Toothbrushing, plaque removal and gingivitis


Plaque removal and control is considered essential to the prevention and treatment of gingivitis and periodontitis. Toothbrushing twice a day is widely promoted as a key element in the prevention of periodontal disease. However, a majority of people do not clean their teeth thoroughly enough to prevent plaque accumulation. The aim of this review was to appraise and summarise systematic reviews of the efficacy and safety of available homecare toothbrush regimens for mechanical plaque removal on plaque and gingivitis in adults?


Medline/PubMed. The Cochrane Library the ADA Center for Evidence-based Dentistry and the PROSPERO databases were searched. Systematic reviews and/or meta-analyses of toothbrushes/toothbrushing written in English or Dutch were considered. Two reviewers selected studies for inclusion and assessed study quality using a combination of items from the PRISMA guideline and the AMSTAR checklist. A narrative summary was presented.


  • 10 reviews were included.
    • 1 evaluating the effect of an oral hygiene instruction with a toothbrush on plaque and gingivitis scores;
    • 5 evaluating the efficacy of manual and power toothbrushes
    • 3 evaluating toothbrush safety
    • 1 evaluating toothbrush contamination.
  • 3 were evaluated as being at low risk, 5 at moderate risk, 1 at substantial risk and 1 at high risk.


The authors concluded: –

Toothbrushing is effective in reducing levels of dental plaque. With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating-rotating brushes. Tooth brushing generally can be considered safe for the teeth and their investing tissues.


Yesterday we looked at a review that considered  some adverse effect that may results from improper toothbrushing. This meta-review brings together 10 systematic reviews covering other aspects of toothbrushing. Each of the included reviews is summarised and they key findings presented. There is also an interesting and extensive discussion covering a range of other issues including brushing methods, filament design, brushing frequency and duration, brushing force, toothbrush wear tongue cleaning as well as the contribution of toothpastes to mechanical cleaning. This provides a useful overview of our current state of knowledge in relation to toothbrushing practices but highlights limited evidence in a number of areas. Several of the review that are included in this meta-review have previously been considered by the Dental Elf (see links).


Van der Weijden FA, Slot DE. Efficacy of homecare regimens for mechanical plaque removal in managing gingivitis a meta review. J Clin Periodontol. 2015 Apr;42 Suppl 16:S77-91. doi: 10.1111/jcpe.12359. PubMed PMID: 25597787.

Dental Elf – 20th Apr 2015 – Which interdental cleaning aids for managing gingivitis?

Dental Elf – 18th Jun 2014 – Powered toothbrushes reduced plaque and gingivitis more than manual toothbrushes

Dental Elf – 21st Jun 2012 – Powered toothbrushes are as safe to use as manual toothbrushes

Dental Elf – 29th Jun 2011- Powered toothbrushes have no adverse effects on teeth and gums


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