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STATEMENT OF THE COCHRANE ORAL HEALTH GROUP ON
POWER TOOTHBRUSH CLAIMS AND THE QUALITY OF MEDICAL EVIDENCE January 21, 2003 When we excluded studies published prior
to 1990, the results failed to detect any benefit of powered toothbrushes
with a side-to-side action on plaque or gingivitis when compared with manual
toothbrushes. In technical language, when all identified studies of Sonicare
after 1990 were combined, plaque scores at 1-3 months at all sites showed a
standardised mean difference (SMD) of -0.68 (95% confidence intervals (CI):
-1.63, 0.27). The SMD for gingival scores at 1-3 months was -0.47 (95%CI:
-1.03, 0.09). No long-term data were available on these brushes. (The
Cochrane data are available at http://www.cochrane-oral.man.ac.uk). Systematic reviews, such as those prepared
in the Cochrane Collaboration, seek to bring together all the relevant
research evidence in order to be as reliable as possible. They do not rely
on the selective highlighting of just one or two research studies or the
experiences of individuals. The review allows people to consider all of the
relevant evidence, not just parts of it. Yet our findings were not entirely
negative for Royal Philips Electronics as their Philip Jordan HP735 was one
of several of the rotation-oscillation brushes included in our review, a
group whose action appeared to be superior. Be that as it may, the 7 percent and 17
percent reductions of plaque and gingivitis we found for brushes in this
group, may still be of borderline benefit for dental health. The American
Dental Association recommends that only oral care products that can prove a
20% improvement may publish a claim for superiority over other products. (Imrey
et al., 1994). Fundamentally, our report highlights the
poor quality of the toothbrush trials upon which every company’s marketing
claims are based. Despite this being a multimillion dollar industry:
Regrettably, these same shortcomings
affect the majority of research on medical devices, treatments, and
medicines. It was for this reason that the Cochrane Collaboration was
established in 1992, as part of the movement towards evidence based
medicine. By producing and disseminating systematic reviews of the evidence,
it aims to allow doctors, patients, third party agencies and governments to
make well informed choices about healthcare. Undoubtedly there will be other
observations on this report and these will be welcomed. Part of the living
nature of Cochrane reviews is that people can submit comments which will be
considered when the review is updated and will be published alongside it in
the future alongside. If new studies are done which might be relevant to the
review, these will be assessed and, if relevant, included in the review when
it is updated in two years time. "The Cochrane Oral Health Group has more
than 100 reviews in the pipeline," Shaw said. The first 29 completed ones
cover diverse topics including orthodontic treatment, treatment of decay in
primary teeth, fluoride varnish, dental implants, dentine sensitivity,
treatment of temporomandibular joint problems, treatment of pre-cancerous
conditions, and the oral care of children receiving cancer treatment. "For
27 of these, our reviewers found that the evidence upon which dentist round
the world rely to make many important everyday decisions was weak and
unreliable." Lobene RR. The effect of an automatic
toothbrush on gingival health. Journal of Periodontology 1964;35:137-9 Imrey PB, Chilton NW, Pihlstrom HW.
Recommended revisions to American Dental Association guidelines for
acceptance of chemotherapeutic products for gingivitis control. Journal of
Periodontal Research 1994;29:299-304 * For more information contact: Professor Bill Shaw c/o Luisa Fernandez,
Univeristy of Manchester The Cochrane Collaboration (www.cochrane.org)
is an international nonprofit organization whose goal is to help consumers
and clinicians make well-informed decisions about healthcare by preparing,
maintaining and promoting accessibility of systematic reviews on the effects
of healthcare interventions. The Collaboration comprises 49 topic-based
collaborative review groups and 8000 contributors in more than 70 countries
around the world. The Cochrane Collaboration’s US headquarters are located
at Brown University, in Providence, Rhode Island with branches in Boston and
San Francisco. The Cochrane Collaboration also has Centers in Australia,
Brazil, Canada, China, South Africa, Holland, Germany, Italy, Spain, Norway,
and the UK. * NOTE TO JOURNALISTS: For copies of the review
go to --END- |