Is chewable toothbrush effective in terms of dental plaque reduction in children? A systematic review and meta‐analysis of randomized controlled trials

Abstract

Objectives To systematically evaluate randomized controlled trials (RCTs) on whether a chewable toothbrush (CTB) is more effective than a manual toothbrush (MTB) in terms of full‐mouth dental plaque reduction in non‐orthodontic children. Materials and Methods Six databases were searched by two independent reviewers according to pre‐specified eligibility criteria up to October 2022. No restrictions regarding language, date of publication and minimum follow‐up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and GRADE for assessing the certainty of evidence. Random‐effects pairwise meta‐analysis compared the dental plaque change scores of CTB and MTB through mean differences (MDs) and associated confidence intervals (95% CI), and sensitivity analysis determined whether an individual study significantly affected the results. Results Seven eligible RCTs were retrieved, including data of 310 children aged 8–14 years. Five RCTs present some concerns and two have high RoB. No significant difference was detected between toothbrushes in terms of Turesky modification of the Quigley‐Hein plaque index reduction (MD = −0.04, 95% CI: −0.26–0.18), with overall very low certainty on evidence. The pooled estimate remains unchanged when any RCT is omitted. Conclusion There is very low‐certainty evidence of no significant difference on plaque removal between MTB and CTB in non‐orthodontic children. Due to unexplained high heterogeneity and low methodological quality of RCTs, we cannot determine the extent to which our finding reflects a true effect or bias arising from limitations of primary studies.