One of the questions I am most frequently asked as an OHE is: "What toothbrush should I be using - electric or manual? Which is better?".
The basic answer to that question is: "It depends upon the individual and how they are using the brush".
Both types of brush are very good if an effective technique is used - but on average, someone using a manual toothbrush only brushes for about 40 seconds!
When I'm discussing electric toothbrushes, I do tend to favour the Braun Oral B professional care range with the round Precision Clean head, purely because I feel they are more forgiving if a less-than-perfect technique is used. Patients generally have good or improved oral hygiene from using them, and they are designed to cater for different budgets. I always advise patients to choose the rechargeable rather than the battery-powered version. This is because the performance and power output of rechargeable brushes remains constant until they can no longer maintain the correct level; then they just stop completely. Battery-powered brushes tend to keep going for longer, but I question whether they maintain the same rate of oscillation and pulsation as the batteries deteriorate. Having said that, battery-powered brushes are good if your patient is unsure about making the investment in an electric toothbrush. This is particularly an issue where children are concerned; there is a chance that the child won't use it in the long term as the novelty wears off, or that they might not actually like the sensation.
Patients who use the Phillips Sonicare brush get fantastic results. These are the patients who recognise the value of having good oral hygiene and are not afraid to make the investment. The Sonicare range does carry quite a high price tag, but Phillips are so confident in the product that they offer a 90-day money back guarantee if the patient has not seen any improvement in their oral hygiene.
When first using an electric toothbrush, people tend to make the mistake of using it exactly as they would a manual toothbrush - i.e. with a scrubbing technique. This is incorrect, and it's important that patients are actually shown how to use an electric toothbrush properly. Encourage your patients to bring their toothbrushes along to OHE and hygiene appointments.
Electric toothbrushes do tend to encourage people to brush for longer. For those who over-brush and suffer with abrasion or recession, there is the built-in pressure sensor. This means that if they are brushing too hard, the brush will change sound, flash a red light or even cut out. Clinical trials have shown that brushing with an electric toothbrush is more effective than brushing with a manual toothbrush. Furthermore, for patients with dexterity issues (such as arthritis), or coordination issues (caused, for example, by learning difficulties) or for carers who are responsible for maintaining someone else's oral health, electric toothbrushes can make a huge difference.
So … what about manual toothbrushes? When discussing manual toothbrushes I always recommend a small head that is soft/medium textured. In our practice, we find both the Sensodyne Search 3.5 and the Curoprox 5460 brushes to be very good. There are obviously other very good manual toothbrushes on the market, but these two brands are the ones our whole clinical team agree are excellent. I also used to find the Oral B Advantage P30 very good, but these are no longer available – the model is only stocked in larger sizes (P35,P40). Supermarkets annoy me - why do they insist on stocking overly large toothbrushes that you would really only be able to use to clean your bathroom? Of course, they also cater for those patients who like a firm/hard toothbrush so they can have a real good scrub and feel like their mouth is clean, regardless of how many times you advise them against this.
I always stress the importance of bring toothbrushes to oral hygiene appointments, especially for children. To be able to see what the child is using as well as the way they are using it can be the solution to their oral health problems. Quite often I find a teenager in front of me with a toothbrush that is too big even for the average adult mouth, let alone for an underdeveloped, crowded mouth. Again, this goes back to the supermarkets and even the manufacturers. Age-appropriate toothbrushes tend to be branded with a character - your average thirteen-year-old doesn't want a Hello Kitty or Spider-Man brush -it's just not cool! This means that parents buy them adult toothbrushes, which are too big.
Younger children, however, often love the character brushes, and they can be a real motivating factor. My two-year-old has become slightly more cooperative with tooth- brushing since I gave in and purchased a Peppa Pig toothbrush; but it's not the best example of a toothbrush, in my opinion, as the bristles are quite spaced out in clumps rather than being more tightly positioned together. Children do love to chew their toothbrushes though. They get a nice splodge of toothpaste on there and shove it in around their molars and treat it like a lollipop chewing and sucking away rather than physically moving it around their teeth. The potential effects of swallowing the fluoride is obviously a topic for discussion, but another result is a splayed toothbrush that is totally ineffective at plaque removal, even when used perfectly.
I always stress to parents the importance of assisted brushing. The guidelines state that brushing should be assisted up to the age of seven, but this is really dependent on the child. A good brushing technique requires very good dexterity, so as a guide I always enquire as to whether the child can tie their own shoelaces. If the answer is no, the child shouldn't really be responsible for their own tooth-brushing, as the level of dexterity required for both actions is fairly similar.
Both for adults and for those children who are brushing their own teeth, I always demonstrate the "bass technique" - small sideways movements with the brush angled into the gum margin - and I ask them to demonstrate this back to me to confirm their understanding and ability.
Going back to the question at the start of this article, which toothbrush is “better” really does depend on the individual. This is where the OHE role is really important in practice; the OHE will work alongside dentists and hygiene therapy teams with each patient in order to find an effective method that the patient can use daily at home to maintain their oral health. Education & prevention for all, I say!
