Manual toothbrushes can be effective at removing dental plaque and reducing the risk of gingivitis (gum inflammation commonly caused by plaque build up), tooth decay, and periodontal disease if they are used regularly, paired with a fluoridated toothpaste, and if proper brushing technique is used. 17

Power toothbrushes differ from manual toothbrushes in that they are electronically powered to create various movements of the toothbrush bristles that replace the need to manually maneuver the toothbrush to create these motions.

Main movements of the power toothbrush include:

• Oscillation - back and forth motion

• Reciprocation - up and down and back motion

• Rotational - circular motion

Which toothbrush is best? Studies have shown that power toothbrushes can reduce plaque scores, improve gingival health, and reduce gingivitis more effectively than manual toothbrushes. 18-19

Why have power toothbrushes been proven superior? The answer has to do more with consumer use rather than the toothbrush design itself. Manual toothbrushes can be as effective as power toothbrushes if they are used correctly, for the appropriate amount of time, and with a fluoridated toothpaste. However, many people do not brush using the most effective techniques, nor the recommended 2 minute intervals. Since power toothbrushes electrically create various motions, this eliminated the need to conscientiously maneuver the toothbrush to brush effectively. Many power toothbrushes also have smaller heads which allow them to reach more surfaces of hard to reach teeth with minimal discomfort. These features contribute to the benefits of power toothbrushes over manual toothbrushes. 

Who should use a power toothbrush? Due to the listed advantages, power toothbrushes can be effective for:

• Those with low dexterity - children, people with arthritis, and older adults can benefit from the larger handles which make it easier to hold and maneuver the toothbrush to reach all tooth surfaces 20

• Those with sensitive gag reflexes - smaller toothbrush heads make it easier to reach the teeth and the back of the mouth with less risk of activating gag reflexes

• Those with gingivitis or gum disease- due to the proven benefits of reducing gingivitis and plaque index, those who struggle with inflammation of the gums or periodontal disease can benefit from regular use of a power toothbrush

There are many kinds of bristle options available that vary according to length, material, texture, and roundness

Length

A variety of bristle lengths are available, some with varying levels and angles.

• Multilevel profiles - toothbrushes with various lengths have been proven to be more effective at reaching surfaces between the teeth versus toothbrushes with only one level. 1

• Zig-zag designs - Zig-zagged bristles of various lengths that are arranged at an angle are designed to reach below the gum line and the spaces between the teeth. These designs have been scientifically proven to minimize plaque and reduce gingivitis when compared to flat head toothbrushes. 22

• Longer toe bristles - Toothbrush heads with longer bristles on the toe are designed to reach hard-to-reach tooth surfaces like the back teeth. 20

Material

• Bristles made of Nylon are more 10x more flexible than other natural bristle materials resulting in less breakage

• Nylon bristles are easier to clean

• Bristles made from natural materials vary in size affecting the texture uniformity1 

• Bristles made from natural, biodegradable sources may be rougher than nylon bristles and can cause damage to the enamel and gums leading to wear on the enamel wear and gum recession23

Texture

• Extra soft and Soft - Extra soft and soft bristles are recommended because they effectively clean teeth without causing damage to the enamel or gums. 21

• Medium, Hard, and Extra-Hard - The harder the bristle, the more damage it can cause to the tooth structures. These bristles can lead to gum recession which can expose the roots of teeth. If this occurs the teeth will be more susceptible to sensitivity to cold and heat.21 a Hard bristles can also damage these exposed root surfaces, and wear away the tooth enamel which will also lead to tooth sensitivity.24

Roundness 

• Rounded endpoints - The ADA only approves toothbrushes with bristle filaments that are rounded at the tips. Endpoint rounding reduces the abrasiveness of the bristles 

The brush is held at a 45° angle from the surface of the tooth. The brush is pointing toward the gums. The brush is moved in horizontal motions to clean under the gums. 

• This technique is suitable for all ages

• Especially beneficial for those with periodontal disease1 

The brush is positioned at the beginning part of the gums. It is then swept downward/upward toward the chewing surface of the teeth. 

• This technique is appropriate for children who do not have sufficient dexterity to master more efficient brushing techniques1

The brush is held at a 45° angle from the tooth facing towards the gums. Half of the toothbrush is on the gums and half is on the tooth at the beginning part of the gums.3 The brush is moved in small horizontal motions. 

• This technique is appropriate for patients with gingivitis (inflammation of the gums)3

The brush is held at a 45° angle from the tooth away from the gums facing the chewing surfaces of the teeth. The brush is moved in circular motions.1 

• This technique is appropriate for patients with orthodontic appliances such as braces

The brush is swept over the top and bottom teeth as they are clenched together. 

• This technique is recommended for young children because of low dexterity development

• This technique can damage the teeth and gums if too much pressure is used1

The brush is held at a 90° degree angle from the surface of the teeth and moved in an up and down motion. 

• This technique can be used by children but is not recommended for adults4

The brush is held at a 90° degree angle from the surface of the teeth and moved in aback and forth horizontal motion. 

• This technique is usually used by children but is not recommended for adults as it can cause tooth abrasion1

The brush is placed on the chewing surfaces of the teeth. The brush is moved in back and forth motions as the brush covers the chewing surfaces and the gums1

• This technique can be used by children and adults

The brush is held at a placed 45° angle from the teeth surface facing the gums and moved in circular motions. It is then swept away from the gums toward the chewing surfaces of the teeth

• This technique is recommended for all ages to use

Brushing twice a day for two minutes is the most effective way to reduce the amount of bacteria on our teeth. 

If this bacteria (plaque) is not removed, it can cause problems like tooth decay, gingivitis, and gum disease.