Cochrane · intervention · CD008829
Flossing for the management of periodontal diseases and dental caries in adults
Cochrane Database of Systematic Reviews · 2011 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
13
current version
GRADE rated
2
No studies
6
Included studies
12
as reported
No studies 6 · 46.2%Ungraded 5 · 38.5%Very low 2 · 15.4%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
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.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Dentate adults 16 years of age and older, regardless of race, gender, socioeconomic status, geographical location, background fluoride exposure, initial dental health status, setting or time of intervention; excluding orthodontic patients, those selected on special health conditions, or those where the majority had severe periodontal disease | Dentate adults aged 18 to 70; overall about 37% male and 63% female; most trials conducted in the USA (10), one in Germany, one in the Netherlands (n=1083 completed) |
| Intervention | Combination of toothbrushing and any flossing procedure (self- or professionally-performed, supervised or non-supervised); primary comparison self-performed unsupervised flossing plus toothbrushing | Flossing plus toothbrushing (n=582); manual flossing (n=383); automated flossing (n=106) |
| Comparison | Toothbrushing alone or toothbrushing plus a negative control | Toothbrushing alone (n=292); toothbrushing plus placebo/negative control (n=209) |
| Outcomes | Periodontal disease (gingivitis indices, inflammatory and bleeding); Interproximal caries (progression into enamel/dentine; D(M)FS index); Harms and adverse effects; Plaque indices; Calculus indices; Clinical attachment loss; Quality of life; Economic and resource cost of flossing; Bad breath (halitosis) | Gingivitis (n=12); Plaque (n=12, 10 usable in meta-analysis); Harms and adverse effects (n=5); Interproximal caries (n=0); Calculus (n=0); Clinical attachment loss (n=0); Quality of life (n=0) |
| Study designs | Randomised controlled trials (including split-mouth and cross-over trials) and cluster-randomised trials; cross-over trials required a minimum 2-week washout or first-period data | Randomised controlled trials (n=12; including split-mouth and cross-over designs) |
| Timing | Minimum intervention duration 4 weeks; 1-, 3- and 6-month (or nearest) time points analysed | 1-, 3- and 6-month time points; median study end point 2 months (range 1 to 9); one study reported 9-month data |
Search date: 2011-10. Databases: The Cochrane Oral Health Group Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCO; LILACS via BIREME; ZETOC Conference Proceedings; Web of Science Conference Proceedings; ClinicalTrials.gov; metaRegister of Controlled…
Questions and results
Current version onlyFlossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse)
Population: Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Harms and adverse effects | 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 |
Gingivitis (Gingival Index, 0-3 scale; SMD) 3 months | SMD -0.41 [-0.68, -0.14] | 6 studies · 656 participants | Ungraded |
Interproximal caries | Not estimable (0 studies). See comment: No included study assessed caries as an outcome. | 0 studies | No studies |
Plaque (0-5 scale; SMD) 6 months | SMD -0.06 [-0.23, 0.12] | 3 studies · 487 participants | Ungraded |
Clinical attachment loss | 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 |
Bad breath (halitosis) | Not reported. No included study measured halitosis; the review notes it may be important to measure in future trials. | 0 studies | No studies |
Economic and resource cost of flossing | 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 |
Gingivitis (Loe-Silness/bleeding indices; SMD) 1 month | SMD -0.36 [-0.66, -0.05] -0.13 [-0.23, -0.02] points (Loe-Silness Gingival Index, 0-3 scale) | 7 studies · 489 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Plaque (Turesky-modified Quigley-Hein/other plaque indices; SMD) 1 month (mean 29 days) | SMD -0.23 [-0.52, 0.06] -0.19 [-0.42, 0.05] points (Turesky-modified Quigley-Hein Plaque Index, 0-5 scale) | 5 studies · 416 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Calculus | Not estimable (0 studies). See comment: No included study assessed calculus as an outcome. | 0 studies | No studies |
Quality of life | Not estimable (0 studies). See comment: No included study assessed quality of life as an outcome. | 0 studies | No studies |
Plaque (0-5 scale; SMD) 3 months | SMD -0.20 [-0.36, -0.04] | 5 studies · 594 participants | Ungraded |
Gingivitis (Gingival Index, 0-3 scale; SMD) 6 months | SMD -0.72 [-1.09, -0.35] | 4 studies · 564 participants | Ungraded |
Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone (with or without a negative-control/placebo rinse)
Population: Dentate adults aged 16 years or older (excluding orthodontic patients and those with severe periodontal disease)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Interproximal caries (progression into enamel/dentine; change in D(M)FS) | no estimate extracted | NR | No studies |
Calculus (assessed by calculus indices) | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Plaque (assessed by plaque indices) | no estimate extracted | NR | No studies |
Bad breath (halitosis) | no estimate extracted | NR | No studies |
Clinical attachment loss | no estimate extracted | NR | No studies |
Economic and resource cost of flossing | no estimate extracted | NR | No studies |
Harms and adverse effects | no estimate extracted | NR | No studies |
Periodontal disease (gingivitis, assessed by gingivitis/bleeding indices) | no estimate extracted | NR | No studies |