Association between toothbrush bristle stiffness and dentine hypersensitivity: a systematic review
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C Molina1, R P Pimentel2, Hjr Oballe2
1PhD student, Postgraduate Program in Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Universidad Internacional del Ecuador-UIDE, Quito, Ecuador.
Background:
Dentine hypersensitivity (DH) is a common condition that affects oral health-related quality of life. Toothbrush bristle stiffness has been suggested as a contributing factor. This systematic review aimed to answer the question: Is there an association between toothbrush bristle stiffness and the prevalence of dentine hypersensitivity in adults?
Methods:
A structured literature search was conducted in PubMed, EMBASE, Scopus, and Web of Science up to January 2025, following PRISMA guidelines. Search terms included "dentine hypersensitivity," "toothbrush bristle," "bristle stiffness," and related keywords. Observational studies assessing DH in individuals using toothbrushes with different bristle stiffness (soft, medium or hard) were included. Studies involving participants under 18 or those with orthodontic appliances were excluded. Two reviewers independently screened the studies and assessed quality using the JBI Appraisal Checklist.
Results:
Of 2694 records, 2 cross-sectional studies met the inclusion criteria. One reported similar DH prevalence with soft (35.6%) and medium or hard (32.7%) bristles. The other found a slightly higher prevalence with medium bristles (53%). No significant associations were reported. A narrative synthesis was performed due to heterogeneity.
Discussion:
Both studies had a high risk of bias, they showed inconsistencies in measuring bristle stiffness and failed to control for confounding factors such as brushing force or technique. The GRADE assessment rated the quality of evidence as very low.
Conclusion:
There is no clear association between toothbrush bristle stiffness and DH prevalence. Brushing technique and force may be more influential and should be emphasized in clinical recommendations.
