The Great Debate: Sonic or Rotating Toothbrush?

Two main categories dominate the market for electric toothbrushes: rotating and sonic¹. Both have unique features and benefits, but which one is better? In this post, we will delve into the details and score the advantages of each to help you make an informed decision.

The Mechanics of Rotating and Sonic Toothbrushes

Rotating Toothbrushes: As the name suggests, these toothbrushes use a circular brushing motion². The brush head rotates, relying on this action to remove plaque and biofilm from the teeth.

Sonic Toothbrushes: These toothbrushes have heads that look more like traditional manual brushes but use sonic vibrations to clean the teeth. Sonic brushes are rated by vibrations per minute (VPM), typically ranging from 15,000 to 60,000³, depending on the model. Instead of rotating, they use high-frequency vibrations to disrupt plaque and biofilm.

Comparing Techniques

The technique required for correctly using each type of toothbrush is crucial for achieving optimal oral health.

Rotating Brushes: These brushes require a specific technique akin to the polishing motion used by hygienists during a dental cleaning. The brush should be angled towards the gums and moved in and out, starting at the backside of the last tooth and working forward. This technique demands mindfulness and dexterity. Improper use, such as random back-and-forth brushing, can lead to ineffective cleaning and increased plaque buildup between teeth.

Sonic Brushes: These are easier to use. Approach the sides of the teeth at a 45-degree angle and use the brush as a gum massager, moving slowly along the gumline and across the biting surfaces⁴. This simpler technique allows for better adaptation and outcomes with less effort. Sonic brushes have a clear advantage in ease of use, especially for individuals with dexterity issues.

Risks

Potential risks associated with each type of toothbrush are another important consideration, particularly concerning gum recession and tooth abrasion.

Gum Recession and Abrasion: aggressive brushing, with stiff bristles and a heavy-handed motion, is a common cause of gum recession and tooth abrasion. While manual brushes are generally considered to be the chief culprit for this issue, the rotating brush's mechanical action can exacerbate them if used incorrectly. With their gentler vibration, sonic brushes generally pose a lower risk for these problems.

Examining the Research

Corporately funded studies have a high risk of research bias⁵ and should be taken at face value as expensive advertising⁶. Manufacturers like Philips (Sonicare) and Proctor & Gamble (Oral-B) predictably publish studies with favorable results for their respective products. Independent studies consistently find that when used correctly, both sonic and rotating brushes remove plaque and biofilm more effectively than manual brushes¹.

One significant advantage of sonic toothbrushes is their ability to increase salivary flow, an important factor in cavity prevention⁷. Additionally, case reports have indicated potential risks associated with rotating brushes, such as physical injury in children⁸, and triggering seizures in epileptic patients⁹,¹⁰.

Which Toothbrush Should You Choose?

The best toothbrush for you depends on your individual needs and preferences. While some people manage their oral health effectively with manual or rotating brushes, my experience over the years suggests that sonic brushes provide the best overall results in oral hygiene.

References

1. Deacon SA, Glenny AM, Deery C, et al. Different powered toothbrushes for plaque control and gingival health. Cochrane database of systematic reviews. 2010;2020(11).

2. Penick C. Power toothbrushes: a critical review. International journal of dental hygiene. 2004;2(1):40-44.

3. Ng C, Tsoi JKH, Lo ECM, Matinlinna, Jukka P. Safety and design aspects of powered toothbrush — a narrative review. Dentistry journal. 2020;8(1):15.

4. Poyato-Ferrera M, Segura-Egea JJ, Bullón-Fernández P. Comparison of modified Bass technique with normal toothbrushing practices for efficacy in supragingival plaque removal. International journal of dental hygiene. 2003;1(2):110-114.

5. Jordan PJ, Troth AC. Common method bias in applied settings: The dilemma of researching in organizations. Australian journal of management. 2020;45(1):3-14.

6. Dane FC, Carhart E, Dane FC. Evaluating research: methodology for people who need to read research. Third edition. Thousand Oaks, California. SAGE; 2023.

7. Papas A, Singh M, Harrington D, et al. Stimulation of salivary flow with a powered toothbrush in a xerostomic population. Special care in dentistry. 2006;26(6):241-246.

8. FDA. Toothbrush can chip teeth and cause choking. Washington: Federal Information & News Dispatch, LLC; 2012.

9. Koutroumanidis M, Pearce R, Sadoh DR, Panayiotopoulos CP. Tooth brushing–induced seizures:  a case report. Epilepsia (Copenhagen). 2001;42(5):686-688.

10. Haytac MC, Aslan K, Ozcelik O, Bozdemir H. Epileptic seizures triggered by the use of a powered toothbrush. Seizure (London, England). 2008;17(3):288-291.