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Anleitung Zusammenfassung
In the past, recommendations were often reserved for those individuals with special needs. Today, with the wide variety of products on the market, almost any individual can benefit from a power brush.1 A practice-based study that included 3,669 dental professionals and 16,903 subjects demonstrates how typical dental office patients can benefit from a power brush. In the study, power toothbrush use was considered by dental professionals to have a positive effect on the oral health of 80.5% of patients. Patients agreed, with 74% stating that they thought the power brush resulted in better oral hygiene. Ninety four percent (94%) of patients reported that they would continue to use their power brush and 75% said they would recommend it to a friend.2 Power brushes are good choices for many individuals. They may be ideal devices for people who provide care to the homebound or for those institutionalized or living in a nursing home. In working with individuals, consider those who present with any of the following as prime candidates for using a power brush:3,4 • Poor plaque (biofilm) control • Gingivitis • Periodontal maintenance • Orthodontic appliances • Implants • Aesthetic restorations • Crowns and bridges • Physically challenged • Gingival overgrowth The Best Power Brush A January 2003 systematic review5 of power brushes by the Cochrane Collaboration evaluated different types of power brushes and tried to determine the superiority of one type of brush over another. The reviewers evaluated 354 clinical trials published between 1964 and 2001. The 354 studies were reviewed for the following criteria:5 • Study design had to be a randomized, controlled trial comparing manual and power toothbrushes • Comparisons between power brushes were excluded • Crossover trials were eligible but not split mouth designs • Subjects could not have a disability that would affect toothbrushing; orthodontic appliances were allowed • Brushing had to be unsupervised • Combined interventions such as those with rinsing or irrigating were excluded • Study had to be a minimum of 28 days • Outcomes measures had to include biofilm (plaque) and gingivitis From these standards, 29 studies fulfilled all inclusion criteria and had results that could be used for meta-analysis. The total number of subjects in these trials was 2,547. Of those, 239 or 9.4% were lost to follow-up.5 The 29 trials were further categorized into groups based on the mechanism of action. Six groups resulted. These included:5 • Side-to-side action with 8 studies • Counter oscillation with 5 studies • Rotation oscillation with 11 studies • Circular with 3 studies • Ultrasonic with 2 studies • Unknown action with 0 studies From the final review, the Cochrane group determined that “Power toothbrushes with a rotational oscillation action provided slightly better plaque removal and may provide better protection against gum inflammation than manual toothbrushes.”5 The researchers discussed the weaknesses of their review and noted:5 • “One possible weakness of this review was the grouping of toothbrushes by their modes of action.” • “So many factors may influence the effectiveness of toothbrushes including filament arrangement, orientation, size, shape and flexibility, brush head size and shape along with presence or absence and characteristics of a timer that not all of them could be analyzed.” • “None of the trials compared durability, reliability, and cost of using manual versus powered brushes, it is presently not possible to make a clear recommendation on toothbrush superiority.” In summary, the Cochrane review provides important information on power toothbrushes, but is not without flaws. Of consideration is that studies on older, obsolete products with outdated technology were included in the meta-analysis.5 Many current power brushes with stateof- the-art technology have been able to show in well- designed scientific trials that they are superior to manual brushes. 1,2,3,4,6,10,11,12 Individual Recommendations Once clinical efficacy has been established, when recommending a power brush, individual preferences can play a significant role in product acceptance. In fact, studies have shown that when individuals play a more assertive role in healthcare decisions, compliance and satisfaction increase.6 Therefore, it is unlikely that all the individuals in a practice will like or benefit from the same type of power toothbrush. Importantly, the individual oral health needs along with personal preferences should influence the brush recommendation.1,3,6 There are a large number of power brushes on the market with a wide array of features, which can influence acceptance of the product. To help individuals find the product right for them, there are multiple features to consider. • Timer: Essential for those who need to extend brushing time • Handle size: Should be of adequate size and feel comfortable • Brush head motion and configuration: Size is important as is dexterity • Lifesty...
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