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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
• Timer: Essential for those who need to extend
brushing time
• Handle size: Should be of adequate size and feel
comfortable
5
toothbrushes.”
• Brush head motion and configuration: Size is important
as is dexterity
The researchers discussed the weaknesses of their review
• Lifestyle: Frequent travelers may prefer a battery-
operated unit
5
and noted:
• “One possible weakness of this review was the grouping
of toothbrushes by their modes of action.”
• Disposability: This generally means that neither the bat-
tery nor the brush head can be replaced. Products gen-
erally last around 3 months - the same as a manual
toothbrush and often cost the same. May be a good
gateway product
• “So many factors may influence the effectiveness of
toothbrushes including filament arrangement, orienta-
tion, 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.”
• Affordability: With multiple products in a wide range of
prices, there is a power brush to fit anyone’s budget
Brushing Recommendations
Some individuals may think that once they use a power
brush, they no longer have to make any effort when
brushing. Therefore, it is important to continue empha-
sizing how often and long to brush. Studies have shown
that good biofilm removal takes time, and those who
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products with outdated technology were included in the
8,9
brush longer tend to remove more biofilm.
Figure 1
5
meta-analysis. Many current power brushes with state-
of-the-art technology have been able to show in well-
designed scientific trials that they are superior to manual
1,2,3,4,6,10,11,12
brushes.
Individual Recommendations
Once clinical efficacy has been established, when recom-
mending 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
6
increase. Therefore, it is unlikely that all the individuals
It is important to explain to first time users that power
brushes have a unique or different sound and sensation
than manual brushes. It may take some time to get
adjusted to a new product. Additionally, some products
may enhance the foaming action of the toothpaste and
this may initially be overwhelming. See Figure 1. Advise
individuals not to use an excessive amount of toothpaste
and not to turn the unit on until they have placed the
brush head in their mouth.
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
1,3,6
the brush recommendation.
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.
3
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While the thoroughness of brushing is dependent on the
nature of the user, power brushes may help simplify the
brushing process. The individual will still need to prop-
erly angle the brush in the mouth, but once in place, the
brush head motion will do all the work. Since a power
brush generates more strokes per minute than a manual
brush, the individual may remove more biofilm in the
Features include:
Figure 2
• Gentle side-to-side
vibrating
action
brushing
• Ergonomically designed
for ease and comfort
• Disposable, like
a
3
same amount of brushing time.
manual brush. No
need to replace batter-
ies or brush heads
Because there are different types of units available, be
sure to review the manufacturer’s complete instruction
guide PRIOR to recommending or demonstrating the
product. Recommending and instructing is easier if you
have read all instructions and tried the product yourself.
• Internal battery lasts
up to six months
• Includes a handy travel
brush cover
• Available in four colors
Oral Health Outcomes
A toothbrush is the most frequently used self-care device.
Yet the ability to effectively remove biofilm with a tooth-
brush varies from person to person. For the last several
years, power toothbrushes have become an integral rec-
ommendation to improve biofilm control. There is a
growing body of evidence on products currently available,
which show when compared to a manual toothbrush,
SenSonic® High
Performance Sonic Plaque Remover
®
The SenSonic tooth-
Figure 3
brush is a brush with
state-of-the-art
sonic
technology producing
30,000 gentle brush
strokes per minute. See
Figure 3. It has a soft,
1,2,3,4,6,10,11,12
many power toothbrushes are:
• Superior at removing biofilm
• Effective at reducing gingivitis
compact,
contoured
• Likely to enhance stain removal
brush head design, elec-
tronic feedback system
that automatically adjusts
speed to maintain peak
performance, a power
indicator light, and a
dishwasher safe, easy to
clean storage carousel.
• As safe as a manual brush for soft and hard tissue
• Well-liked and even preferred by individuals
Waterpik® Power Toothbrushes
Waterpik Technologies entered the power toothbrush
market more than thirty years ago. From the original
®
Touch-Tronic toothbrush to today’s SynchroSonic™ Plus
®
advanced action sonic plaque removal system, Waterpik
rechargeable power brushes remove biofilm and reduce
Several clinical trials
15,16,18
®
bleeding better than a manual toothbrush.
have been conducted on the SenSonic toothbrush
including studies that show its ability to alter bacteria,
reduce biofilm, stain, and gingivitis, and equivalency to
Vibe® Electric Toothbrush
®
®
13,14,15,16,17
The Vibe toothbrush is quiet and small enough to take
the Sonicare toothbrush.
everywhere. See Figure 2. Up to 15,000 brush strokes per
19
minute clean better than a manual toothbrush.
Ability to alter bacteria
• Blanco and co-workers showed that exposure to the
®
sonic frequency generated by the SenSonic toothbrush
severely disrupted the structural integrity of the
13
periodontal pathogen, T denticola (spirochetes).
4
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• MacNeill et al found that sonic energy from the
In a randomized clinical
trial by Barnes et al, the
SynchroSonic™ Plus tooth-
brush was significantly
more effective at reducing
biofilm and gingival bleed-
ing than a manual tooth-
brush. There was no evi-
dence of hard or soft tissue
abrasion from the use of the
Figure 4
®
SenSonic toothbrush severely shortened and/or removed
fimbriae from the cell walls of A viscosus. The researchers
observed that these study findings were consistent with
previous studies on other sonic brushes that have exam-
14
ined the effect of sonic energy on bacteria.
Biofilm, stain, gingivitis reductions
®
• Barnes and others demonstrated that the SenSonic
toothbrush showed statistically significant reductions in
15
both biofilm and gingivitis after four weeks use.
SynchroSonic™
Plus
®
• Hefferren showed that the SenSonic toothbrush is
18
toothbrush.
The chart
effective at reducing both existing stain (of one year’s
duration) and that induced by diet - after just one
below highlights the clinical
outcomes from the study.
17
minute of brushing.
Percent Reductions from Baseline18.
®
DENTAL
GINGIVAL
BIOFILM INDEX BLEEDING INDEX
Comparison to Sonicare toothbrush
• Zimmer and co-workers compared a manual brush to the
Manual toothbrush
SynchroSonic™ Plus toothbrush
5.4%
9.7%*
20%
32%*
®
®
SenSonic toothbrush and Sonicare toothbrush and
found both sonic brushes were more effective in removing
biofilm and reducing gingivitis than the manual tooth-
18
*Statistically significant
16
brush. The chart below highlights the percent reduc-
A synopsis and comparison of other high-speed power
brushes is included in the chart on page 6.
tions from baseline for each of the brushes in the study:
Percent Reductions from Baseline16
When you recommend products, it is beneficial to know
where they can be purchased along with an estimated cost.
Having this information will enhance credibility and
increase compliance with your recommendation.
Alternatively, products can be purchased at professional
discounts for dispensing in the office.
BIOFILM
INDEX
APPROXIMAL
PAPILLARY
BIOFILM INDEX BLEEDING INDEX
Sonicare® toothbrush 48.3%
SenSonic® toothbrush 52.5%
74.6%
75.9%
17.4%
87.5%*
82.9%*
52.5%
Manual toothbrush
10%
®
®
*Both the SenSonic toothbrush and the Sonicare tooth-
brush reduced bleeding to nearly the same level, 0.06 and
®
Conclusion
0.07 respectively. However, the Sonicare toothbrush
®
Power toothbrushes are safe and effective devices for many
people. According to Maria Perno Goldie, RDH, MS,
international speaker and author,
started with a higher baseline reading than the SenSonic
16
toothbrush, 0.56 versus 0.35 respectively.
SynchroSonic™ Plus Advanced Action Sonic Plaque Remover
The SyncroSonic™ Plus toothbrush is the first affordable,
dual motor sonic plaque removal system. See Figure 4.
With 40,000 brush strokes per minute, this dual motor
design creates a unique multi-directional bristle action.
The ergonomic angled design allows for better access to
posterior teeth. In addition to brush heads, the system
comes with a tongue cleaner and polishing attachment.
The SynchroSonic™ Plus toothbrush is clinically proven
“No longer are power toothbrushes
considered only for special needs clients, but
rather the logical choice for all adult and
child clients. Cost is no longer an issue
because prices of deluxe models are lower
than ever, and low-cost battery operated
portable toothbrushes are now available.”1
18
superior to a manual toothbrush.
5
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Product Comparison: High Speed Power Brushes*
SynchroSonic™ Plus Advanced Action Sonic Plaque
Removal System - Model DT 400
Waterpik Technologies
Braun Oral B®3D Excel Pulsating
Model - D17511
Oral-B® Laboratories
Oscillation + in & out pulsation
40,000 pulsations
7,600 oscillations
2
Sonicare® Elite
Model 7500
Philips Oral Healthcare, Inc
Sonic (back & forth)
31,000
Parent company
Brush stroke
Brush stroke per minute
Randomized (sonic)
40,000
Speeds
Timer
2
2 minute
Yes
2
2 minute
No
2 minute
Yes
30 second quadrant alert
Brush heads/accessories
2 brush heads
1 tongue cleaner
1 polisher
$24.99
1 brush head
1 brush head
Promotional price
$29.95
Yes
$39.99
Yes
Direct professional pricing
Clinically proven better than
a manual brush at reducing:
• Plaque
• Gingivitis/bleeding
• Stain
Yes
• Yes
• Yes
• No
• Yes
• Yes
• Yes
• Yes
• No
• No
*Information as of April 2003
9. Hawkins BF et al. Duration of toothbrushing for effec-
tive plaque control. Quintessence Int 1986; 17: 361-365.
10. Walmsley AD. The electric toothbrush: A review.
B Dent J 1997; 182: 209-218.
Product Disclaimer
All power brushes are not equivalent when it comes to
brush head configuration, brush head motion, and
number and type of brush strokes per minute. Therefore,
expectations of similar clinical outcomes on products of
differing brands cannot be assumed.
11. Heasman PA et al. Power toothbrushes: A review of
clinical trials. J Clin Periodontol 1999; 26: 407-420.
12. Brothwell DJ et al. An update of mechanical oral hygiene
practices: Evidence based recommendations for disease
prevention. Can Dent Assoc J 1998; 64(4): 295-304.
References
1. Goldie MP. Power toothbrushing: An easy, effective
way to improve oral health. Contemporary Oral
Hygiene 2002; July/August: 28-33.
2. Warren PR et al. A practice-based study of a power
toothbrush: Assessment of effectiveness and accept-
ance. JADA 2000; 131: 389-394.
3. Jahn C. Making patient-centered self-care recommen-
dations: Automatic toothbrushes. J Practical Hyg 2001;
10(5): 38-39, 42.
®
13. Blanco VL et al. In vitro effect of the SenSonic
toothbrush on Treponema denticola.
J Clin
Periodontol 1997; 24: 318-323.
14. MacNeill S et al. Sonic and mechanical toothbrushes:
An in vitro study showing altered microbial surface
structures but lack of effect on viability. J Clin
Periodontol 1998; 25: 988-993.
15. Barnes C. A clinical evaluation of the effect on gin-
®
givitis and plaque reduction of the SenSonic plaque
4. Bowen D. An evidence-based review of power tooth-
brushes. Compend Contin Educ Oral Hyg 2002; 9: 3-16.
5. Heanue M et al. Manual versus powered toothbrushing
for oral health (Cochrane Review) In: The Cochrane
Library, Issue 1, 2003. Oxford: Update Software.
6. Jahn CA. Automated oral hygiene self-care devices:
Making evidence-based choices to improve client
outcomes. J Dent Hyg 2001; 75: 171-186.
7. Larrabee JH. The changing role of the consumer in health
care quality. J Nurs Care Qual 1995; 9: 8-15.
8. Lang WP et al. Preventive behaviors as correlates of
periodontal health status. J Public Health Dent 1995;
55(1): 10-17.
removal instrument. Abstract presented at ADHA
Annual Session, 1995.
16. Zimmer S et al. Clinical study of the effectiveness of
two sonic toothbrushes. J Clin Dent 1999; 11: 24-27.
17. Hefferren J et al. Assessment of the stain removal
®
cleaning power of the SenSonic plaque removal
instrument in beagles. J Dent Res 1996; 75: 86.
®
18. Barnes C et al. A comparison of a Waterpik dual
motor power toothbrush and a manual toothbrush in
affecting interproximal bleeding reduction and dental
biofilm accumulation. J Clin Dent 2003; 14: 49-52.
19. In-house data on file.
PN 20007016-ART
© 2003 Water Pik, Inc. FN 20007016ART-F AA
6
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Post Test for Course #03-03
Power Brushes: An Effective Alternative
1. What features may influence individual preference for a power brush?
a) Timer
b) Handle size
c) Brush head configuration
d) All of the above
2. Which type of individual would NOT be a candidate for a power brush?
a) Orthodontic
b) Periodontal maintenance
c) Edentulous
d) Physically challenged
3. When compared to a manual toothbrush, the SynchroSonic™ Plus power toothbrush:
a) Was better at removing biofilm but not at reducing gingivitis
b) Was better at reducing gingivitis but not at removing biofilm
c) Equal to the manual brush in biofilm removal and gingivitis reduction
d) Better than the manual brush at biofilm removal and gingivitis reduction
®
®
4. When the SenSonic toothbrush and Sonicare toothbrush were compared to a manual toothbrush, what were
the results?
®
®
a) The SenSonic toothbrush was superior in all measures to the Sonicare toothbrush and the manual toothbrush
®
®
b) The Sonicare toothbrush was superior in all measures to the SenSonic toothbrush and the manual toothbrush
®
®
c) The SenSonic toothbrush and Sonicare toothbrush were both superior to the manual toothbrush
®
®
d) The manual toothbrush was superior to both the SenSonic toothbrush and Sonicare toothbrush
5. Which statement is true about the power toothbrush review by the Cochrane Collaboration?
a) One weakness of the study was grouping by modes of action
b) 92 studies were included in the meta-analysis
c) Randomized clinical trials were excluded
d) Studies need to be a minimum of 6 months for inclusion
7
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Obtaining Continuing Education Credits
Waterpik Technologies is designated as an Approved
PACE Program Provider by the Academy of General
Dentistry. The formal continuing education programs of
this provider are accepted by the AGD for Fellowship,
Mastership, and membership maintenance credits.
Approval does not imply acceptance by a state or provin-
cial board of dentistry. The current term of approval
extends from 04-05-1998-05-31-2006.
CE Registration Form and Answer Sheet
Course #03-03: Power Brushes: An Effective
Alternative
Name: ______________________________________
Credentials: __________________________________
Street Address: ________________________________
City: ________________________________________
State: ________________ Zip:__________________
Daytime Phone: ______________________________
Email: ______________________________________
Credits: 1 hour
If you have questions about CE requirements in your state
or province, please consult your regulatory board.
Directions
• Fill out the Waterpik CE Registration Form and Answer
Sheet.
• Answers should be logged on the answer sheet. Please
make a copy of the post test and your answer sheet to
retain for your records.
Answer Sheet - Please circle the correct
answer for each question.
• Only one original answer sheet per individual will be
accepted. PHOTOCOPIES ARE NOT VALID.
• Answers left blank will be graded as incorrect.
• Please fill out the course evaluation portion.
• Submit your answer sheet via mail to:
1.
2.
3.
4.
5.
a
a
a
a
a
b
b
b
b
b
c
c
c
c
c
d
d
d
d
d
Carol Jahn, RDH, MS
Educational Programs Manager
Waterpik Technologies
1730 East Prospect Road
Fort Collins, CO 80553
Course Evaluation – Circle your response:
1 = lowest, 5 = highest
Scoring
In order to receive credit, you must answer correctly 4
Course objectives were met
questions out of 5.
1
2
3
4
4
4
4
5
5
5
5
Results
Will be mailed in 6 – 8 weeks.
Content was useful
1
2
3
Questions
Questions were relevant
Please contact Carol Jahn, Education Programs Manager,
at 1.800.525.2020 x 8565 or via email at
cjahn@waterpik.com.
1
2
3
Rate the course overall
1
2
3
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