Dental plaque is one of the causes of gingival and periodontal diseases. Therefore, prevention and treatment of these diseases by maximizing plaque reduction and control. The toothbrush is a tool to reduce plaque.

Manual and Electric Toothbrushes Efficacy Comparison
Manual Toothbrush and Electric Toothbrush

Daily dental plaque control by brushing teeth is an important component in efforts to prevent and treat diseases of gingival, periodontal tissue, including preventing dental caries. An expert from Sweden, Fredrick Wilhelm Tornberg, was the one who designed the first electric toothbrush. In 1927, for the first time, an electric toothbrush was produced in America.

The main reason the electric toothbrush was first launched is for people who have motor skills problems, such as people with disabilities and those who have no dexterity. Since it was first produced to develop today, there has been controversy about its effectiveness compared to manual toothbrushes.

Electric Toothbrush

An electric toothbrush is a toothbrush that uses electricity from the battery as its driving force. The components consist of a motor that can carry out mechanical movements on the brush head, with a filament can move quickly. Electric toothbrushes motivate people to brush their teeth with the right technique and in the right duration. Over time, electric toothbrushes have experienced several developments, as follows:

1. The first generation:

The first generation has a head that resembles a manual toothbrush and can move back and forth (oscillation) to simulate manual brushing. The disadvantage of this product is the short working time and easy mechanical damage to its components.

2. Second generation:

This generation has a unique rotating head and is powered by a more durable or rechargeable battery. Newer types combine vibration and reciprocity, as well as additional features such as pressure sensors and timers.

3. Third generation:

Sonic-powered toothbrushes and ultrasonic-powered toothbrushes were introduced. This tool can remove more plaque compared to manual toothbrushes.

a. Sonic Toothbrush
It has a conventionally shaped head that vibrates at very high speeds,> 30,000 vibrations per minute. This vibrating motion creates turbulent dynamics in the liquid, which can interfere with plaque adhesion so that dental plaque can disappear. Sonic toothbrushes usually have a 200-400 Hz frequency, which is 12,000-24,000 oscillations or 24,000-48,000 movements per minute. The point is that this sonic toothbrush relies on high amplitude from the swift, sweeping movements to clean plaque attached to the teeth.

b. Ultrasonic Electric Toothbrush
This latest type of electric toothbrush uses ultrasonic waves to clean teeth. The ultrasonic toothbrush emits vibrations with a very high frequency, a minimum of 20,000 Hz but low amplitude. Toothbrush vibrations are believed to break the chain of bacteria that form dental plaque and eliminate plaque adhesion on the teeth' surface up to 5 mm below the gum line.

Ultrasonic toothbrushes can provide sweeping motion and additional capabilities to remove food particles and bacterial chain residues. Because ultrasound motion is very low in amplitude, it can be used by people who need additional cleaning power, such as patients who have just had periodontal surgery.

c. Ionic Electric Toothbrush
The action mechanism of ionic toothbrushes is based on ion theory, in which natural teeth have a positive ionic charge, and food particles naturally have a negative ionic charge.

The ionic forces of attraction cause food particles to stick to the teeth. The ionic toothbrush's mechanism is to convert a negative ion charge into a positive ion charge. Then, the positively charged part will pull plaque and food particles away from the teeth.  Simultaneously, the bristles on the brushwork remove debris particles and the remaining plaque attached to the teeth.

A Recommended Electric Toothbrushes
Electric Toothbrush by Oral B
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Additional Design Features on Electric Toothbrushes

Some new generation electric toothbrushes also add additional features to increase cleaning power and reduce the possibility of tooth abrasion and gingival trauma due to the pressure of brushing your teeth too hard in the long run. These features include:
- timer and LCD to show brushing time,
- pressure sensor brushing teeth to prevent over-aggressiveness,
- Bluetooth to be connected to other devices as a timely reminder for brushing teeth,
- and other complementary cleaning modes

Manual Toothbrushes

Manual toothbrushes that are commonly used by many people must have ideal characteristics. The manual toothbrush design should suit the user's individual needs in size, shape, and texture, easy to use, easy to clean after use, resistant to moisture, durable and inexpensive, and designed for utility, efficiency cleanliness.

Several considerations need to be considered when choosing a manual toothbrush, namely:

- Fine hair must be adjusted to the toothbrush head size 
- The toothbrush head must be small enough to have maximum maneuverability in the oral cavity. Therefore, the head length must be <4.2 cm for adult toothbrushes and <2.5 cm for children, while width <1.3 cm for adults and <2.2 cm for children
- The toothbrush grip can be adjusted to individual preferences; it must be long enough to fit your palm's size.
- Manual toothbrush design is designed to efficiently clean and reach all parts of the oral cavity, such as the grip configuration that is made curved or tilted to increase user comfort and brush bristles have a round cross-section to reduce the risk of trauma to the gums.

Efficacy Comparison of Electric and Manual Toothbrushes

A randomized clinical trial study in 2017 by Kulkarni et al. compared the efficacy of electric toothbrushes with manuals for 4 weeks in controlling plaque and gingivitis. The assessment uses the gingival index, plaque index, and the oral hygiene index. A total of 45 patients with the age group 19-23 years were included in this study.

The results of the study were that there was a decrease in plaque index scores in gingival health. However, when assessed at week 4, individuals who use electric toothbrushes show better results than manual toothbrushes.

Basith et al. conducted a comparative evaluation of electric and manual toothbrushes' effectiveness in removing plaque and gingivitis. Subjects consisted of 80 dental students with an age group of 18-28 years. The research lasted for 2 months. The study results are both types of toothbrushes that significantly reduce plaque accumulation, improve gingival health, and improve the oral hygiene index. However, electric tooth brushing showed greater improvement.

In 2019, Petker et al. Conducted a similar study for more than 6 months, with student participants divided into groups using electric toothbrushes (N = 55) and manual toothbrush groups (N = 60). Participants were asked to clean teeth as well as possible with their own devices.

Dental plaque is assessed before and immediately after being brushed. Next, gingival bleeding, tooth abrasion, periodontal pocket depth, and tooth status were assessed. Participant performance was recorded with a video to be analyzed on the duration of tooth brushing, the location of tooth brushing, and the application of an interproximal cleaning tool. Conclusion This study concludes that there is no advantage to brushing your teeth with an electric toothbrush every day than manual toothbrushes. The toothbrush type does not cause Low oral hygiene.

Maintaining good oral hygiene is influenced by individuals' ability and motivation to brush their teeth every day. Electric and manual toothbrushes have the same ability to remove plaque on the teeth and gums. The agility level and technical skills of users greatly influence the effectiveness of manual toothbrushes.

While the advantage of electric toothbrushes can simplify the technique of brushing teeth so that it can increase people's motivation to brush their teeth regularly, electric toothbrushes have better potential than manual toothbrushes to improve optimal oral hygiene.

But in economic terms, the use of manual toothbrushes is still preferred by users compared to the relatively expensive electric toothbrushes. Therefore, the electric toothbrush is highly recommended for individuals with limited tooth brushing skills, such as the elderly, children, and individuals with disabilities.