Do electric toothbrushes actually make a difference for patients with braces, or is a manual brush just as good?
Maintaining good oral hygiene can be more challenging during fixed orthodontic treatment, where brackets and wires create additional areas for plaque accumulation. Choosing an effective toothbrush is therefore an important consideration for both patients and clinicians.
A new systematic review and meta-analysis investigates whether powered toothbrushes really outperform manual toothbrushes for plaque and gingivitis control during fixed orthodontic treatment.
Powered vs Manual Toothbrushes During Fixed Orthodontic Treatment
In this systematic review, the authors searched PubMed-MEDLINE and Cochrane-CENTRAL through November 2025, screening 841 unique papers. After title/abstract and full-text screening, 23 papers covering 39 comparisons were included in the review.
The studies involved patients aged 10 to 53 years with buccal fixed appliances. All 39 comparisons reported plaque scores, 21 reported gingivitis scores, and 24 reported gingival bleeding scores.
Powered toothbrushes were restricted to rechargeable, single-brush-head, motor-driven devices, and studies that used additional interdental aids such as dental floss or water jets were excluded to avoid confounding.
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Do Electric Toothbrushes Perform Better for Patients With Braces?
Most individual comparisons showed no significant difference between powered and manual brushes: 64% for plaque scores, 76% for gingivitis scores, and 75% for bleeding scores.
But when the data were pooled in meta-analysis, a different picture emerged. Powered toothbrushes showed medium effects on plaque scores, large effects on gingivitis scores, and medium effects on bleeding scores compared with manual brushes.
This discrepancy may be explained by the meta-analysis including only studies with complete and comparable data, which excluded many comparisons showing no difference.
Looking at brush type, counter-rotational powered brushes showed large benefits over manual brushes for plaque reduction. However, the evidence was of low quality and, notably, these brushes are largely no longer available on the market.
Oscillating-rotating and oscillating-rotating-pulsating brushes, which dominate the current market along with sonic brushes, showed no significant advantage over manual brushes for any outcome.
Sensitivity analyses consistently supported the benefit of powered toothbrushes for reducing bleeding scores. Analyses restricted to randomised controlled trials also supported their benefits in reducing plaque and gingivitis.
What Does This Mean for Clinical Practice?
Current evidence suggests that powered toothbrushes may provide a modest to large advantage over manual toothbrushes in reducing plaque and gingival inflammation in orthodontic patients with fixed appliances.
However, the evidence is of low quality, and the findings are influenced by a small number of studies. Therefore, no definitive clinical recommendation can be made.
The findings provide useful context for conversations around oral hygiene during orthodontic treatment, but they do not suggest that choosing a powered toothbrush alone is enough to ensure effective plaque control. Supporting patients with appropriate oral hygiene throughout fixed appliance treatment remains an important part of ongoing orthodontic care.
Study Limitation
Most included studies had small sample sizes, inconsistent use of plaque and gingivitis indices, and moderate to high risk of bias, which limits confidence in the pooled estimates.
Read More
Liu Y, Van der Weijden FN, Jaquet N, Van der Weijden GA, Slot DE. Powered vs. manual toothbrushes in fixed orthodontic patients: a systematic review and meta-analysis. European Journal of Orthodontics. 2026 Aug;48(4).
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