No good evidence to link toothbrushing trauma to gingival recession

Medline, Embase, Web of Knowledge, the Cochrane Central Register of Controlled Trials, Current Contents Connect and the Google Scholar databases were searched. Searches by hand were also made of the Journal of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of narrative reviews, conference proceedings and relevant texts known to the authors were also searched.

Screening of studies was carried out independently by three reviewers and assessed for quality. Studies of Level III, ie, observational studies without control groups (cross sectional studies, before-and-after studies, case series) or better were included. Studies reported in the English, German, Spanish or Greek language were included.

Data were extracted from the full-text articles using a purposely designed data extraction form, and a qualitative summary was carried out.

Eighteen studies were included. One abstract from the meeting EuroPerio 5 reported a randomised-controlled clinical trial (RCT; Level I evidence) in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over the course of 18 months. Of the remaining 17 observational studies, two concluded there was no apparent relationship between toothbrushing frequency and gingival recession. Eight studies reported a positive association between toothbrushing frequency and recession. Other potential risk factors were duration of toothbrushing, brushing force, and frequency of changing the toothbrush, brush (bristle) hardness and toothbrushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal, and a valid appraisal of the quality of the RCT was not possible.

The data to support or refute the association between toothbrushing and gingival recession are inconclusive.