Do electric toothbrushes remove more plaque?

Does An Electric Toothbrush Remove More Plaque?

The short answer is yes, it does.

I am not sure about you, but when I go to the dentist I could almost predict what they will say about my teeth.  

‘Pay a little more attention when brushing’.

This seemed to be what the dentist would say every time.  Whether this was part of his script or he generally meant it, I am not entirely sure, he never said I had any problems.

I guess regardless, his intention was right.  He wants me to have good teeth and not get buildup of plaque and tartar.  A buildup of such can lead to issues such as gum disease and decay.

However, for the last few years I have not had such comments.  Maybe because the dentist I have has changed, but maybe also because I do now pay more attention when brushing.

This attention was brought on by me understanding better the health benefits and importance of cleaning my teeth properly.

One of the big selling points of an electric toothbrush is apparently how much plaque it can remove.  Statements of up to 100% more when compared to a manual brush is not uncommon, in fact many Oral-B literature items will state this.

What is plaque?

Plaque is a sticky substance on the teeth that contains bacteria. Plaque builds up over the course of the day. Whilst some bacteria in plaque are harmless, but some are harmful to your gum health, and this is why not removing plaque causes gingivitis (gum disease) and dental decay.

Over time, if the teeth and gums are not properly cleaned, the plaque is not removed. The plaque builds up and the bacteria in it produce acids which irritates your gums. This can lead to redness with bleeding, swelling and tenderness.

This is the early stages of a condition called gingivitis, or as it might more commonly known, gum disease.

The bacteria in plaque produce acids that can also soften the outermost surface of your tooth, eventually leading to holes in your teeth – dental decay.

How to remove plaque from the teeth

The answer to this is really quite simple.

Cleaning the teeth and gums, daily, is the answer.

The main tools for this are a toothbrush and floss.

Electric is best, but a manual brush is acceptable.

You can use floss or interdental brushes to clean the areas of the teeth the brush won’t reach.

You can go to the dentist or dental hygienist for dental scaling and polishing to help clean plaque away, but unless it is hardened onto the teeth, it is not absolutely necessary.

But how and why is this?

As outlined in our post on the benefits of electric toothbrushes, one of the primary reasons that an electric toothbrush will remove more plaque from the teeth and gums is the consistent power delivery.

Unlike a manual toothbrush the electric toothbrush continues to deliver the same power from the second it is switched on to the moment it is switched off.

A manual toothbrush is controlled by the arm of a human and keeping up a regular motion is much more difficult and unlikely.

When something is consistent and uniform you often see improvement.

A great example would be someone who cleans their teeth once a day.  If they then brushed twice a day, within a couple of weeks there are very likely to see and feel the benefits of this.

It is the same principle if you use an electric toothbrush for cleaning your teeth rather than a manual brush, however it can be harder to see or feel the difference and improvement in such a short space of time, but some will.

Of course there are the array of interchangeable brush heads that are available too, which further aid with an efficient plaque and bacteria removal.

100% improvement claimed by leading brands is a little hard to believe and the results of all clinical studies do not quite agree with this statement.

Clinical studies into plaque removal

Despite not all the studies I have researched and read agreeing quite with the claims of the big brands, there has been significant research into the differences of plaque removal with an electric and manual brush.  The results are quite impressive, with the majority supporting such claims.

Whilst it is not the easiest process to average out the results, independent research group Cochrane did just this.

In 2014, they concluded research into 56 studies published from 1964 to 2011 in which 5068 participants were randomised to receive either a powered toothbrush or a manual toothbrush. The majority of the studies included adults, and over 50% of the studies used a type of powered toothbrush that had a rotation oscillation mode of action.

The results?

The evidence produced showed benefits in using a powered toothbrush when compared with a manual toothbrush. There was an 11% reduction in plaque at one to three months of use, and a 21% reduction in plaque when assessed after three months of use. For gingivitis, there was a 6% reduction at one to three months of use and an 11% reduction when assessed after three months of use.

More recent studies, notably a very impressive 11 year study into electric toothbrush use, published in the Journal of Clinical Periodontolgy found that 36.9% of the participants had less probing depth, one measure of overall gum and oral health.

These independent studies might not quite agree or confirm 100%, but the truth of the matter is, electric toothbrushes will remove more plaque which leads to healthier teeth, healthier gums and a healthier you.

The authors comments from Cochrane did comment how the studies and trials needed more standardisation with variances in how each was carried out.  This was further confirmed by Forrest and Miller who analysed Cochranes study.   

Whilst the evidence demonstrates benefits to using an electric toothbrush, the longer term benefits and accuracy of this figure to some degree can be questioned.

When I consider how I have been using an electric toothbrush for a good few years and have had no problems with my teeth, something inside of me feels that the electric toothbrush has a part to play, and the evidence would suggest so.

Electric toothbrushes do remove more plaque – The supporting evidence

The Cochrane group may have conducted their analysis but I wanted to dig a little deeper to see what some of the studies said for myself.

Below are a list out to some of the leading studies I have found over the last few decades and their comments on plaque removal with an electric toothbrush.

Powered toothbrushes reduce plaque and gingivitis more than manual tooth brushing in the short and long term. Yaacob, M – Department of Periodontics, Kulliyyah of Dentistry, International Islamic University Malaysia 

High-frequency, high-amplitude, sonic-powered toothbrushes decreased plaque and gingivitis significantly more effectively than manual toothbrushes in everyday use in studies lasting from four weeks up to three months. – de Jager M – Philips Research 

The subject group using the powered toothbrush demonstrated clinical and statistical improvement in overall plaque scores. Powered toothbrushes offer an individual the ability to brush the teeth in a way that is optimal in terms of removing plaque and improving gingival health, conferring good brushing technique on all who use them, irrespective of manual dexterity or training. – Yashika Jain –  Department of Periodontology and Implantology, SGT Dental College and Research Institute, Gurgaon (Haryana), India

A wealth of new research – with a few exceptions – supports that the current generation of power brushes removes more plaque than manual toothbrushes in a variety of clinical trial models. – Walters, P – RDH

In our sample, Group A patients, who used the Oral B Professional Care electric toothbrush, were found to have a greater positive variation in plaque and bleeding gum indices with respect to those in Group B, who were provided with a manual toothbrush. –  Silvestrini Biavati, A – Department of Orthodontics, University of Genoa 

Compared to manual brushing, both brush heads removed significantly more plaque (p<0.01.). Percent reductions whole mouth were 77%, 76%, and 74% and 71%, 71%,and 68% along the margin for D12/EB17, D12/EB417 and manual toothbrushes respectively. – Goyal, C – Biosci Research Canada 

Philips Sonicare DiamondClean was statistically signi cantly more e ective than a manual toothbrush at reducing gingival inflammation, gingival bleeding and surface plaque following two and four weeks of home use. – Delaurenti M – University Park Research Centre 

Electric toothbrushes do not remove more plaque – The supporting evidence

As I mentioned earlier, not all studies have agreed with the claims a powered brush will remove more plaque and the following are those that question the so called benefits brought on by using an electric brush.

‘No significant difference was detected between the study toothbrushes in terms of plaque removal’ – Seyedeh Mahsa Sheikh-Al-Eslamian – Avicenna Journal of Dental Research 

In general there was no evidence of a statistically significant difference between powered and manual brushes. However, ionic brushes significantly reduce plaque and gingivitis in both the short-term evaluations.  – Akshay Vibhute – Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India

In general there was no evidence of a statistically significant difference between powered and manual brushes. However, rotation oscillation powered brushes significantly reduce plaque and gingivitis in both the short and long-term. – Deery, C – Department of Paediatric Dentistry, Edinburgh Dental Institute

Interestingly and probably as expected there are claims between the brands that one does a better job than the other at cleaning.  The following study compared Sonicare to Oral-B and claims Oral-B products helped clean better.

Results from the review found no evidence to support a greater efficacy for the Sonicare toothbrushes either generally or at approximal surfaces. Data revealed that the oscillating/rotating toothbrush was more effective than the Sonicare toothbrushes with respect to plaque removal. It is possible that factors associated with the clinical situation such as damping resulting from bristle contact with the tooth surface and the high viscosity of saliva and dentifrice may counteract dynamic fluid activity in vivo. This review indicates that dynamic fluid activity beyond the reach of bristles as demonstrated in the laboratory is yet unproven in the clinical situation. – Warren PR – Oral-B Laboratories

It is likely quite clear to you that there is greater support in the idea that powered brushes do remove more plaque than a manual.  Whilst some tests are funded by the big brands, there are enough studies and data available to quash some of those possibly exaggerated results and bring them to a more realistic level.  There are also groups like the Oral Health Foundation that do assess manufacturer’s claims. Oral-B is one of their approved partners.

The Cochrane group have done the best job at averaging out the results, and whilst nothing scientific on my part, I do personally believe that the electric toothbrush has been instrumental in me achieving the oral hygiene results and health that I have today.