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Each row is one question a systematic review asked: who, what, compared with what, and which outcome, with the effect it found and how certain that is. Words match anywhere in the field.
793 questions in 32 reviews · Periodontology
current versionsNo studies 148 · 18.7%Ungraded 429 · 54.1%Very low 137 · 17.3%Low 53 · 6.7%Moderate 14 · 1.8%High 12 · 1.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
| Question | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Powered toothbrush (any mode of action) vs Manual toothbrush Gingivitis score (>3 months) · Individuals of any age with no reported disability that might affect toothbrushing (including people wearing… · Long term (>3 months) Powered versus manual toothbrushing for oral health (2014) · Cochrane | SMD -0.21 [-0.31, -0.12] | 16 studies · 1645 participants | Moderate |
Powered toothbrush, side-to-side action vs Manual toothbrush Gingivitis score (1 to 3 months) · Individuals of any age with no reported disability that might affect toothbrushing (including people wearing… · Short term (1 to 3 months) Powered versus manual toothbrushing for oral health (2014) · Cochrane | SMD -0.32 [-0.81, 0.17] | 9 studies · 795 participants | Ungraded |
Powered toothbrush (any mode of action) vs Manual toothbrush Plaque score (>3 months) · Individuals of any age with no reported disability that might affect toothbrushing (including people wearing… · Long term (>3 months) Powered versus manual toothbrushing for oral health (2014) · Cochrane | SMD -0.47 [-0.82, -0.11] | 14 studies · 978 participants | Moderate |
Powered toothbrush, ultrasonic action vs Manual toothbrush Plaque score (1 to 3 months) · Individuals of any age with no reported disability that might affect toothbrushing (including people wearing… · Short term (1 to 3 months) Powered versus manual toothbrushing for oral health (2014) · Cochrane | SMD -1.33 [-1.59, -1.07] | 4 studies · 301 participants | Ungraded |
Powered toothbrush (any mode of action) vs Manual toothbrush Cost (relative cost of powered vs manual) · Individuals of any age with no reported disability that might affect toothbrushing (including people wearing… Powered versus manual toothbrushing for oral health (2014) · Cochrane | None of the included trials reported on the relative costs of manual compared with powered toothbrushes. | 0 studies | No studies |
Powered toothbrush, ultrasonic action vs Manual toothbrush Gingivitis score (>3 months) · Individuals of any age with no reported disability that might affect toothbrushing (including people wearing… · Long term (>3 months) Powered versus manual toothbrushing for oral health (2014) · Cochrane | Ultrasonic vs manual, gingivitis at >3 months: one trial (Terezhalmy 1995a); no statistically significant difference; totals not selected (no pooled estimate presented in this version). | 1 study · 46 participants | Ungraded |
Interdental brushing plus toothbrushing vs Toothbrushing alone Harms and adverse effects · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. Only 1 study reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids. (See comment) In this comparison the single study (Jared 2005) asked participants to… | 1 study | Ungraded |
Interdental brushing plus toothbrushing vs Toothbrushing alone Bad breath (halitosis) · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed bad breath as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Gingivitis (bleeding and gingival indices; standardised across indices) · Dentate adults aged 16 years and older · 1 month (4 to 6 weeks) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | SMD -0.53 [-0.81, -0.24] | 7 studies · 326 participants | Low |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Interproximal caries · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed caries as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Plaque (plaque indices; standardised across indices) · Dentate adults aged 16 years and older · 1 month (4 to 6 weeks) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | SMD 0.10 [-0.13, 0.33] | 7 studies · 326 participants | Low |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Gingivitis (bleeding and gingival indices; standardised across indices) · Dentate adults aged 16 years and older · 3 months (12 weeks) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | SMD -1.98 [-5.42, 1.47] | 2 studies · 107 participants | Very low |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Bad breath (halitosis) · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed bad breath as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Toothbrushing alone Quality of life · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed quality of life as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Toothbrushing alone Gingivitis (Loe-Silness gingival index, interproximal; scale 0 to 4) · Dentate adults aged 16 years and older · 4 weeks (1 month) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | MD -0.53 [-0.83, -0.23] | 1 study · 62 participants | Very low |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Quality of life · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed quality of life as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Toothbrushing alone Interproximal caries · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed caries as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Harms and adverse effects · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. 2 studies reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids. We were unable to pool data. (See comment) Three further studies reported that no adverse… | 5 studies | Ungraded |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Plaque (plaque indices; standardised across indices) · Dentate adults aged 16 years and older · 3 months (12 weeks) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | SMD -2.14 [-5.25, 0.97] | 2 studies · 107 participants | Very low |
Interdental brushing plus toothbrushing vs Toothbrushing alone Periodontitis (clinical attachment loss) · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed periodontitis as an outcome. (See comment) | 0 studies | No studies |
Interdental brushing plus toothbrushing vs Toothbrushing alone Plaque (Quigley & Hein plaque index, Turesky modification; scale 0 to 5) · Dentate adults aged 16 years and older · 4 weeks (1 month) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | MD -0.95 [-1.34, -0.56] | 1 study · 62 participants | Very low |
Interdental brushing plus toothbrushing vs Flossing plus toothbrushing Periodontitis (clinical attachment loss) · Dentate adults aged 16 years and older Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults (2013) · Cochrane | Not estimable. No included study assessed clinical attachment loss, a measure of progression of periodontitis. (See comment) | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Plaque (Turesky-modified Quigley-Hein/other plaque indices; SMD) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) · 1 month (mean 29 days) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | SMD -0.23 [-0.52, 0.06] | 5 studies · 416 participants | Very low |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Harms and adverse effects · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not estimable (5 studies). Adverse effects were assessed in five studies, but they used different outcome measures, so meta-analysis was not appropriate. The main harm identified was soft-tissue trauma to the gingival… | 5 studies | Ungraded |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Gingivitis (Gingival Index, 0-3 scale; SMD) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) · 3 months Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | SMD -0.41 [-0.68, -0.14] | 6 studies · 656 participants | Ungraded |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Economic and resource cost of flossing · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not reported. No included study measured the economic or resource cost of flossing; the review notes it may be important to measure in future trials. | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Gingivitis (Loe-Silness/bleeding indices; SMD) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) · 1 month Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | SMD -0.36 [-0.66, -0.05] | 7 studies · 489 participants | Very low |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Interproximal caries · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not estimable (0 studies). See comment: No included study assessed caries as an outcome. | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Plaque (0-5 scale; SMD) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) · 6 months Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | SMD -0.06 [-0.23, 0.12] | 3 studies · 487 participants | Ungraded |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Clinical attachment loss · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not estimable (0 studies). SoF comment reads (verbatim) 'No included study assessed calculus as an outcome' (apparent copy-paste typo in the clinical attachment loss row; no study assessed clinical attachment loss). | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Bad breath (halitosis) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not reported. No included study measured halitosis; the review notes it may be important to measure in future trials. | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Calculus · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not estimable (0 studies). See comment: No included study assessed calculus as an outcome. | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Quality of life · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | Not estimable (0 studies). See comment: No included study assessed quality of life as an outcome. | 0 studies | No studies |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Plaque (0-5 scale; SMD) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) · 3 months Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | SMD -0.20 [-0.36, -0.04] | 5 studies · 594 participants | Ungraded |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse) Gingivitis (Gingival Index, 0-3 scale; SMD) · Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease) · 6 months Flossing for the management of periodontal diseases and dental caries in adults (2011) · Cochrane | SMD -0.72 [-1.09, -0.35] | 4 studies · 564 participants | Ungraded |
Side to side action powered toothbrush vs Counter oscillation powered toothbrush Adverse events · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | One trial (Khocht 1992) reported 'transient abrasions' in both powered toothbrush groups. | 1 study | Ungraded |
Ultrasonic powered toothbrush vs Multidimensional powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | One cross-over trial (Costa 2007) made this comparison; data were not available in a useable form. | 1 study | Ungraded |
Counter oscillation powered toothbrush vs Rotation oscillation powered toothbrush Gingivitis (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months), Adolescents Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Trimpeneers 1997 (36 adolescents); no significant differences between counter oscillation and rotation oscillation for gingival index / bleeding index at 1 and 2 months (P values 0.06 to 0.75); data unsuitable for… | 1 study · 36 participants | Ungraded |
Multidimensional powered toothbrush vs Rotation oscillation powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Analysis 6.1 Plaque < 3 months: 1 trial; totals not selected. The two trials making this comparison (Heasman 1999; Williams 2002) show no significant difference for plaque in the short term (1-3 months). | 1 study | Ungraded |
Side to side action powered toothbrush vs Rotation oscillation powered toothbrush Calculus · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | One trial (Isaacs 1998) reported a significant reduction in lower lingual incisor calculus with rotation oscillation versus side to side in the short term (1-3 months). | 1 study | Ungraded |
Multidimensional powered toothbrush vs Side to side action powered toothbrush Gingivitis (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Analysis 5.2 Gingivitis < 3 months: 2 trials (Patters 2005; Zimmer 2005); considerable heterogeneity, so no statistical pooling was undertaken. | 2 studies | Ungraded |
Side to side action powered toothbrush vs Rotation oscillation powered toothbrush Gingivitis (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Long term (>3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | SMD -0.44 [-0.98, 0.11] | 1 study · 54 participants | Ungraded |
Side to side action powered toothbrush vs Rotation oscillation powered toothbrush Adverse events · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Grossman 1995 reported some discomfort with use of one mode of action brush; Hefti 2000 reported no difference in dentine hypersensitivity. | 2 studies | Ungraded |
Side to side action powered toothbrush vs Rotation oscillation powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | SMD 0.24 [0.02, 0.46] | 5 studies | Ungraded |
Side to side action powered toothbrush vs Counter oscillation powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | SMD -0.02 [-0.37, 0.32] | 2 studies · 130 participants | Ungraded |
Multidimensional powered toothbrush vs Rotation oscillation powered toothbrush Gingivitis (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | SMD 0.24 [-0.10, 0.58] | 2 studies · 137 participants | Ungraded |
Ionic powered toothbrush vs Powered toothbrush with a different mode of action Outcome NR · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Ionic: no included trials investigated this brush type (Table 3, 'Interventions used in included trials'). | NR | No studies |
Side to side action powered toothbrush vs Rotation oscillation powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Long term (>3 months) Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Analysis 2.3 Plaque > 3 months (Turesky): 1 trial; totals not selected (no pooled estimate). No differences between the modes for plaque in the long term (> 3 months). | 1 study | Ungraded |
Counter oscillation powered toothbrush vs Circular powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months), Adolescents Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | Trimpeneers 1997 reported a significant difference in favour of the counter oscillation brush for plaque index at 2 months over a circular mode of action brush; data were unsuitable for meta-analysis. | 1 study · 36 participants | Ungraded |
Counter oscillation powered toothbrush vs Rotation oscillation powered toothbrush Plaque (level reduction) · People of any age with no reported disability affecting their ability to practise normal self-toothbrushing;… · Short term (1-3 months), Adolescents Different powered toothbrushes for plaque control and gingival health (2010) · Cochrane | One cross-over trial of 36 adolescents (Trimpeneers 1997); data not presented in a suitable format for meta-analysis; no significant differences between counter oscillation and rotation oscillation for plaque index /… | 1 study · 36 participants | Ungraded |