title: Does tooth brushing influence the development and progression of non-inflammatory gingival recession? A systematic review.
abstract: OBJECTIVE
  The aim of this systematic review was to produce the best available evidence and pool appropriate data to evaluate the effect of tooth brushing on the initiation and progression of non-inflammatory gingival recession.
  
  
  METHODS
  A protocol was developed a priori for the question: "Do factors associated with tooth brushing predict the development and progression of non-inflammatory gingival recession in adults?" The search covered six electronic databases between January 1966 and July 2005. Hand searching included searches 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. Inclusion of titles, abstracts and ultimately full texts was based on consensus between three reviewers.
  
  
  RESULTS
  The full texts of 29 papers were read and 18 texts were eligible for inclusion. One abstract from EuroPerio 5 reported a randomized-controlled clinical trial [Level I evidence] in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over 18 months. Of the remaining 17 observational studies, two concluded that there appeared to be no relationship between tooth brushing frequency and gingival recession. Eight studies reported a positive association between tooth brushing frequency and recession. Other potential risk factors were duration of tooth brushing, brushing force, frequency of changing the toothbrush, brush (bristle) hardness and tooth brushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal and a valid appraisal of the quality of the randomized-controlled trial was not possible.
  
  
  CONCLUSIONS
  The data to support or refute the association between tooth brushing and gingival recession are inconclusive.
authors.affiliation: University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: P Sunethra
authors.initials: PS
authors.lastname: Rajapakse
authors.forename: Giles I
authors.initials: GI
authors.lastname: McCracken
authors.forename: Erika
authors.initials: E
authors.lastname: Gwynnett
authors.forename: Nick D
authors.initials: ND
authors.lastname: Steen
authors.forename: Arndt
authors.initials: A
authors.lastname: Guentsch
authors.forename: Peter A
authors.initials: PA
authors.lastname: Heasman
mesh_terms: D003773:Dental Plaque / Q000628:therapy; D018450:Disease Progression; D004560:Electricity; D005889:Gingival Recession / Q000209:etiology*; D006801:Humans; D009910:Oral Hygiene / Q000295:instrumentation / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014099:Toothbrushing / Q000009:adverse effects* / Q000295:instrumentation