Eighteen studies (n=4,457) were included in the review: one RCT (n=109); one cohort study (n=25); and 16 cross-sectional studies (n=4,323).
Use of both powered and non-powered toothbrushes was associated with a significant decrease in recessions on buccal tooth surfaces (reported in the RCT). Eight studies reported an association between tooth brushing frequency and gingival recession; one study reported a significantly increased likelihood of development of gingival recession in participants that brushed more than once a day compared to less frequent brushing (odds ratio was 2.1). One study reported that participants that brushed for more than three minutes had a mean severity of gingival recession twice that of those who brushed less than one minute. Two studies found that force was significantly associated with gingival recession. Higher standards of hygiene (three studies), hardness of brush or toothbrush bristles (four studies) and frequency of changing toothbrush (three studies) were associated with development of gingival recession.
Two studies found no association between tooth brushing frequency and gingival recession. One study was inconclusive that toothbrushing was an indirect aetiological factor for gingival recession.