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Anelectric toothbrush,motorized toothbrush, orbattery-powered toothbrush is atoothbrush that makes rapid automatic bristle motions, either back-and-forthoscillation orrotation-oscillation (where the brush head alternates clockwise and counter clockwise rotation while also vibrating at variable frequencies), in order toclean teeth. Motions at sonic speeds or below are made by anelectric motor. In the case ofultrasonic toothbrushes,ultrasonic motions are produced by apiezoelectric crystal. A modern electric toothbrush is usually powered by arechargeable battery, which is charged throughinductive charging, typically through a charging base.
Electric toothbrushes can be classified according to thefrequency (speed) of their movements as power, sonic orultrasonic toothbrushes, depending on whether they make movements that are below, in or above theaudible range (20–20,000 Hz or 2400–2,400,000 movements per minute), respectively.
The earliest example of an electric toothbrush was produced by Tomlinson Moseley.[1] Sold as the Motodent, a patent was filed by his company, Motodent Inc. on December 13, 1937.[2] In Switzerland in 1954, Dr. Philippe Guy Woog invented the Broxodent.[3] Woog's electric toothbrushes were originally manufactured in Switzerland (later in France) for Broxo S.A. The device plugged into a standard wall outlet and ran on line voltage. Electric toothbrushes were initially created for patients with limited motor skills and for orthodontic patients (such as those with braces).[4]
The Broxo Electric Toothbrush was introduced in the US byE. R. Squibb and Sons Pharmaceuticals in 1960.[5] After introduction, it was marketed in the US by Squibb under the names Broxo-Dent or Broxodent.[5] In the 1980s, Squibb transferred distribution of the Broxodent line to the Somerset Labs division ofBristol-Myers Squibb.[6]
TheGeneral Electric automatic toothbrush was introduced in the early 1960s;[7] it was cordless, with rechargeableNiCad batteries and although portable, was rather bulky, about the size of a two-D-cellflashlight handle.[8]The NiCad batteries of this period suffered from thememory effect. The GE automatic toothbrush came with a charging stand that held the hand piece upright; most units were kept in the charger, which, due to how prolonged charging creates heat that damages the battery, was not the best way to getmaximum service life from a NiCad battery.[9] Early NiCad batteries tended to have a short lifespan. The batteries were sealed inside the GE device, and the whole unit had to be discarded when the batteries failed.
The use of an AC line voltage appliance in a bathroom environment was problematic. By the early 1990s theUnderwriter Laboratories (UL) andCanadian Standards Association (CSA) no longer certified line-voltage appliances for bathroom use. Newer appliances had to use a step-downtransformer to operate at low voltage (typically 12, 16 or 24 volts). Wiring standards in many countries require that outlets in bathroom areas must be protected by anRCD/GFCI device (e.g., required in the US since the 1970s on bathroom outlets in new construction).[10]
By the 1990s, there were problems with the safety certification of Broxo's original design. Further, improved battery-operated toothbrushes were providing serious competition.[citation needed]
The firstultrasonic toothbrush, first called the Ultima and later the Ultrasonex, was patented in the US in 1992, the same year theFDA gave it approval for daily home use. Initially, the Ultima worked only on ultrasound, but a few years later, a motor was added to give the Ultrasonex brush additional sonic vibration. Today, several ultrasonic toothbrushes simultaneously provide both ultrasound and sonic vibration. In more modern times, electric toothbrushes have been used as a substitute forvibrators for those who wish to avoid embarrassment.[11]
The negative environmental impact of electric toothbrushes when compared with manual toothbrushes has been established.[12]
Electric toothbrushes can be classified according to their type of action:
For some vibrating toothbrush designs, a brushing technique similar to that used with a manual toothbrush is recommended, whereas with brushes with a spinning head, the recommended cleaning technique is to simply move the brush slowly from tooth to tooth.[14]
Electric toothbrushes can also be classified according to the speed of their movements as standard power toothbrushes, sonic toothbrushes orultrasonic toothbrushes. If the motion of the toothbrush is sufficiently rapid to produce a hum in theaudible frequency of human range (20 Hz to 20,000 Hz), it can be classified as a sonic toothbrush. Any electric toothbrush with movement faster than this limit can be classified as an ultrasonic toothbrush. Certain ultrasonic toothbrushes, such as the Megasonex and the Ultreo, have both sonic and ultrasonic movements.[15]
The oscillating rotating toothbrush is a type of electric toothbrush which was introduced byOral-B in the 1990s.[16][17][13][18][19] This type of toothbrush is not shaped like a conventional manual toothbrush. Instead, it is made of a small round brush head that oscillates and rotates to remove plaque. The shape of the brush head is very similar to the prophylaxis hand piece used by dental professionals to remove plaque in the dental office.[20] This design enables the bristles to reach further into the hard-to-reach areas between the teeth to remove plaque. Some versions of the oscillating rotating toothbrush also involve a pulsating motion which enables a more three dimensional clean.[citation needed]
The safety of oscillating rotating toothbrushes has also been studied. Oscillating rotating toothbrushes are proven to be safe as compared to manual toothbrushes and are safe for both the hard and soft tissues of the oral cavity.[21]
Sonic toothbrushes are a subset of electric toothbrushes with movement that is fast enough to producevibration in theaudible range. Most modern rechargeable electric toothbrushes fall into this category and typically have frequencies that range from 200 to 400 Hz, that is 12,000–24,000 oscillations or 24,000–48,000 movements per minute. Because sonic toothbrushes rely on sweeping motion alone to clean the teeth, the movement that they provide is often high inamplitude, meaning that the length of the sweeping movements that they make is large. One study found that using a sonic toothbrush causes less abrasion to the gum when compared to the manual toothbrush.[22]
The newest developments in this field areultrasonic toothbrushes, which useultrasonic waves to clean the teeth. In order for a toothbrush to be considered "ultrasonic" it has to emit a wave at a minimum frequency of 20,000 Hz or 2.4 million movements per minute. Typically, ultrasonic toothbrushes approved by the U.S.Food and Drug Administration (FDA) operate at a frequency of 1.6 MHz, which translates to 192 million movements per minute.
Ultrasonic toothbrushes emit vibrations that are very high infrequency but low inamplitude. These vibrations break up bacterial chains that make up dental plaque and remove their methods of attachment to the tooth surface up to 5 mm below the gum line.[23]
Some ultrasonic toothbrushes, provide only ultrasonic motion. Other ultrasonic toothbrushes provide additional sonic vibration ranging from 9,000 to 40,000 movements per minute, comparable to a sonic toothbrush, in order to provide additional sweeping motion which facilitates removal of food particles and bacterial chain remnants. The sonic vibration in these ultrasonic toothbrushes may be lower in amplitude than that found in a comparable sonic toothbrush because the bacterial chains do not need to be removed through sonic vibration and swept away, as they have already been broken up by the ultrasound.
Because of the similarity of the terms "ultrasonic" and "sonic", there is some confusion in the marketplace and sonic toothbrushes are frequently mislabeled as ultrasonic ones. A toothbrush operating at a frequency or vibration of less than 20,000 Hz is a "sonic" toothbrush. It is called "sonic" because its operating frequency, for example, 31,000 movements per minute, is within the human hearing range of between roughly 20 Hz to about 20,000 Hz. Only a toothbrush that emitsultrasound, or vibration at a frequency greater than the upper limit of human hearing, can be called an "ultrasonic" toothbrush.
In 2014, aCochrane review demonstrated that power toothbrushes may remove more plaque and reduce gingival inflammation than manual toothbrushes, showing a generally greater effectiveness over manual toothbrushes.[13] Plaque build-up and gingival inflammation were reduced by 11% and 6% respectively, following one to three months of use.[13] After three months, the observed effect reached 21% reduction in plaque and 11% reduction in gingival inflammation.[13] Although the scale of these differences in a clinical setting remains questionable,[13] other reviews have reached similar conclusions.[24][25] Anothersystematic review also concluded that power toothbrushes were more effective in removing plaque than manual brushes for children.[26] For patients with limited manual dexterity or where difficulty exists in reaching rear teeth, electric toothbrushes may be especially beneficial.[27][28]
With regards to the effectiveness of different electric toothbrushes, the oscillation rotation models have been found to remove more plaque than manual toothbrushes.[29][20][19] More specific studies have also been conducted which demonstrates oscillating rotating toothbrush effectiveness to be superior to manual toothbrushes for patients undergoing orthodontic treatment.[30][31] Only the oscillating rotating power toothbrush was able to consistently provide statistically significant benefit over manual toothbrushes in the 2014 Cochrane Review.[13] This suggests that oscillating rotating power toothbrushes may be more effective than other electric toothbrushes. More recent evidence also supports this, as new studies suggest that oscillating rotating toothbrushes are more effective than high-frequency sonic power toothbrushes.[32][16][33] Overall, oscillating rotating toothbrushes are effective in reducing gingival inflammation and plaque.[34]
Other factors that influence effectiveness amongst electric toothbrushes involve factors such as the amount of time spent brushing and the condition of the brush head. Manufacturers recommend that heads be changed every three months or as soon as the brush head has visibly deteriorated.[35][36]
However, studies also show that while initial use of an electric toothbrush showed improvements to oral health, the benefits decreased with continuous use. This initial improvement was suggested to be because of theHawthorne effect and/or because of novelty change.[37]
Modern electric toothbrushes run on low voltage, generally 12 V or less. Certain units use a step-downtransformer to power the brush[citation needed], but most use a battery, usually (but not always) rechargeable and non-replaceable. The battery is usually fitted inside the handle, which is hermetically sealed to prevent water damage. While early NiCd battery toothbrushes used metal tabs to connect with the charging base[citation needed], some toothbrushes useinductive charging.
According toFriends of the Earth, "Disposable electric toothbrushes are one example of a terrible product ... it's virtually impossible to separate out the tech from the batteries and plastic casing, which means valuable and often toxic materials are dumped in landfill or burnt in incinerators."[38] A study published in theBritish Dental Journal found theclimate change potential of the electric toothbrush was 11 times greater than the bamboo toothbrush. The bamboo toothbrush was, however, not the most environmentally sustainable toothbrush, because using them may contribute to land not being put to better use, such as fostering biodiversity, or growing forests tooffset carbon emissions[citation needed]. A plastic manual replaceable head toothbrush was likely the best, according to the study.[12]
Many modern electric toothbrushes have a timer that buzzes or briefly interrupts power, typically after two minutes, though sometimes every 30 seconds.[39] This is associated with a customary recommendation to brush for two minutes, 30 seconds for each of the four quadrants of the mouth.[40]
Some electric toothbrushes haveLCD screens that show brushing time and sometimes smiley faceicons or other images to encourage optimal brushing. These features could encourage people to brush more accurately.[41]
Brushing teeth too hard causes enamel and gum damage. Most modern quality sonic toothbrushes come with a pressure sensor, which prevents users from brushing too aggressively.[39]
Because ultrasonic frequencies are beyond theaudible range and the amplitude of movement emitted by an ultrasonic toothbrush is typically too small to be perceived, the ultrasound is imperceptible to humans, and it may not be apparent that a brush is running if pure ultrasound is turned on. Ultrasonic toothbrushes may include an indicator to notify the user that ultrasound is being emitted.[39]
Bluetooth connectivity enables data to be transmitted from an electric toothbrush to another Bluetooth device, such as a smartphone. The brush can send data to amobile app, such as how long it has been brushing for and if too much pressure has been applied when brushing.[39] The app can, in turn, send data back to the brush, such as changing the cleaning modes available and cleaning time. The sharing of data between a toothbrush and a smartphone is intended to assist the user in creating better brushing techniques and habits. This technology enables coaching for the user as it tracks metrics including where the user brushes and how long is spent in each area, and consequently can identify areas where the user commonly misses. Several electric toothbrushes utilize Bluetooth technology.
Most sonic toothbrushes come with different cleaning modes and intensity levels, designed for special types of cleaning. Some of the most well known are those meant for daily care, sensitive teeth, whitening, and tongue cleaning.
Certain toothbrushes that offer both ultrasonic and sonic motion allow for the intensity of the sonic motion to be reduced, or even for the sonic motion to be turned off entirely so that only ultrasound is emitted. Since ultrasound movements are very low in amplitude, this setting may be indicated for patients who may not be suitable candidates for typical sonic or power toothbrush vibration but need the additional cleaning power of an ultrasonic toothbrush, such as patients who have recently undergone periodontal surgery.[citation needed]
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