Plaque Removal by a Powered Toothbrush Versus a Manual Toothbrush in Children: A Systematic Review and Meta-Analysis

Purpose: The purpose of this study was to determine the relative plaque reduction efficacy of powered versus manual toothbrushes in children. Methods: A systematic review and meta-analysis were conducted based on a literature search that included Medline, Embase, FDA publications, Cochrane Database of Systematic Reviews, Dentistry and Oral Science, and Berman Medical Library, Hebrew University. Studies were chosen that were randomized controlled trials and published between 1980 to 2019 in English that compared plaque reduction with manual and powered toothbrushes in children. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Results: From a search of 1,502 articles, nine articles were selected for meta-analysis. A statistically significant plaque reduction benefit for a powered toothbrush versus manual toothbrush (P<0.001): combined mean difference (MD) was 0.590 and the 95 percent confidence interval was 0.352 to 0.828 (random-effects model). Two tests revealed considerable heterogeneity (I² equals 96 percent; Cochran's Q, P<0.001). A low possibility of bias was indicated by Begg-Mazumdar and Egger tests (P>0.1 for both). Evidence quality was given a GRADE score of moderate. Conclusions: Powered toothbrushes were more effective than manual toothbrushes for plaque removal in children.