What do systematic reviews say?

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

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

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

1450 ppm F toothpaste vs 440 ppm F toothpaste

The review found no eligible studies for this question.

• Fluoride toothpastes of different concentrations for preventing dental caries 2019 · Cochrane All outcomes
  Adverse effects of toothpaste: no studies reported this outcome.
  0 studies
  No studies found

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

1450 ppm F toothpaste vs 250 ppm F toothpaste

The review found no eligible studies for this question.

• Fluoride toothpastes of different concentrations for preventing dental caries 2019 · Cochrane All outcomes
  Adverse effects of toothpaste: no studies reported this outcome.
  0 studies
  No studies found

1055 to 1100 ppm F toothpaste vs 500 to 550 ppm F toothpaste

• Fluoride toothpastes of different concentrations for preventing dental caries 2019 · Cochrane All outcomes

  12 months
  Adverse effects of toothpaste: not estimable. "There were no reports on adverse effects, but some children complained about the taste of the dentifrice" (Cardoso 2014); 195 participants (1 RCT); low-certainty.
  1 study · 195 participants
  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

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 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

Fluoride toothpaste vs Placebo (non-fluoride) toothpaste or fluoride toothpaste of a different concentration

• Fluoride toothpastes of different concentrations for preventing dental caries 2019 · Cochrane All outcomes

  Closest to 36 months
  16 studies assessed possible side effects, principally oral (soft tissue) pathologies and tooth staining. 6 studies reported no untoward events; 6 reported greater staining in the stannous fluoride group; 1 reported no…
  16 studies
  GRADE not reported

1500 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

• Fluoride toothpastes of different concentrations for preventing dental caries 2019 · Cochrane All outcomes

  24 months
  Adverse effects of toothpaste: not estimable; 0 events reported (Fan 2008); 998 participants (1 RCT); low-certainty.
  1 study · 998 participants
  Low

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
  Harms and adverse outcomes: Not reported (neither study reported on adverse effects).
  0 studies
  No studies found

1000 or 1100 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

The review found no eligible studies for this question.

• Fluoride toothpastes of different concentrations for preventing dental caries 2019 · Cochrane All outcomes
  Adverse effects of toothpaste: no studies reported this outcome.
  0 studies
  No studies found

Rubber/elastomeric cleaning stick plus toothbrushing vs Toothbrushing alone

It is very uncertain whether rubber/elastomeric cleaning stick 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
  MD -0.22 [-0.41, -0.03]
  1 study · 30 participants
  Very low