Antiplaque and antigingivitis efficacy of new and worn manual toothbrushes: A systematic review and meta-analysis

Objective To systematically review the literature about the antiplaque and antigingivitis efficacy of new and worn manual toothbrushes. Methods Five databases were searched to identify randomized controlled trials, involving adults, comparing the clinical efficacy of new and worn manual toothbrushes. Experimental groups need to have different usage time in changing their manual toothbrush. Two reviewers performed studies selection, data extraction and risk of bias assessment independently. Meta-analyses were performed comparing the toothbrushes after a single use (antiplaque efficacy) and after multiple uses (antiplaque and antigingivitis efficacy). Results Eight studies were included, totalling 344 individuals. In studies with a single-use design, no statistically difference was found between new and worn toothbrushes for antiplaque efficacy (SMD:-0.39; 95%CI:-0.80 to 0.03). Studies with a multiple-use design showed no statistically difference between groups for the antigingivitis efficacy (MD:-0.10; 95%CI:-0.24 to 0.03). However, higher antiplaque efficacy was demonstrated in new toothbrushes in the studies with a multiple-use design (SMD:-0.75; 95%CI:-1.37 to -0.14). The certainty of the evidence ranged from very low (antiplaque) to low (antigingivitis). Conclusion New and worn toothbrushes presented similar antiplaque and antigingivitis efficacy. However, further randomized controlled trials, with a lower risk of bias, are needed to enhance the certainty of this evidence.