Are bristle stiffness and bristle end-shape related to adverse effects on soft tissues during toothbrushing? A systematic review.
Level 1 - systematic review of randomized trials
Systematic review of controlled trials
PubMed 30152076 · doi:10.1111/idj.12421
What was done
Authors searched PubMed, EMBASE, Scopus, and grey literature for controlled trials evaluating manual toothbrush bristle stiffness and/or bristle end-shape on oral soft tissue safety in adults. Studies had to evaluate at least two toothbrushes with at least 7 days of follow-up and report adverse soft tissue effects. Two independent reviewers performed screening and assessed risk of bias using the Cochrane tool. Qualitative data synthesis was conducted using meta-ethnography.
What was found
Thirteen controlled trials were included from 1,945 records (6 assessed end-shape, 2 assessed stiffness, and 5 assessed both). No numerical effect estimates, counts, or p-values were reported in the abstract. Hard bristles produced more gingival lesions than medium or soft bristles. A slight increase in gingival recession width was observed with end-rounded bristles compared to tapered bristles, though overall soft tissue injuries were similar between the two shapes. Only 4 studies evaluated adverse effects as a primary outcome.
Why it matters
This review provides evidence supporting clinical recommendations for soft or extra-soft toothbrushes over hard bristles to minimize soft tissue trauma during routine brushing.
Limits
The abstract provides no quantitative data, effect sizes, or participant numbers. Only 4 of the 13 included trials evaluated soft tissue adverse effects as a primary outcome, and synthesis was limited to a qualitative meta-ethnography.
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