Advocating the use of Powered Toothbrushes
Submitting InstitutionUniversity of Sheffield
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
Our research showed that powered rotation oscillation toothbrushes were
superior to manual toothbrushes for the removal of plaque and reduction of
gingivitis. This information has had impacts on national public policy, on
commerce and on society.
- The findings were used by the Department of Health in its
evidence-based guidelines for preventing oral disease, which is NHS
policy on preventive dentistry in England and Wales.
- The research has also been used in worldwide marketing by Procter and
Gamble (the manufacturers of the leading brand of powered
rotation-oscillation toothbrush), and by another manufacturer as part of
its marketing strategy for a new toothbrush.
- Finally, as a result of this work there have been critical reviews of
the research and of the toothbrushes in the media that have enabled more
informed consumer choice for oral hygiene.
There have been many evaluations of powered toothbrushes stretching back
to the 1960s. The methods and findings of these studies have been
inconsistent, leaving dental teams worldwide and policy makers on dental
prevention unable to provide valid advice to dentists and to the public.
Since 2003, Professors Peter Robinson and Chris Deery (School of Clinical
Dentistry, University of Sheffield) have been principle investigators
working with a dental practitioner and academics at Birmingham, Manchester
and Bristol universities conducting a series of Cochrane systematic
reviews (R1, R2, R3) to identify and synthesise the evidence on the
effectiveness of powered toothbrushes as used in normal conditions by
people in their own homes.
The research has identified that powered toothbrushes with a rotation
oscillation action (where the toothbrush head spins one third of a turn in
one direction and back again) were superior to manual toothbrushes for the
removal of plaque and reduction of gingivitis (R1,R2). This superiority is
consistent across patient groups and no other designs of powered
toothbrushes were shown to offer these advantages.
A third study (R3) investigated comparisons of the different designs of
powered toothbrush against each other and further supported the use of
powered rotation oscillation toothbrushes.
These Cochrane reviews remain the most highly cited reviews by the
Cochrane Oral Health group and when secondary published in the Journal of
Dentistry was the most frequently downloaded paper in that journal (R4).
The research was also secondary published by other peer-reviewed journals
in the US, Australia and China (E.g. R5).
Further, the research highlighted methodological problems in research
evaluating powered toothbrushes and we were able to provide guidance on
the conduct of future clinical trials (R6).
References to the research
R1. Henue M, Deacon S, Deery C, Robinson PG, Worthington H, Walmsley D,
Shaw W. Manual versus powered toothbrushing for oral health. Cochrane
Database Syst Rev. 2003;(1):CD002281.
R2. Robinson PG, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington
HV, Glenny AM, Shaw WC. Manual versus powered toothbrushing for oral
health. The Cochrane Database of Systematic Reviews 2005, Issue 2.
Art. No.: CD002281.pub2.
R3. Deacon SA, Glenny AM, Deery C, Robinson PG, Heanue M, Walmsley AD,
Shaw WC. Different powered toothbrushes for plaque control and gingival
health. Cochrane Database Syst Rev. 2010 Dec 8;12:CD004971.
R4. Henue M, Deacon S, Deery C, Robinson PG, Worthington H, Walmsley D,
Shaw W. Manual versus powered toothbrushing for oral health. Journal
of Dentistry. 2004; 32: 197-211.
R5. Niederman R, ADA Council on Scientific Affairs, ADA Division of
Science, Journal of the American Dental Association. Manual versus powered
toothbrushes: the Cochrane review. Journal of the American Dental
R6. Robinson PG, Walmsley AD, Henue M, Deacon S, Deery C, Glenny AM,
Worthington H, Shaw W. Quality of trials in a systematic review of powered
toothbrushes: Suggestions for future clinical trials. J Periodontol
2006;77:1944-53, doi: 10.1902/jop.2006.050349
Details of the impact
Context for impact
The impacts arise because the research is topical, having direct
relevance to professional and public behaviour and to commercial interest.
For example, one quarter of adults (26%) with natural teeth in England and
Wales use a powered toothbrush, the UK toothbrush market is valued at £201
million and powered brushes account for almost half of this market. These
patterns will be replicated in many other countries.
The impact of our research falls into three categories: on public health
policy, on commerce and on society.
Impact on national public health policy
The research has been incorporated into national clinical and public
health guidelines across England and Wales. Dental teams may now recommend
powered rotation oscillation toothbrushes with confidence. Their use is
incorporated into the guidance of the Department of Health / British
Association for the Study of Community Dentistry toolkit for dental
prevention Delivering Better Oral Health (S1). This document forms
Department of Health policy on preventive dentistry in England and is
implemented almost universally across the NHS. In this way, policy
underpinned by Sheffield has been sent to all 23,000 NHS dentists in
England and Wales. Delivering Better Oral Health is named in
nearly all local NHS prevention strategies and has been used as a standard
in many criterion-based audits of NHS dentistry including those conducted
in Somerset, South and West England, Hounslow and Manchester (S2).
Moreover, Delivering Better Oral Health is used as part of the
currency of NHS dental contracts; it is cited as a standard to be adhered
to as part of those contracts. It is also cited in the guidance on
commissioning the NHS dental pathway as an integrated model of service
delivery and as part of the rationale for the forthcoming contract (S3).
The review was also cited to support the use of powered toothbrushes in
the Royal College of Surgeons guidelines for the oral management of
oncology patients (S4) and four other standard nursing and dermatology
texts (See S5 for an example).
The Cochrane Reviews were used extensively by Procter and Gamble
(P&G) in their global marketing strategy to gain competitive
advantage. P&G used the reviews in their worldwide dental professional
engagement because of their high quality and independence. Their
professional engagement takes the form detail aids supplied to practices
and in scientific exchange lectures given at dental schools and by key
thought leaders (S6). P&G train their representatives extensively on
the importance and relevance of the Cochrane Power Reviews.
The P&G Director of Global Professional and Scientific Relations has
"Following the first Cochrane systematic review on Power versus manual
tooth brushing, published in 2003, we used this information to convince
dental professionals of the validity of our data as it had been
independently and systematically reviewed. The subsequent Cochrane
updates have led to a change in attitude regarding recommending power
toothbrushes with an oscillating/rotating action. P&G has used the
results of the Cochrane studies in more than twenty countries worldwide
in dental professional advertising, as detail aids supplied to practices
and in scientific exchange lectures provided at dental schools and by
key thought leaders. We train our representatives extensively on the
importance and relevance of the Cochrane Power Reviews.
"The consumer media in North America have used data from the Cochrane
Collaboration to support endorsement of oscillating/rotating power
toothbrushes, notably on CNN, NBC, Fox News and through Consumer
Reports. These direct to consumer communications drive conversations
between practitioners and their patients and lead to more specific
product recommendations for oscillating/rotating power toothbrushes.
"While it is impossible to quantify the value of the Cochrane Review
in terms of yearly product sales, it can be shared that the power
toothbrush business for P&G is worth over 1 billion dollars in sales
worldwide and over 50% of consumer sales follow recommendation from a
dental professional" (S7).
Another company, Colgate, used the review ahead of the launch of their
new ProClinical electric toothbrush to position it in the market. The
product was the company's first entry in the powered rechargeable
toothbrush category. The launch of the toothbrush was accompanied by a
strong marketing campaign, which was informed by our research.
ProClinical's share of the electric toothbrush market reached 7% just
three months after launch (S8, S9).
Impacts on society
Impacts on society arise from critical reviews in the media. Commentaries
on the first reviews received front page coverage in The Washington
Post, New York Times, The Observer and Daily
Mail (2005, outside the reference period for REF2014). The debate
has continued with each update of the reviews being discussed in, for
example, Which? Which? Conversation, Choice (The
Australian version of Which?), The Daily Mail, The Gadget Show
and in numerous other consumer publications etc. (S10). In this way the
reviews have informed better consumer choice for oral hygiene.
Sources to corroborate the impact
S1. The Department of Health 2009 report Delivering Better Oral
Health corroborates the use of our research to evidence their
recommendation to use a powered oscillating toothbrush (http://tinyurl.com/mrhtllv,
S2. The South & West Local Assessment Panel Report corroborates the
claim that Delivering Better Oral Health has been implemented
across NHS dental practices, and that that implementation has been audited
across 107 dental practices in South and West England alone (p.4).
S3. The Department of Health 2012 report NHS dental contract pilots -
Care Pathway Review corroborates that the advice given in Delivering
Better Oral Health was part of the rationale for the approach of the
pilot NHS dental contract (http://tinyurl.com/p4zlw8o,
S4. The Royal College of Surgeons of England / The British Society for
Disability and Oral Health. The Oral Management of Oncology Patients
Requiring Radiotherapy, Chemotherapy and / or Bone MarrowTransplantation.
Clinical Guidelines. Updated 2012
S5. Debnath AR. Professional Skills in Nursing: A Guide for the Common
Foundation Programme (2009) corroborates the use of our research in
guiding standard practice for the oral care of hospital patients.
S6. An article on the Oral-B website corroborates their use of our
research in their global marketing of powered toothbrushes (http://tinyurl.com/7aw2anx).
S7. A statement from P&G corroborates that the research informed
their marketing strategies.
S8. The Colgate 2012 Annual Report Innovation For Growth
corroborates the market share of the ProClinical toothbrush (http://tinyurl.com/ozrpttc)
S9. A statement from Colgate corroborates that the research informed
their marketing strategies.
S10. An example of the debate stimulated by the research is an online
article and associate public comments on the Which? Conversation