Efficacy of Electric Tooth Brushing Compared to Manual Toothbrushing in Patients With Special Health Care Needs: A Systematic Review

Objectives: The primary objective of this systematic review is to evaluate the efficacy of electric toothbrushing compared to manual toothbrushing in improving oral hygiene among people with special health care needs, including individuals requiring caregiver assistance as well as those capable of independent brushing with or without supervision, using an evidence-based approach. Data/Sources: In April 2023, a comprehensive search was conducted across Medline (PubMed), the Cochrane Library and Dentistry and Oral Sciences Source (DOSS), targeting studies from January 1985 to January 2023. Data was collected using a custom form focusing on study characteristics, population attributes and key outcomes. The methodological quality was evaluated using the Risk of Bias Tool-2 (RoB-2) for randomized controlled trials (RCTs) and a descriptive analysis was performed according to SWiM guidelines. Study Selection: Titles and abstracts were screened to exclude duplicates and irrelevant studies, followed by a full-text review of potentially eligible articles. Two independent reviewers assessed each study against predefined criteria. Studies were selected based on their design (RCTs), population (people with special health care needs, including those requiring caregiver assistance or supervision) and outcomes (oral hygiene measures such as plaque index, gingival index, biofilm reduction, microbial salivary count, pocket depth, bleeding on probing, patient and caregiver-reported outcomes). From 3862 studies identified, 14 were included in the final review. Conclusion: Both electric and manual toothbrushes can maintain or improve oral hygiene for patients with special health care needs. Although some studies show electric brushes often lead to better plaque reduction and gingival health, others report comparable outcomes when manual brushing is well supervised. Future research should assess the impact of caregiver training, cost and evolving brush technologies to optimise long-term oral care for individuals with physical or cognitive impairments.