Do powered toothbrushes remove more plaque than manual toothbrushes?

Yes, the overall evidence consistently supports that powered toothbrushes remove more plaque than manual toothbrushes, though the magnitude varies by population and study design.

In adults, a network meta-analysis found a statistically significant difference in post-brushing plaque scores favouring oscillating-rotating (OR) powered toothbrushes over manual toothbrushes (SMD = -0.43), with high certainty for a small effect ^[1]. A separate meta-analysis of single brushing exercises confirmed a significant benefit for powered toothbrushes regardless of plaque index used, with moderate certainty ^[2]. For sonic powered toothbrushes used in everyday brushing over four weeks to three months, combined results from 18 studies showed significantly greater plaque removal (SMD = -0.89) compared to manual toothbrushes ^[3]. A further meta-analysis reported powered toothbrushes were approximately 9% more effective at removing plaque, with OR, sonic, and ultrasonic modes all outperforming manual brushing, though counter-oscillation and ionic types did not show a significant benefit ^[4].

In children, a meta-analysis of nine randomised controlled trials found a statistically significant plaque reduction benefit for powered toothbrushes (combined mean difference = 0.590, moderate quality evidence) ^[5]. However, in adults aged 55 and older, current evidence did not reach statistical significance (SMD = -0.10, p = .38), suggesting the advantage may be less clear in this age group and that more targeted research is needed ^[6].

One important clinical note from the literature is that the advantage of powered toothbrushes may diminish in adequately instructed and motivated patients, highlighting the importance of individualised oral hygiene education ^[4].