Manual vs. electric toothbrushes: Which is better for your teeth ...

Some electric toothbrushes are better at removing plaque than manual toothbrushes.
Manual toothbrushes are usually less expensive than electric ones and more easily portable.
Patients need to talk with their dentist to choose the brush that best fits their individual needs.
Brushing your teeth is a cornerstone of dental health. It is the most effective way to remove dental plaque, which helps prevent cavities, gingivitis, and more serious gum disease. But what kind of toothbrush is best?
Certain types of electric toothbrushes are better at removing plaque than manual toothbrushes, according to Sally Cram, DDS, a periodontist and spokesperson for the American Dental Association. However, patients need to talk with their dentist to choose which toothbrush best fits their individual needs.
Learn the pros and cons of manual and electric toothbrushes, plus what to look for when you are deciding which brush is right for your dental care routine.
What to look for in a manual toothbrush
Manual toothbrushes are usually less expensive than their electric counterparts, but studies show they are not necessarily as effective at reducing plaque and gingivitis.
If you want to use a manual toothbrush, Cram says to look for one with a small, compact head to reach back teeth.
Brushing with hard bristles may damage your gums, says David Leader, DMD, associate professor at Tufts University School of Dental Medicine.
No matter how stiff the bristles are, they are not going to remove tartar from your teeth, but they may remove gum tissue, which can lead to tooth sensitivity and gum recession.
Pros and cons of manual toothbrushes
When deciding which type of manual toothbrush to buy, your dentist may tell you to consider some of the following pros and cons:
Pros
Portable. It is easy to bring a manual toothbrush to the office, to keep one in your purse, or use it while traveling.
Inexpensive. The average manual toothbrush in a drugstore or supermarket costs less than $10.
Widely available. Manual toothbrushes are sold at most pharmacies or grocery stores.
No batteries: There is no need for a power supply, nor does it cause battery waste.
Cons
Missing hard-to-reach spots. "I noticed it seems like almost everybody wants a toothbrush with a head on the toothbrush that's too big," Leader says. People may want to choose a compact brush head to make sure they are properly cleaning their teeth. However, when used properly, a manual toothbrush can be as effective as an electric toothbrush. Flossing is key — neither brushing technique is complete without it.
Less effective for cleaning teeth. A 2014 review found a manual toothbrush was less effective at removing plaque and preventing gingivitis in both the long and short-term when compared to an electric toothbrush, but the authors caution more standardization of the experiments is needed.
Creates excess plastic waste. Experts say toothbrushes need to be replaced about every three months or when the bristles start fraying, which generates plastic waste.
Bristles may be more abrasive than electric brushes. If you are brushing too hard with a manual toothbrush or using bristles that are too stiff, it is difficult to tell. Unlike many electric toothbrushes, there is no warning alarm if you are applying too much pressure to the gums.
What to look for in an electric toothbrush
There are a variety of electric toothbrushes. Three popular types of electric toothbrushes include:
Oscillating rotary heads, which are circular heads that both spin and move back and forth.
Sonic brush heads, which vibrate back and forth extremely fast.
Ultrasonic brushes, which vibrate at a frequency beyond the limit of human sound, hence the name ultrasonic.
There are very few clinical trials comparing the different types of electric toothbrushes that are not company-sponsored, so more independent research is needed to determine whether one type is more effective than another.
Cram recommends a sonic toothbrush. She says "the bristles get further in between your teeth, in those tight spaces and further down under that little collar of gum tissue that surrounds each of your teeth."
What research says: A 2016 review that compared battery type in different electric toothbrushes found that brushes with rechargeable rather than replaceable batteries did a better job at removing plaque.
Pros & cons of electric toothbrushes
Studies show the best electric toothbrush may have an edge up compared to manual toothbrushes for keeping your mouth healthy. Still, it's worthwhile to consider the pros and cons before purchasing and discuss with your dentist.
Pros
More effective at reducing plaque and gingivitis than a manual toothbrush. Over an 11-year time period, a large 2019 study in Germany found those who used electric toothbrushes had better overall oral health, including less gum disease and tooth loss than those who used manual brushes.
In a 2014 review, an analysis of 56 studies showed electric toothbrushes are more effective at removing plaque and preventing gingivitis in the long and short term when compared to manual toothbrushes. Researchers found an 11% reduction in plaque short-term and a 21% reduction long-term compared to manual toothbrushes.
Better for gum health in people with braces. The results of a 2017 review indicated orthodontic patients may have better gum health, including less inflammation and less bleeding if they use an electric toothbrush instead of a manual one, but more long-term research is needed.
Better for children. One small 2013 study found that an electric toothbrush was more effective at removing plaque than a manual toothbrush in children ages 8 to17 years old.
Better for seniors. Electric toothbrushes are good for older people because the handles are easier to hold on to and the vibrations make them easier to use without vigorous arm or hand movements. It is especially effective for people with issues like arthritis. When positioned correctly, the head of the device does the work.
Better for some people with skin conditions. Leader says he works with patients who have scleroderma, which causes tight skin around the mouth. For them, electric toothbrushes are much easier to use than manual brushes.
Extra features. Different types of electric toothbrushes come with features that can help you track your brushing, such as the ability to link with your smartphone through an app. They also have timers and sensors, which help you brush for the right amount of time, i.e. two minutes, and not press too hard.
Cons
Cost: An electric toothbrush generally costs between $30 and $200, which is more expensive than a typical $10 manual toothbrush. You will need to replace the brush head around four times a year; they range between $1 and $10 each depending on the brand.
Loud: Electric toothbrushes are significantly louder than their manual counterparts, which can be annoying or disruptive to some.
Using with too much force: Abrasions and associated sensitivity can occur when people use an electric toothbrush along with a forceful hand. This can cause damage to the oral tissues.
Manual vs. electric toothbrush
Electric toothbrushes may be more expensive than their manual counterparts, but studies show they are more effective at reducing plaque and gingivitis than manual toothbrushes.
Here is a brief break down of the pros and cons of both manual and electric toothbrushes:
Manual toothbrush
Electric toothbrush
Cost
Typically $1-$10
Typically $25-$200
Customer
Good for those looking for a compact, portable brush
Good for those looking for a brush with extra features and a handle that is easy to hold onto
Effectiveness
A 2012 review found plaque has reduced an average of 42% with manual brushing. Using a manual toothbrush is also effective at reducing gingivitis.
More effective at reducing plaque and gingivitis than manual brushes. Researchers found an 11% reduction in plaque short-term and a 21% reduction long-term compared to manual toothbrushes.
Safety
Can be hard on gums if someone brushes too forcefully or uses bristles that are too hard
Typically have pressure sensors, making it difficult to brush too hard and damage gums
Need to be replaced
Replace the whole toothbrush every 2-3 months
Replace the toothbrush head every 2-3 months
Who may benefit most
People in need of a portable, inexpensive toothbrush
Good for those who have disabilities or dexterity issues
Sustainability
Generates plastic waste
Generates plastic waste, but it may be less than a manual toothbrush. Can also generate battery waste
Insider's takeaway
People have been brushing their teeth in some fashion for thousands of years. The first toothbrush with nylon bristles was sold in 1938 while the first electric toothbrush was first patented in 1937 — though it didn't catch on until decades later.
Manual toothbrushes are small and portable while electric toothbrushes generally have larger handles, making them bulkier and easier to hold onto for children and people with disabilities. Experts agree that a discussion with your dentist is necessary to determine the best type of toothbrush for you.
Leader says for people who can easily use both types, the best toothbrush is "whichever one you are more likely to use."
Brushing is only part of a complete oral health care process. Observing dietary habits, flossing, and antibacterial rinsing are essential components of a healthy oral hygiene plan.