What do systematic reviews say?

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

Interdental brushing plus toothbrushing may leads to lower gingivitis (proportion of bleeding sites) compared with flossing plus toothbrushing (low certainty).

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

  4 to 6 weeks
  MD -0.06 [-0.08, -0.03]
  6 studies · 234 participants
  Low
• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  4 to 6 weeks
  SMD -0.40 [-0.70, -0.11]
  3 studies · 183 participants
  Low
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  1 month (4 to 6 weeks)
  SMD -0.53 [-0.81, -0.24]
  7 studies · 326 participants
  Low

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

Rubber/elastomeric cleaning stick plus toothbrushing vs Interdental brushing plus toothbrushing

It is very uncertain whether rubber/elastomeric cleaning stick plus toothbrushing changes plaque compared with interdental brushing plus toothbrushing (very low certainty).

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

  4 to 6 weeks
  SMD 0.08 [-0.33, 0.49]
  2 studies · 92 participants
  Very low

Wooden cleaning stick plus toothbrushing vs Flossing plus toothbrushing

It is very uncertain whether wooden cleaning stick plus toothbrushing changes plaque 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

  3 months
  MD 0.02 [-0.06, 0.10]
  1 study · 24 participants
  Very low

Rubber/elastomeric cleaning stick plus toothbrushing vs Flossing plus toothbrushing

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Five studies assessed adverse events. One did not report findings, but the others reported either no adverse events or minor adverse events that did not significantly differ between interventions.
  5 studies
  GRADE not reported

Rubber/elastomeric cleaning stick plus toothbrushing vs Flossing plus toothbrushing

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  One study measured periodontitis but the data were not usable (Smith 1988 measured PPD but data unusable).
  1 study
  GRADE not reported

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

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

It is very uncertain whether interdental brushing plus toothbrushing changes plaque 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 (4 to 6 weeks)
  SMD -0.47 [-0.84, -0.11]
  5 studies · 290 participants
  Very low
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  1 month (4 to 6 weeks)
  SMD 0.10 [-0.13, 0.33]
  7 studies · 326 participants
  Low
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  3 months (12 weeks)
  SMD -2.14 [-5.25, 0.97]
  2 studies · 107 participants
  Very low

Rubber/elastomeric cleaning stick plus toothbrushing vs Interdental brushing plus toothbrushing

It is very uncertain whether rubber/elastomeric cleaning stick plus toothbrushing changes gingivitis (proportion of bleeding sites) compared with interdental brushing 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 -0.02 [-0.10, 0.06]
  1 study · 31 participants
  Very low
• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  4 to 6 weeks
  MD 0.10 [-0.32, 0.52]
  1 study · 61 participants
  Very low

Oral irrigation plus toothbrushing vs Toothbrushing alone

Oral irrigation plus toothbrushing showed no clear difference in plaque compared with toothbrushing alone (low certainty).

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

  1 month
  SMD -0.16 [-0.41, 0.10]
  3 studies · 235 participants
  Low

Rubber/elastomeric cleaning stick 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 caries as an outcome.
  0 studies
  No studies found

Interdental brushing 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
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed caries as an outcome. (See comment)
  0 studies
  No studies found

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
  Three studies reported that there were no adverse events, one reported one incidence of aphthous ulcer in irrigator group, one reported oral lacerations but found no difference between the interventions, and one did…
  5 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

Rubber/elastomeric cleaning stick 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
  Harms and adverse outcomes: Not reported (neither study reported on adverse effects).
  0 studies
  No studies found

Rubber/elastomeric cleaning stick 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 mentioned PPD as outcome but no data).
  1 study
  GRADE not reported

Wooden cleaning stick 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

Interdental brushing 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

Interdental brushing 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 caries as an outcome.
  0 studies
  No studies found
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed caries as an outcome. (See comment)
  0 studies
  No studies found

Wooden cleaning stick 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
  Gingivitis measured by gingival index: Not measured.
  0 studies
  No studies found
• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes

  3 months
  MD 0.01 [-0.12, 0.14]
  1 study · 24 participants
  Very low