Niederman Richard
Department of Epidemiology and Health Promotion, Director, Center for Evidence-Based Dentistry, College of Dentistry, New York University, New York, USA.
Evid Based Dent. 2014 Sep;15(3):77-8. doi: 10.1038/sj.ebd.6401041.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. Reference lists of identified articles were also scanned for relevant papers. Identified manufacturers were contacted for additional information.
Only randomised controlled trials comparing manual and powered toothbrushes were considered. Crossover trials were eligible for inclusion if the wash-out period length was more than two weeks.
Study assessment and data extraction were carried out independently by at least two reviewers. The primary outcome measures were quantified levels of plaque or gingivitis. Risk of bias assessment was undertaken. Standard Cochrane methodological approaches were taken. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months).
Fifty-six trials were included with 51 (4624 patients) providing data for meta-analysis. The majority (46) were at unclear risk of bias, five at high risk of bias and five at low risk. There was moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short and long-term. This corresponds to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and a 21% reduction in the long term. There was a high degree of heterogeneity that was not explained by the different powered toothbrush type subgroups.There was also moderate quality evidence that powered toothbrushes again provide a statistically significant reduction in gingivitis when compared with manual toothbrushes both in the short and long term. This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness indices respectively. Again there was a high degree of heterogeneity that was not explained by the different powered toothbrush type subgroups. The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points.
Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses. Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.
考科蓝口腔健康小组试验注册库、考科蓝对照试验中央注册库（CENTRAL）、医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、护理学与健康领域数据库（CINAHL）、美国国立卫生研究院试验注册库以及世界卫生组织临床试验注册平台中的正在进行的试验。还对已识别文章的参考文献列表进行了扫描以查找相关论文。联系了已识别的制造商以获取更多信息。
仅考虑比较手动牙刷和电动牙刷的随机对照试验。如果洗脱期长度超过两周，则交叉试验符合纳入标准。
研究评估和数据提取由至少两名审阅者独立进行。主要结局指标为牙菌斑或牙龈炎的量化水平。进行了偏倚风险评估。采用了标准的考科蓝方法学方法。如果荟萃分析中纳入四项或更多研究，则使用随机效应模型，否则使用固定效应模型。数据分为短期（一至三个月）和长期（超过三个月）。
纳入了56项试验，其中51项（4624名患者）提供了荟萃分析的数据。大多数（46项）偏倚风险不明确，5项偏倚风险高，5项偏倚风险低。有中等质量的证据表明，在短期和长期内，电动牙刷在减少牙菌斑方面比手动牙刷具有统计学上的显著优势。这相当于短期Quigley Hein指数（Turesky）的牙菌斑减少11%，长期减少21%。存在高度异质性，不同类型的电动牙刷亚组无法解释这种异质性。也有中等质量的证据表明，在短期和长期内，与手动牙刷相比，电动牙刷在减少牙龈炎方面再次具有统计学上的显著效果。这分别对应于Löe指数和Silness指数的牙龈炎减少6%和11%。同样存在高度异质性，不同类型的电动牙刷亚组无法解释这种异质性。证据最多支持旋转振荡式牙刷，其在两个时间点的牙菌斑和牙龈炎减少方面均显示出统计学上的显著效果。
在短期和长期内，电动牙刷比手动刷牙更能减少牙菌斑和牙龈炎。这些发现的临床重要性尚不清楚。遵循方法学指南并提高设计的标准化程度将有利于未来的试验和荟萃分析。成本、可靠性和副作用的报告不一致。任何报告的副作用都是局部的且只是暂时的。
