What do systematic reviews say?

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

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

Intervention not reported

• Dental caries experience, care index and restorative index in children with learning disabilities and children without… 2019 All outcomes
  no estimate extracted
  2 studies
  GRADE not reported

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

Learning disability (CLD) vs No learning disability (CNLD)

The care index (met dental care need) for permanent teeth could not be meta-analyzed because no study reported variance; it was lower or equal in children with learning disabilities in 5 of 8 studies (certainty not graded).

• Dental caries experience, care index and restorative index in children with learning disabilities and children without… 2019 All outcomes

  Community and clinical settings (specialist paediatric dental clinics to school classrooms); 25 studies across 18 countries
  Mean care index CLD 0.12 (SD 0.12) vs CNLD 0.18 (SD 0.27) for permanent teeth; CI in CLD was less than or equal to CNLD in 5 of 8 studies. Not meta-analyzed (no variance data reported in any study).
  8 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

Learning disability (CLD) vs No learning disability (CNLD)

The restorative index for permanent teeth could not be meta-analyzed (no variance data); it was lower or equal in children with learning disabilities in 4 of 9 studies, and the pattern suggested more extraction- than restoration-based care in CLD (certainty not graded).

• Dental caries experience, care index and restorative index in children with learning disabilities and children without… 2019 All outcomes

  Community and clinical settings (specialist paediatric dental clinics to school classrooms); 25 studies across 18 countries
  Mean restorative index CLD 0.15 (SD 0.14) vs CNLD 0.28 (SD 0.33) for permanent teeth; RI in CLD was less than or equal to CNLD in 4 of 9 studies. Not meta-analyzed (no variance data). In CLD the RI tended to exceed the…
  9 studies
  GRADE not reported

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

Intervention not reported

• Dental caries experience, care index and restorative index in children with learning disabilities and children without… 2019 All outcomes

  Disability: autism
  no estimate extracted
  2 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