Should You Use an Electric Toothbrush or a Manual?

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If there’s one point that dental professionals all agree on, it’s this: Brushing your teeth for 2 minutes, twice a day, is the most effective step you can take for oral health.

This helps get rid of bacteria that causes plaque, a sticky, germy film that adheres to teeth. When plaque builds up, it can cause tooth decay as well as gum disease.

But ever since the advent of the electric toothbrush—battery-operated devices whose bristles vibrate or rotate rapidly—in the 1960s, debate has raged over whether powered or manual brushes do a better job at cleaning teeth. And whether one type is safer than another for your teeth and gums.

Despite the current glut of advertisements for electric, or powered, devices, manual brushes are still by far the most common. According to a recent report by Mintel, a consumer marketing analysis firm, only 36 percent of adults say that they use a powered toothbrush.

But powered brushes become more popular as both age and income increase. According to Mintel, almost half of people 55 and older with annual incomes of $75,000 or more prefer powered brushes to manual ones.

There are, of course, cost differences. You can buy a manual toothbrush for less than a dollar, and basic powered models—which run on replaceable batteries—can be had for less than $10. Those with rechargeable batteries (for which a single charge lasts anywhere from a few days to several weeks) start as low as $20. But you can spend more than $250 for high-end "smart" powered toothbrushes that sync with an app on your phone, and offer recommendations on improving your brushing technique.

Which should you choose? Dental experts point out that each has its pros and cons, and that personal preferences and factors such as your age and general health might play a role in what kind of toothbrush is best for you.

Here, what to know and how to decide what’s right for keeping your pearly whites strong, clean, and cavity-free.

Do Powered Brushes Clean Better?

One of the more comprehensive analyses of the topic—a 2014 review of studies by the independent Cochrane Collaboration—gave powered brushes a slight edge at cleaning away plaque.

The researchers looked at 56 clinical trials of unsupervised tooth brushing by more than 5,000 adults and children, and found that study subjects who used a powered toothbrush showed an 11 percent reduction in plaque at one to three months, and a 21 percent reduction after three months or more, compared with those who used manuals.

They also found that powered brush users had a 6 percent reduction in gingivitis (gum disease) at one to three months and an 11 percent reduction after three or more months.

In addition, the researchers found that oscillating powered brushes (which have small round heads that rotate quickly in one direction and then the other) were slightly better at reducing plaque than sonic powered brushes (which have oval heads that move or vibrate rapidly from side to side). But the study authors say more research is needed to confirm that finding.

A German study, published in 2019 in the journal Clinical Periodontology, also found that powered brushes were more effective for gum health. Here, researchers at University Medicine Greifswald, who followed 2,819 adults over 11 years, determined that using a powered toothbrush reduced the progression of periodontal disease. Plus, electric toothbrush users had healthier gums overall and retained 19 percent more teeth over the study period than those using manual brushes.

That said, “You can brush very effectively with a manual toothbrush,” notes Matt Messina, D.D.S., a consumer adviser with the American Dental Association (ADA). “If you get good checkups and your dentist is confident you’re doing a thorough job, you don’t need to change from a manual brush.”

Can Electrics Hurt Your Teeth?

Powered brushes can be very, well, powerful, which explains why they can do such a thorough job on plaque. But too much power may also be potentially problematic.

A 2017 study, published in the journal PLOS One, found that powered brushes were more likely than manual to abrade dentin—the tissue directly below the tooth’s enamel, which can become exposed when enamel wears away or gums recede. Abrasions to the dentin increase tooth sensitivity and can hike cavity risks.

For the study, researchers took dentin samples from teeth and then used a machine that simulated the effects of eight-and-a-half years of brushing. They found that sonic toothbrushes caused the most abrasion to the dentin, followed by oscillating, and that manual brushes—especially those with rippled bristles—created the least. 

Another simulated brushing study, this one published in 2013 in the journal Clinical Oral Investigations, had somewhat different results. It found that manual and powered brushes had similar effects on intact enamel, but that on worn enamel, manual toothbrushing abraded dentin more. 

But there's an important caveat: In this study, the manual brushing simulation used a lot more force than the powered brush simulation. And experts say that brushing too forcefully with any kind of brush may increase the likelihood of gum recession and damaged tooth enamel. 

In fact, a gentle touch with a soft-bristled brush—whether manual or electric—is the safest bet. “It doesn’t take much force to brush away bacteria and food particles,” says Vera W. L. Tang., D.D.S., clinical assistant professor, vice-chair and predoctoral director at the New York University College of Dentistry, department of periodontology and implant dentistry.

And that may be especially important to keep in mind with powered brushes. “When you brush with a powered toothbrush, you don’t really have to do anything because the rotating or vibrating head does the work for you,” Tang says.

What's in a Brush?

When you're deciding on a toothbrush, consider the basics first. Both powered and manual toothbrushes come in a variety of head sizes and bristle configurations, including bristles that are clustered, angled, or rippled in various ways. “Some studies have shown that tapered or angled bristles are slightly more effective at reducing plaque than flat brushes,” says Tang.

Whether you opt for a manual or powered toothbrush, choose one with soft bristles. “Bristles that are too hard are more likely to cause damage to gums and enamel,” Tang says.

When in doubt, Messina suggests checking to see whether a toothbrush has earned the ADA Seal of Acceptance. “That indicates that it’s been independently tested, and that it safely and effectively removes plaque and reduces gingivitis,” he says.

If you're thinking about a powered brush, one feature to consider is a 2-minute timer. According to the ADA, most people brush for an average of only about 45 seconds, so this may encourage you to brush longer (certain manual brushes also have this feature or light up after 2 minutes of use). Some powered models have quadrant timers that buzz every 30 seconds to remind you to move on to another area of your mouth.

A powered brush with a pressure sensor may be beneficial for people who tend to brush too aggressively. “Some models sense if you’re pushing too hard and respond by stopping the bristles from moving until you lighten your touch,” Tang says.

Powered devices may also yield better results for certain groups, experts say. For instance, older adults, especially those with arthritis, might not have the dexterity to maneuver a manual brush effectively, says Tang. “Powered brushes not only do much of the work for you, but the larger handles are easier to hold,” she says.

Youngsters may benefit from them for the same reasons. Plus, some powered brushes made specifically for kids play music or connect to timer apps to encourage longer brushing sessions—although whether or not that actually inspires children to brush for the recommended 2 minutes hasn’t been studied. (The ADA and the American Academy of Pediatric Dentistry recommend that parents supervise kids’ brushing until they’re about 7 or 8 and say that kids who can routinely tie their own shoes can also brush their own teeth, with a manual or a powered toothbrush.)

Powered brushes can also be a boon for anyone with braces. “It’s much easier to get around all the brackets and wires than with a manual brush,” Messina says. Some powered products even have heads specifically designed to clean thoroughly around and between braces. 

Use the Best Brushing Technique

Whether you choose a basic brush or one with all the bells and whistles, the way you brush is key. “The correct technique can be used with a powered or manual toothbrush,” says Paulo Camargo, D.D.S., chair of periodontics at the UCLA School of Dentistry. “People who do a good job can do a good job with either.”

To get the most out of every toothbrushing session:
Hold it at the proper angle. “The biggest mistake most people make is holding their brush at 90 degrees, which cleans the teeth but not the gums,” says Camargo. “Bacteria grows in the space between the teeth and gums, and in order to disrupt it, you need to use the bristles at a 45-degree angle and get them below the gum line.”

Brush two at a time. Work your way methodically around your mouth, focusing your attention on two teeth at a time, suggests Tang. “If you’re using a powered brush, just set it on those two teeth and let it do its thing, then move on to the next two,” she says.

Be thorough. “Regardless of what type of brush you use, you still have to make sure the bristles touch every surface of every tooth,” Messina says. Clean the front and back sides of all your teeth, top and bottom, including the sharp edges. You also need to get the brush behind your back teeth. For good measure, use your brush to go over the surface of your tongue, to reduce bacteria and prevent bad breath.

Use the right touch. “There’s a fine line between doing a good job and overdoing it,” Camargo says. If you’re concerned that you're brushing too hard, try this trick: Instead of grasping the brush in your fist, hold it with just your fingertips. “It doesn’t allow you to put as much pressure on your gums,” Tang says. And know the signs of overly aggressive brushing: tooth sensitivity, bleeding or irritated gums, receding gums, and splayed toothbrush bristles.

Replace regularly. You’ll need to break out a new toothbrush—or new brush head for a powered toothbrush—every three to four months. If you notice the bristles are frayed or splaying open, it’s definitely time for a new one. “Splayed bristles can no longer effectively get under the gum line,” Camargo says.

Last, consider this: Plastic toothbrushes create a lot of trash—of the type that doesn’t break down easily. With powered models, you’re typically tossing a little less plastic because it’s only the brush head that’s replaced regularly. However, some manufacturers now offer manual toothbrushes with replaceable heads. And some companies make manual brushes from sustainable bamboo, compostable bio-plastic, or cellulose (plastic generated from wood)—though these aren't necessarily ADA-approved. 

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