a daily basis.
a. 30
b. 45
c. 62
d. 70
e. 75

7.

In a study where patients used the Oral-B 3D, they reported an increase in their brushing
time and effectiveness.
a. True
b. False

8.

Less plaque is removed using a power brush even when brushing longer.
a. True
b. False

11

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

9.

Power brushes using the _____ action have been proven to reduce more plaque and
gingivitis than a manual brush.
a. Circular
b. Counter oscillation
c. Side to side
d. Up and down
e. Rotation oscillation

10.

One study compared power brushes to a manual brush. The manual brush used tartar
control toothpaste while the power brushes used conventional toothpaste. The results
showed one of the powered brushes to be superior even though conventional toothpaste
was used.
a. True
b. False

11.

Which of the following brush heads are available for the powered brush?
a. Interdental
b. Adult
c. Children
d. Orthodontic patients
e. All of the above

12.

The best brush filaments to recommend are hard, end-rounded and nylon.
a. True
b. False

13.

The speed of a battery-powered brush is not affected as the battery life is reduced.
a. True
b. False

14.

Some power brushes are available with pressure sensors to make patients aware when too
much pressure is being applied to the tooth surface.
a. True
b. False

15.

Toothbrush abrasion and gingival recession can be caused by excessive pressure when
toothbrushing.
a. True
b. False

16.

Research has shown that more pressure is used when patients brush with a manual brush
compared to a power brush.
a. True
b. False

17.

Evidence suggests that power brushes can increase the amount of stain and calculus on
the teeth.
a. True
b. False

12

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

18.

Research has shown that the Braun Oral-B power brush does not cause gingival recession.
a. True
b. False

19.

Which of the following should be considered when making recommendations to patients?

a. The best evidence
b. Clinical experience
c. Patients values
d. Patients willingness
e. All of the above

20.

To ensure patient compliance, the dental professional should make sure:

a. The patient understands why the product is needed
b. The patient knows how the product might benefit them
c. The patient is willing to make the change
d. The patient is involved in the evaluation of the product and its effectiveness
e. All of the above

21.

Self-instructional materials are the best method to teach patients new oral hygiene
methods.
a. True
b. False

22.

When using a power brush, the patient has to focus on the placement of the brush, not the
brushing action.
a. True
b. False

23.

Power brushes should not be used to clean the tongue.

a. True
b. False

24.
a.

Which of the following are methods taught to patients using power brushes?
Use a dentifrice with minimum abrasivity
b. Spread dentifrice over several teeth before turning the brush on
c. Vary the brush position to reach each tooth surface
d. Brush occlusal pits by pointing bristles at a right angle into the pits
e. All of the above

25.

Clinical trials have shown that power brushing appears to be superior to manual brushing.
a. True
b. False

13

Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006

References
1. Sharma NC, Galustians HJ, Qaqish J, Cugini M, Warren PR. The effect of two power toothbrushes
on calculus and stain formation. Am J Dent. 2002 Apr;15(2):71-6. Erratum in: Am J Dent. 2002
Oct;15(5):348.
2. Alexander JF. Toothbrushes and Toothbrushing, in Menaker, L., ed.: The Biologic Basis of Dental
Caries. Hagerstown, MD: Harper & Row, 1980, pp. 482-496.
3. Fischman SL. Oral hygiene products: How far have we come in 6000 years? Periodontology 2000
15 (1997): 7-14.
4. Saxer UP, Yankell SL. Impact of improved toothbrushes on dental diseases. II. Quintessence Int.
1997 Sep;28(9):573-93.
5. Frandsen A. Mechanical oral hygiene practices. In: Loe H, Kleinman D V. (eds) Dental Plaque
Control Measures and Oral Hygiene Practices. Oxford: IRL Press, 1986, pp. 93-116.
6. Van der Weijden GA, Timmerman MF, Danser MM, et al. The role of electric toothbrushes:
advantages and limitations. In: Lang NP, Attstrom R, Loe H (eds.). Proceedings of the European
Workshop on Mechanical Plaque Control. Berlin: Quintessence Verlag, 1998, pp. 138-155.
7. Greene JC. World Workshop in Periodontics, eds. Ramfjord, S.P., Kerr, D.A. & Ash, M.M., Ann Arbor,
MI.: American Academy of Periodontology, 1966, pp. 399-443.
8. Garmyn P, van Steenberghe D, Quirynen. Efficacy of Plaque Control in the Maintenance of Gingival
Health: Plaque Control in Primary and Secondary Prevention. In: Lang NP, Attstrom R, Loe H (eds.).
Proceedings of the European Workshop on Mechanical Plaque Control. Berlin: Quintessence Verlag,
1998, pp. 107-120.
9. Smulow JB, Turesky SS, Hill RG. The effect of supragingival plaque removal on anaerobic bacteria
deep periodontal pockets. J Am Dent Assoc. 1983 Nov;107(5):737-42.
10. Stalnacke K, Soderfeldt B, Sjodin B. Compliance in use of electric toothbrushes. Acta Odontol
Scand. 1995 Feb;53(1):17-9.
11. Warren PR, Ray TS, Cugini M, Chater BV. A practice-based study of a power toothbrush:
assessment of effectiveness and acceptance. J Am Dent Assoc. 2000 Mar;131(3):389-94.
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10(5) (2001): 36.
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22. Manual versus powered toothbrushing for oral health (Cochrane Review). Heanue M, Deacon S,
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Suggested Readings

Bowen D. An evidence-based review of power toothbrushes. Comp of Cont Ed in Oral Hygiene.

Vol. 9, No. 1. 2002
Bowen D, Forrest J. Solving Puzzling Clinical Questions. RDH May (2003): 34, 36, 38, 40, 100.
Haffajee AD, Arguello EI, Ximenez-Fyvie LA, Socransky SS. Controlling the plaque biofilm. Int Dent
J. 2003;53 Suppl 3:191-9.
Proceedings of the European Workshop on Mechanical Plaque Control. Lang NP, Attstrom R, Loe
H. Switzerland: Quintessence, 1998. Internet link, July 2006.
Slots J. Update on general health risk of periodontal disease. Int Dent J. 2003;53 Suppl 3:200-7.
Sharma NC, Galustians HJ, Qaqish J, Cugini M. Safety and plaque removal efficacy of a batteryoperated power toothbrush and a manual toothbrush. Am J Dent. 2001 Nov;14 Spec No:9B-12B.
van der Weijden GA, Timmerman MF, Piscaer M, IJzerman Y, van der Velden U. A clinical
comparison of three powered toothbrushes. J Clin Periodontol. 2002 Nov;29(11):1042-7.
Warren PR, Cugini M, Marks P, King DW. Safety, efficacy and acceptability of a new power
toothbrush: a 3-month comparative clinical investigation. Am J Dent. 2001 Feb;14(1):3-7.

About the Author

Ginger B. Mann, BSDH, MS
Ms. Mann was a clinical associate professor at the UNC School of Dentistry at Chapel Hill for ten
years. She graduated from Old Dominion University in 1991 with a Masters Degree in Dental
Hygiene Education. During her ten years at UNC she was responsible for teaching numerous
courses, including Dental Health Education and Clinical Coordinator for second year dental hygiene
students. Ms. Mann has received numerous teaching excellence awards. She is a published author
and presents continuing education courses. Currently she is the project coordinator for numerous
community projects focusing on preschool aged children. Ms. Mann is also a part-time clinical
instructor at Wake Technical Community College and an adjunct faculty at the UNC School of Dentistry
at Chapel Hill.

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Crest Oral-B at dentalcare.com Continuing Education Course, September 6, 2006