Powered or manual toothbrushing for people with physical or intellectual disabilities - A systematic review

• Published in: Special care in dentistry 2023-09, Vol.43 (5), p.515-529
• Main Authors: Kalf-Scholte, Sonja M, Valkenburg, Cees, van der Weijden, Fridus G A, Slot, Dagmar Else
• Format: Article
• Language: English
• Subjects: Caregivers; Clinical trials; Dental Plaque - prevention & control; Dental Plaque Index; Disability; Equipment Design; Gingiva; Gingivitis; Humans; Inflammation; Intellectual disabilities; Intellectual Disability; Meta-analysis; Reviews; Single-Blind Method; Statistical analysis; Systematic review; Toothbrushing
• ISSN: 0275-1879; 1754-4505
• DOI: 10.1111/scd.12821

The aim of this systematic review is to compare the effectiveness of a powered (PTB) and a manual (MTB) toothbrush in the hands of people with physical (PD) or intellectual (ID) disabilities or in the hands of a caregiver on parameters of plaque and gingival inflammation. MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched from initiation up to February 2022. The inclusion criteria were clinical trials conducted in people with PDs or IDs and comparing the effect of toothbrushing with a PTB to an MTB on plaque removal and gingival health. Data were extracted from the eligible studies and analyzed in four subgroups based firstly on the person performing the toothbrushing, either the participants or a caregiver, not a dental professional, and secondly on the main disability of the participants, either PD or ID. Heterogeneity and risk of bias were assessed, data were extracted from the eligible studies, and a descriptive analysis was performed. The search yielded 294 unique papers; after selection 16 eligible publications describing 25 comparisons were included: 12 self-brushing and 13 caregiver-brushing comparisons. Considerable clinical and methodological heterogeneity was present; together with limited numerical data, not allowing for a meta-analysis. The descriptive analysis showed, in the majority, no statistically significant difference between PTB and MTB. This applied to self-brushing and caregiver-brushing in both disability groups. This review demonstrates with a low level of evidence that a PTB compared to an MTB in the hands of people with PD or ID or in the hands of their caregivers results in no clinical difference in effectiveness on parameters of plaque and gingival inflammation.