Electric toothbrush

A typical electric toothbrush

An electric toothbrush, motorized toothbrush, or battery-powered toothbrush is a toothbrush that creates rapid, automatic bristle movements through either back-and-forth oscillation or rotation-oscillation (where the brush head alternates clockwise and counter-clockwise rotation while also vibrating at variable frequencies) in order to clean teeth. Motions at sonic speeds or below are made by an electric motor. In the case of ultrasonic toothbrushes, ultrasonic motions are produced by a piezoelectric crystal. A modern electric toothbrush is usually powered by a rechargeable battery, which is charged through inductive charging, typically through a charging base.

Electric toothbrushes can be classified according to the frequency (speed) of their movements as power, sonic, or ultrasonic toothbrushes, depending on whether they make movements that are below, in, or above the audible range (20–20,000 Hz or 2,400–2,400,000 movements per minute), respectively.

Many modern models also incorporate timers, pressure sensors, and multiple cleaning modes to improve brushing technique and overall oral health.

History

A Motodent electric toothbrush. A patent for this toothbrush was filed in 1937.

The earliest example of an electric toothbrush was produced by Tomlinson Moseley. ^[1] Sold as the Motodent, a patent was filed by his company, Motodent Inc., on December 13, 1937. ^[2] In Switzerland in 1954, Dr. Philippe Guy Woog invented the Broxodent. ^[3] Woog's electric toothbrushes were originally manufactured in Switzerland (later in France) for Broxo S.A. The device plugged into a standard wall outlet and ran on line voltage. Electric toothbrushes were initially created for patients with limited motor skills and for orthodontic patients (such as those with braces). ^[4]

The Broxo Electric Toothbrush was introduced in the US by E. R. Squibb and Sons Pharmaceuticals in 1960. ^[5] After the introduction, it was marketed in the US by Squibb under the names Broxo-Dent or Broxodent. ^[5] In the 1980s, Squibb transferred distribution of the Broxodent line to the Somerset Labs division of Bristol-Myers Squibb. ^[6]

The General Electric automatic toothbrush was introduced in the early 1960s. ^[7] It was cordless, with rechargeable NiCad batteries, and although portable, it was rather bulky, about the size of a two-D-cell flashlight handle. ^[8] The NiCad batteries of this period suffered from the memory effect. The GE automatic toothbrush came with a charging stand that held the hand piece upright; most units were kept in the charger, which, due to the prolonged charging that creates heat and damages the battery, was not the best way to get maximum service life from a NiCad battery. ^[9] Early NiCad batteries tended to have a short lifespan. The batteries were sealed inside the GE device, and the whole unit had to be discarded when the batteries failed.

The use of an AC line voltage appliance in a bathroom environment was problematic. By the early 1990s, the Underwriter Laboratories (UL) and Canadian Standards Association (CSA) no longer certified line-voltage appliances for bathroom use. Newer appliances had to use a step-down transformer to operate at low voltage (typically 12, 16, or 24 volts). Wiring standards in many countries require that outlets in bathroom areas must be protected by an RCD/GFCI device (e.g., required in the US since the 1970s on bathroom outlets in new construction). ^[10]

By the 1990s, there were problems with the safety certification of Broxo's original design. Newer, battery-operated toothbrushes were invented by Tomlinson I Moseley and patented by Motodent in 1940. ^[11]

The first ultrasonic toothbrush, first called the Ultima and later the Ultrasonex, was patented in the US in 1992, the same year the FDA gave it approval for daily home use. Initially, the Ultima worked only on ultrasound, but a few years later, a motor was added to give the Ultrasonex brush additional sonic vibration. Today, several ultrasonic toothbrushes simultaneously provide both ultrasound and sonic vibration.

The negative environmental impact of electric toothbrushes when compared with manual toothbrushes has been established. ^[12]

Types

Electric toothbrush

Electric toothbrushes can be classified according to their type of oscillation:

Side-to-side vibration, which has a brush head action that moves laterally from side to side.

Counter oscillation, which has a brush action in which adjacent tufts of bristles (usually six to 10 in number) rotate in one direction and then the other, independently, with each tuft rotating in the opposite direction to that adjacent to it.

Rotation oscillation, which has a brush action in which the brush head rotates in one direction and then the other.

Circular, which has a brush action in which the brush head rotates in one direction only.

Ultrasonic, which has a brush action where the bristles vibrate at ultrasonic frequencies (>20 kHz).

Ionic, which has a brush that aims to impart an electrical charge to the tooth surface with the intent of disrupting the attachment of dental plaque. ^[13]

For some vibrating toothbrush designs, a brushing technique similar to that used with a manual toothbrush is recommended, whereas with brushes with a spinning head, the recommended cleaning technique is to simply move the brush slowly from tooth to tooth. ^[14]

Electric toothbrushes can also be classified according to the speed of their movements as standard power toothbrushes, sonic toothbrushes, or ultrasonic toothbrushes. If the motion of the toothbrush is sufficiently rapid to produce a hum in the audible frequency of human range (20 Hz to 20,000 Hz), it can be classified as a sonic toothbrush. Any electric toothbrush with movement faster than this limit can be classified as an ultrasonic toothbrush. Certain ultrasonic toothbrushes, such as the Megasonex and the Ultreo, have both sonic and ultrasonic movements. ^[15]

Oscillating rotating

Oral-B iO toothbrush

The oscillating rotating toothbrush is a type of electric toothbrush which rapidly alternates its direction of rotation. This type of toothbrush is not shaped like a conventional manual toothbrush. Instead, it is made of a small circular brush head that spins in both directions to remove plaque. This design enables the bristles to reach further into the interdental spaces between the teeth to remove plaque. ^[16] Some versions of the oscillating rotating toothbrush also involve a pulsating motion designed to aid in plaque removal. ^[17]

The safety of oscillating rotating toothbrushes has also been studied. Oscillating rotating toothbrushes are proven to be safe compared to manual toothbrushes and are safe for both the hard and soft tissues of the oral cavity. ^[18]

Sonic

Sonic toothbrush (Sonicare)

Sonic toothbrushes are a subset of electric toothbrushes with movement that is fast enough to produce vibration in the audible range. Most modern rechargeable electric toothbrushes fall into this category and typically have frequencies that range from 200 to 400 Hz, that is, 12,000–24,000 oscillations or 24,000–48,000 movements per minute. Because sonic toothbrushes rely on sweeping motion alone to clean the teeth, the movement that they provide is often high in amplitude, meaning that the length of the sweeping movements that they make is large. One study found that using a sonic toothbrush causes less abrasion to the gums when compared to manual toothbrushes. ^[19]

Ultrasonic

Ultrasonic toothbrush (Megasonex)

Main article: Ultrasonic toothbrush

The newest developments in this field are ultrasonic toothbrushes, which use ultrasonic waves to clean the teeth. In order for a toothbrush to be considered "ultrasonic," it has to emit a wave at a minimum frequency of 20,000 Hz or 2.4 million movements per minute. Typically, ultrasonic toothbrushes approved by the U.S. Food and Drug Administration (FDA) operate at a frequency of 1.6 MHz, which translates to 192 million movements per minute.

Ultrasonic toothbrushes emit vibrations that are very high in frequency but low in amplitude. These vibrations break up bacterial chains that form dental plaque and remove their methods of attachment to the tooth surface up to 5 mm below the gum line. ^[20]

Some ultrasonic toothbrushes provide only ultrasonic motion. Other ultrasonic toothbrushes provide additional sonic vibration ranging from 9,000 to 40,000 movements per minute, comparable to a sonic toothbrush, in order to provide additional sweeping motion which facilitates removal of food particles and bacterial chain remnants. The sonic vibration in these ultrasonic toothbrushes may be lower in amplitude than that found in a comparable sonic toothbrush because the bacterial chains do not need to be removed through sonic vibration and swept away, as they have already been broken up by the ultrasound.

Because of the similarity of the terms "ultrasonic" and "sonic," there is some confusion in the marketplace, and sonic toothbrushes are frequently mislabeled as ultrasonic ones. A toothbrush operating at a frequency or vibration of less than 20,000 Hz is a "sonic" toothbrush. It is called "sonic" because its operating frequency, for example, 31,000 movements per minute, is within the human hearing range of between roughly 20 Hz to about 20,000 Hz. Only a toothbrush that emits ultrasound, or vibration at a frequency greater than the upper limit of human hearing, can be called an "ultrasonic" toothbrush.

Effectiveness

A 2014 Cochrane review found that power toothbrushes remove more plaque and reduce gingival inflammation compared to manual toothbrushes, showing generally greater effectiveness over manual toothbrushes. ^[13] Plaque build-up and gingival inflammation were reduced by 11% and 6%, respectively, following one to three months of use. ^[13] After three months, the observed effect reached 21% reduction in plaque and 11% reduction in gingival inflammation. ^[13] Although the scale of these differences in a clinical setting remains questionable, ^[13] other reviews have reached similar conclusions. ^{[21] [22]} Another systematic review also concluded that power toothbrushes were more effective in removing plaque than manual brushes for children. ^[23] For patients with limited manual dexterity or where difficulty exists in reaching rear teeth, electric toothbrushes may be especially beneficial. ^{[24] [25]}

With regards to the effectiveness of different electric toothbrushes, the oscillation rotation models have been found to remove more plaque than manual toothbrushes. ^{[26] [16] [27]} More specific studies have also been conducted which demonstrate that the oscillating rotating toothbrush effectiveness is superior to manual toothbrushes for patients undergoing orthodontic treatment. ^{[28] [29]} Only the oscillating rotating power toothbrush was able to consistently provide statistically significant benefit over manual toothbrushes in the 2014 Cochrane Review. ^[13] This suggests that oscillating rotating power toothbrushes may be more effective than other electric toothbrushes. More recent evidence also supports this, as new studies suggest that oscillating rotating toothbrushes are more effective than high-frequency sonic power toothbrushes. ^{[30] [31] [32]} Overall, oscillating rotating toothbrushes are effective in reducing gingival inflammation and plaque. ^[33]

Other factors that influence effectiveness among electric toothbrushes involve factors such as the amount of time spent brushing and the condition of the brush head. Manufacturers recommend that heads be changed every three months or as soon as the brush head has visibly deteriorated. ^{[34] [35]}

However, studies also show that while initial use of an electric toothbrush showed improvements to oral health, the benefits decreased with continuous use. This initial improvement was suggested to be because of the Hawthorne effect and/or because of novelty change. ^[36]

Power source and charging

Modern electric toothbrushes run on low voltage, generally 12 V or less. Certain units use a step-down transformer to power the brush, ^[37] but most use a battery, usually (but not always) rechargeable and non-replaceable. The battery is usually fitted inside the handle, which is hermetically sealed to prevent water damage. While early NiCad battery toothbrushes used metal tabs to connect with the charging base, ^[38] newer toothbrushes use inductive charging.

Environmental concerns

According to Friends of the Earth, "Disposable electric toothbrushes are one example of a terrible product ... it's virtually impossible to separate out the tech from the batteries and plastic casing, which means valuable and often toxic materials are dumped in landfill or burnt in incinerators." ^[39] A study published in the British Dental Journal found the climate change potential of the electric toothbrush was 11 times greater than the bamboo toothbrush. A bamboo toothbrush or a plastic manual brush with replaceable heads is likely the option with the least environmental impact, according to the study. ^[12]

Optional features

Timer

Many modern electric toothbrushes have a timer that buzzes or briefly interrupts power, typically after two minutes, though sometimes every 30 seconds. ^[40] This is associated with a customary recommendation to brush for two minutes, 30 seconds for each of the four quadrants of the mouth. ^[41]

Display

Some electric toothbrushes have LCD screens that show brushing time and sometimes smiley face icons or other images to encourage optimal brushing. These features could encourage people to brush more accurately. ^[42]

Pressure sensor

Brushing teeth too hard causes enamel and gum damage, which is why some electric toothbrushes include pressure sensors, which prevent users from brushing too aggressively. ^[40]

Ultrasound indicator

Because ultrasonic frequencies are beyond the audible range and the amplitude of movement emitted by an ultrasonic toothbrush is typically too small to be perceived, the ultrasound is imperceptible to humans, and it may not be apparent that a brush is running if pure ultrasound is turned on. Ultrasonic toothbrushes may include an indicator to notify the user that ultrasound is being emitted. ^[40]

Bluetooth

Bluetooth connectivity enables data to be transmitted from an electric toothbrush to another Bluetooth device, such as a smartphone. The brush can send data to a mobile app, such as how long it has been brushing for and if too much pressure has been applied when brushing. ^[40] The app can, in turn, send data back to the brush, such as changing the cleaning modes available and cleaning time. The sharing of data between a toothbrush and a smartphone is intended to assist the user in creating better brushing techniques and habits. This technology enables coaching for the user as it tracks metrics including where the user brushes and how long is spent in each area and consequently can identify areas where the user commonly misses. Several electric toothbrushes utilize Bluetooth technology.

Cleaning modes

Most sonic toothbrushes come with different cleaning modes and intensity levels designed for special types of cleaning. Some of the most well-known are those meant for daily care, sensitive teeth, whitening, and tongue cleaning.

Certain toothbrushes that offer both ultrasonic and sonic motion allow for the intensity of the sonic motion to be reduced or even for the sonic motion to be turned off entirely so that only ultrasound is emitted. Since ultrasound movements are very low in amplitude, this setting may be indicated for patients who may not be suitable candidates for typical sonic or power toothbrush vibration but need the additional cleaning power of an ultrasonic toothbrush, such as patients who have recently undergone periodontal surgery. ^[43]

References

• Medicine portal

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