Brushing teeth appears to be commonly recommended, but the evidence appears to be anecdotal. Have any randomized prospective trials been done to determine the efficacy of brushing to prevent conditions such as dental caries?

I am interested in research that measures dental disease, not merely plaque removal.

A Google Scholar search for "brush teeth" returns articles that:

  • Compare toothbrushes (eg, traditional vs electronic)
  • Compare toothpastes
  • Test pre-brush mouth washes
  • Editorials/Opinions about brushing
  • Survey attitudes toward brushing
  • Test new vs old toothbrushes
  • Test brush strokes against each other
  • Test different electric toothbrush heads
  • Etc.

Within the first 20 pages, no articles test the efficacy of brushing. Around page 16, results became less relevant to brushing.

I have looked through the list of ADA references that JonMark Perry refers to. They don't address brushing vs not or the prevention of dental conditions, such as caries. For instance:

  • The first article, and a few others, are about plaque or biofilm removal, which may or may not be related to dental caries. Since approximately 100% of the population has dental plaque, it's not a useful predictor of dental disease.

  • Second article is about fluoride levels, not dental caries, or other dental conditions. It also tests brushing duration, rather than brushing vs not brushing.

  • Several about brush design.

  • Some about brush contamination and sanitation.
  • Some about gingival abrasion and recession.

A list of references to research papers on the topic of the possible benefits of brushing teeth can be found at:


under 'References'.

For example, the first three are:

  • Creeth JE, Gallagher A, Sowinski J, et al. The effect of brushing time and dentifrice on dental plaque removal in vivo. J Dent Hyg 2009;83(3):111-6.
  • Newby EE, Martinez-Mier EA, Zero DT, et al. A randomised clinical study to evaluate the effect of brushing duration on fluoride levels in dental biofilm fluid and saliva in children aged 4-5 years. Int Dent J 2013;63 Suppl 2:39-47.
  • Darby ML, Walsh MM. Dental Hygiene: Theory and Practice. St. Louis: Saunders; 2010.

According to 2 recent systematic reviews, tooth brushing frequency is associated with less dental caries. The studies included were case-control, prospective cohort, retrospective cohort, experimental trials...

Tooth brushing frequency and risk of new carious lesions (Evidence Based Dentistry, 2016)

Individuals who state that they brush their teeth infrequently are at greater risk for the incidence or increment of new carious lesions than those brushing more frequently. The effect is more pronounced in the deciduous than in the permanent dentition. A few studies indicate that this effect is independent of the presence of fluoride in toothpaste.

Effect of Toothbrushing Frequency on Incidence and Increment of Dental Caries: A Systematic Review and Meta-Analysis (Journal of Evidence Based Dental Practice, 2017)

The authors concluded that the self-reported infrequent brushers had a higher incidence and increment of dental caries than those individuals reported to be frequent brushers. The effect of infrequent brushing on the caries rates was higher for primary teeth than for permanent teeth.

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