Biodegradable oral hygiene tools show no clear plaque reduction versus plastic toothbrushesNatural toothbrushes work as well as plastic for plaque

Frontiers in Medicine Published June 25, 2026 Study authors: Frank Mayta-Tovalino, Fran Espinoza-Carhuancho, Cesar Mauricio-Vilchez, Ivan Calderon-Cortez, Miguel… DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Interpret the lack of clear plaque reduction with biodegradable tools cautiously due to very low certainty evidence.

This meta-analysis evaluated the effectiveness of biodegradable or natural oral hygiene tools (e.g., bamboo toothbrushes, miswak) compared with conventional plastic toothbrushes for plaque control in children and adults. The analysis included 408 participants. The primary outcome was plaque index (PI).

The pooled result showed no clear difference between groups, with a mean difference of -0.09 (95% CI -0.47 to 0.29). The authors note that the certainty of evidence is very low (GRADE), and there was very high statistical heterogeneity (I2 = 89%). Additionally, the included studies had a high risk of bias.

Limitations include the very low certainty of evidence, high heterogeneity, and high risk of bias. Adverse events and follow-up duration were not reported. The authors conclude that biodegradable and natural oral hygiene products may result in little to no difference in plaque control compared with conventional plastic toothbrushes, but confidence in this estimate is very low.

For clinicians, these findings suggest that switching to biodegradable tools is unlikely to provide superior plaque control, but the evidence is too weak to draw firm conclusions. Patients may choose such products for environmental reasons without expecting improved oral hygiene outcomes.

How this fits prior evidence

This meta-analysis extends prior coverage of interdental brushes for orthodontic patients by examining a different category of oral hygiene tools (biodegradable/natural) in a broader population. While the prior systematic review suggested interdental brushes may reduce plaque, the current analysis found no clear difference between biodegradable tools and plastic toothbrushes, though both findings are limited by low-certainty evidence. The results contrast with the potential benefit seen for interdental brushes, but direct comparisons are not possible due to different interventions and populations.

A new analysis of 408 people found that biodegradable or natural oral hygiene tools, such as bamboo toothbrushes and miswak sticks, may remove plaque about as well as conventional plastic toothbrushes. The study combined results from several smaller trials to compare plaque index scores between the two types of tools.

However, the evidence is not strong enough to draw firm conclusions. The researchers noted very high statistical heterogeneity, meaning the individual study results varied widely. They also rated the overall certainty of the evidence as very low, and there was a high risk of bias in the included studies.

No safety concerns were reported in the analysis, but the studies did not provide information on side effects or how well people tolerated the natural tools.

For now, people who prefer eco-friendly options can feel reasonably confident that natural tools are likely not worse than plastic for plaque control. But the findings are preliminary, and more rigorous research is needed to confirm any differences.

What this means for you:

Natural oral hygiene tools may be a reasonable alternative to plastic toothbrushes, but evidence is weak.

Common questions

Do bamboo toothbrushes clean teeth as well as plastic ones?

This analysis found no clear difference in plaque removal between biodegradable tools like bamboo toothbrushes and conventional plastic toothbrushes. However, the evidence is very low certainty, so more research is needed.

Is using a miswak stick better than a regular toothbrush?

The study included miswak sticks as a natural tool and found they performed similarly to plastic toothbrushes for plaque control. But the results are not definitive due to high variability and low confidence in the evidence.

Are natural oral hygiene tools safe?

The analysis did not report any adverse events or safety concerns. However, safety data were not provided in the included studies, so it is not possible to fully assess risks.

Should I switch from a plastic toothbrush to a natural one?

The findings suggest natural tools may be a reasonable option, but the evidence is weak. If you are considering a switch, talk to your dentist about what is best for your oral health.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Due to the immense environmental impact of plastic waste, there has been a significant increase in interest for both biodegradable and natural toothbrushes (BT) as sustainable forms of daily oral care. This includes bamboo toothbrushes, as well as plant-based products (i.e., miswak). As such, these two types of products can be considered similar because they are both renewable and biodegradable in nature. However, their effectiveness when compared to traditional plastic toothbrushes at controlling dental biofilm has not been fully established. To evaluate the effectiveness of biodegradable and natural oral hygiene tools compared with conventional plastic toothbrushes for controlling dental plaque in children and adults. This systematic review/meta-analysis was reported according to PRISMA guidelines, and its protocol was registered in PROSPERO. All databases were searched using electronic methods from their inception to December 2025: PubMed, Scopus, Web of Science, and Embase. All randomized controlled trials (RCTs) that examined biodegradable/natural oral hygiene products compared to conventional plastic toothbrushes and that had plaque index (PI) as outcome were included. The analyses used random effects model, and certainty of evidence was evaluated using GRADE methodology. Five RCTs (n = 408) met the criteria for inclusion. There was no clear difference in plaque index between biodegradable/natural oral hygiene tools and conventional plastic toothbrushes [mean difference (MD): −0.09, 95% CI: −0.47 to 0.29]. However, the pooled estimate was characterized by very high statistical heterogeneity (I2 = 89%) and the certainty of the evidence was rated as very low, which substantially limits confidence in this result. The results of subgroup analyses according to type of oral hygiene tool and population did not show any meaningful differences from those of the pooled analysis. The overall certainty of evidence was rated as very low and had a high risk of bias. Biodegradable and natural oral hygiene products may result in little to no difference in plaque control compared with conventional plastic toothbrushes; however, confidence in this estimate was very low. Well-designed, adequately powered RCTs are required to reduce uncertainty and inform evidence-based clinical and sustainability-related recommendations. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251273997, PROSPERO CRD420251273997.

Biodegradable oral hygiene tools show no clear plaque reduction versus plastic toothbrushesNatural toothbrushes work as well as plastic for plaque

How this fits prior evidence

Common questions

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How this fits prior evidence

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