What do systematic reviews say?

Brushing vs No treatment (immersion in distilled water)

• Interventions for cleaning dentures in adults 2009 · Cochrane All outcomes
  Moore 1984 found that the seven tested methods were similar and resulted in a significant reduction in total aerobes and anaerobes compared with immersion in distilled water (paired t test, P < 0.05). Some chemical…
  1 study · 12 participants
  GRADE not reported

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

Electric toothbrush (self, carer or carer-assisted brushing) showed no clear difference in plaque (medium term) compared with manual toothbrush (self, carer or carer-assisted brushing) (low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  SMD 0.29 [-0.07, 0.65]
  2 studies · 120 participants
  Low
• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  Assorted plaque indices scale 0-5, 1-4 weeks; 247 participants (4 RCTs); Very Low. Uncertain effect on plaque short term: 2 studies (69 participants) favoured the electric toothbrush; 2 studies (178 participants)…
  4 studies · 247 participants
  Very low

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Long term (>12 months)
  Comparison 2.8 (reported; not GRADE-rated). One NRS (Bratel 1991, 23 participants), self-efficacy at 16 months: 10/12 people with ID using the electric toothbrush reported a preference for it, finding it easier to use…
  1 study · 23 participants
  GRADE not reported

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  Electric vs manual toothbrush. Assorted gingival indices scale 0-4, 2-4 weeks; 252 participants (4 RCTs); Low. Four studies showed no significant differences for gingival inflammation short term; data could not be…
  4 studies · 252 participants
  Low

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

Electric toothbrush (self, carer or carer-assisted brushing) showed no clear difference in gingival inflammation (medium term) compared with manual toothbrush (self, carer or carer-assisted brushing) (moderate certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD 0.02 [-0.06, 0.09]
  2 studies · 120 participants
  Moderate

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

Electric toothbrush (self, carer or carer-assisted brushing) showed no clear difference in calculus (medium term) compared with manual toothbrush (self, carer or carer-assisted brushing) (low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  SMD -0.04 [-0.40, 0.32]
  2 studies · 120 participants
  Low

Special manual toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  Comparison 1.5 (graded in the Effects of interventions text; not tabulated in the SoF). Single-use suction toothbrush vs standard manual toothbrush (both with a chemical agent), 90 days, Ferozali 2007: Total Oral…
  1 study · 22 participants
  Very low

Special manual toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  Comparison 1.6 (graded in the Effects of interventions text; not tabulated in the SoF). Bildt 2010, Superbrush vs conventional, 4 months, 18 participants (1 RCT): carer handling of toothbrush MD 0.50 (95% CI -0.35 to…
  1 study · 18 participants
  Very low

Special manual toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

It is very uncertain whether special manual toothbrush (self, carer or carer-assisted brushing) changes plaque (short term) compared with conventional manual toothbrush (self, carer or carer-assisted… (very low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  MD 0.20 [-0.45, 0.85]
  1 study · 25 participants
  Very low
• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD -0.44 [-0.93, 0.05]
  1 study · 18 participants
  Very low

Special manual toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

Special manual toothbrush (self, carer or carer-assisted brushing) showed no clear difference in gingival inflammation (short term) compared with conventional manual toothbrush (self, carer or carer-assisted… (low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  MD -0.10 [-0.77, 0.57]
  1 study · 25 participants
  Low

Special manual toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

It is very uncertain whether special manual toothbrush (self, carer or carer-assisted brushing) changes gingival inflammation (medium term) compared with conventional manual toothbrush (self, carer or carer-assisted… (very low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD -12.40 [-24.31, -0.49]
  1 study · 18 participants
  Very low

Flossing plus toothbrushing vs Toothbrushing alone

The review found no eligible studies for this question.

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  No included study assessed caries as an outcome.
  0 studies
  No studies found

Flossing plus toothbrushing vs Toothbrushing alone

It is very uncertain whether flossing plus toothbrushing changes gingivitis (proportion of bleeding sites) compared with toothbrushing alone (very low certainty).

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  MD -0.03 [-0.14, 0.08]
  2 studies · 158 participants
  Very low
• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  SMD -0.58 [-1.12, -0.04]
  8 studies · 585 participants
  Low

Flossing plus toothbrushing vs Toothbrushing alone

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Adverse effects were assessed and reported in seven studies. Three reported no adverse events on the oral hard or soft tissues. Four reported sporadic adverse events with mild severity, with no evidence of a difference…
  7 studies
  GRADE not reported

Flossing plus toothbrushing vs Toothbrushing alone

It is very uncertain whether flossing plus toothbrushing changes plaque compared with toothbrushing alone (very low certainty).

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  SMD -0.42 [-0.85, 0.02]
  7 studies · 542 participants
  Very low

Flossing plus toothbrushing vs Toothbrushing alone

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  One study measured probing pocket depth but no data were reported (Graziani 2017).
  1 study
  GRADE not reported

Oral irrigation plus toothbrushing vs Flossing plus toothbrushing

The review found no eligible studies for this question.

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  No included study assessed periodontitis.
  0 studies
  No studies found

Oral irrigation plus toothbrushing vs Flossing plus toothbrushing

It is very uncertain whether oral irrigation plus toothbrushing changes gingivitis (gingival index) compared with flossing plus toothbrushing (very low certainty).

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  MD -0.06 [-0.12, 0.00]
  1 study · 63 participants
  Very low
• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  MD -0.12 [-0.19, -0.05]
  2 studies · 133 participants
  Low

Oral irrigation plus toothbrushing vs Toothbrushing alone

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Periodontitis measured in one study but useable data not provided (Walsh 1989 reported proportion of sites with >4 mm pocket depth at 3 months but not mean PD; attachment loss measured but no data).
  1 study
  GRADE not reported

Oral irrigation plus toothbrushing vs Toothbrushing alone

It is very uncertain whether oral irrigation plus toothbrushing changes gingivitis (gingival index) compared with toothbrushing alone (very low certainty).

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  SMD -0.48 [-0.89, -0.06]
  4 studies · 380 participants
  Very low
• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  1 month
  MD -0.00 [-0.07, 0.06]
  2 studies · 126 participants
  Low