What do systematic reviews say?

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

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

Salvadora persica (miswak) mouthrinse vs Chlorhexidine mouthwash

It is very uncertain whether miswak (Salvadora persica) mouthwash changes dentist-reported organoleptic test (OLT) score (scale 0 to 5) compared with chlorhexidine mouthwash (very low certainty).

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  mean 1 week
  MD 0.01 [-0.95, 0.97]
  1 study · 21 participants
  Very low

Thymosin alpha 1 (10-minute soak prior to replantation) vs Normal saline

• Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted 2019 · Cochrane All outcomes
  Loo 2008 did not report this outcome; following email correspondence, authors reported no adverse effects were seen (uncertain whether formally assessed).
  1 study
  GRADE not reported

Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID

It is very uncertain whether oral hygiene training (toothbrushing routine) of people with ID changes plaque (short term) compared with no oral hygiene training of people with ID (very low certainty).

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

  Short term (<6 weeks)
  MD -0.47 [-0.92, -0.02]
  1 study · 10 participants
  Very low

0.2% zinc sulphate toothpaste vs Placebo toothpaste (without zinc)

0.2% zinc sulphate toothpaste led to lower volatile sulphur compounds (VSC) compared with placebo toothpaste (without zinc); GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  4 weeks
  MD -11.3 [-20.45, -2.15]
  1 study · 188 participants
  GRADE not reported

Salvadora persica (miswak) mouthrinse vs Chlorhexidine mouthwash

It is very uncertain whether miswak (Salvadora persica) mouthwash changes patient self-assessment VAS (scale 0 to 10) compared with chlorhexidine mouthwash (very low certainty).

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  mean 1 week
  MD -0.18 [-1.59, 1.23]
  1 study · 21 participants
  Very low

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs usual care

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene… showed no clear difference in gingival bleeding (long term) compared with usual care (no specific treatment) (low certainty).

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

  Long term (>12 months)
  MD -0.20 [-0.86, 0.46]
  1 study · 304 participants
  Low

Ledermix root canal medicament (day 0 to 10) vs Ultracal root canal medicament (day 7 to 10)

• Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted 2019 · Cochrane All outcomes

  12 months
  Tooth survival at 12 months: Not estimable (due to no events in either arm); 27 teeth in 22 patients (1 RCT). At 12 months, no teeth were lost. 1 tooth was lost at 16 months in the Ultracal group.
  1 study · 22 participants
  Very low

Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID

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

  Long term (>12 months)
  Behaviour, attitude and self-efficacy (steps achieved in a toothbrushing routine), 100 days to 19 months; 59 participants (4 NRS); Very Low. Results not in a format for meta-analysis: 3 NRS (56 participants) reported…
  4 studies · 59 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

Oral hygiene care training of carers vs No training (or a placebo training session) of carers

It is very uncertain whether oral hygiene care training of carers changes behaviour, attitude and self-efficacy of carers (medium term) compared with no training (or a placebo training session) of carers (very low certainty).

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

  Medium term (6 weeks to 12 months)
  MD 0.15 [-0.80, 1.10]
  2 studies · 189 participants
  Very low

0.6% eucalyptus chewing gum vs 0.4% eucalyptus chewing gum

0.6% eucalyptus chewing gum showed no clear difference in volatile sulphur compounds (VSC) compared with 0.4% eucalyptus chewing gum; GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  4 weeks
  MD 0.0 [-0.21, 0.21]
  1 study · 64 participants
  GRADE not reported

Toothbrushing + 0.075% cetylpyridinium chloride mouthwash vs Toothbrushing alone

The review found no eligible studies for this question.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  mean 3 weeks
  Patient-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score.
  0 studies
  No studies found

Pycnogenol chewing gum vs Placebo chewing gum

Pycnogenol chewing gum led to lower VSC: hydrogen sulphide compared with placebo chewing gum; GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  4 weeks
  MD -114.9 [-206.59, -23.21]
  1 study · 21 participants
  GRADE not reported

Zinc chloride + sodium fluoride dentifrice vs Sodium fluoride (control) toothpaste

• Interventions for managing halitosis 2019 · Cochrane All outcomes
  Payne 2011 reported 19 non-oral and 12 oral adverse effects. The oral effects were tingling sensation in lips, dry mouth or sore gums.
  1 study
  GRADE not reported

Miswak (Salvadora persica) stick vs Chlorhexidine mouthwash

It is very uncertain whether miswak (Salvadora persica) stick changes patient self-assessment VAS (scale 0 to 10) compared with chlorhexidine mouthwash (very low certainty).

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  mean 1 week
  MD -0.26 [-1.16, 0.64]
  1 study · 24 participants
  Very low

Chlorine dioxide mouthrinse (with tongue scraping) vs Chlorhexidine mouthwash (with tongue scraping)

Chlorine dioxide mouthrinse (with tongue scraping) showed no clear difference in VSC: hydrogen sulphide compared with chlorhexidine mouthwash (with tongue scraping); GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  1 week
  MD -11.0 [-31.61, 9.61]
  1 study · 22 participants
  GRADE not reported

Protease cysteine + actinidine tablets vs placebo (3 tablets/4 times a day

Protease cysteine + actinidine tablets showed no clear difference in volatile sulphur compounds (VSC), OralChroma compared with placebo tablets; GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  1 week
  MD -45.8 [-258.38, 166.78]
  1 study · 14 participants
  GRADE not reported

Triclosan/copolymer-containing fluoride toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

• Interventions for managing halitosis 2019 · Cochrane All outcomes
  Niles 1999 (cross-over trial) compared 0.3% triclosan + 2.0% PVM/MA + 0.243% NaF toothpaste versus placebo toothpaste; VSC by gas chromatograph. We could not use the results in the meta-analysis as there was no…
  1 study
  GRADE not reported