Cochrane · intervention · CD009857

Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults

Cochrane Database of Systematic Reviews · 2013 · Cochrane Library

Oral Health Dental caries Periodontology2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 8 · 50%Ungraded 2 · 12.5%Very low 4 · 25%Low 2 · 12.5%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 participants 16 years of age and older, regardless of race, gender, socioeconomic status, geographical location, background exposure to fluoride, initial dental health status, setting or time of the intervention; excluding participants with orthodontic appliances, special (general or oral) health conditions, or the majority with severe periodontal disease	Total 326 participants analysed for interdental brushing versus flossing (197 in interdental brushing plus toothbrushing arms; 195 in flossing plus toothbrushing arms), and 62 participants for interdental brushing versus toothbrushing alone (30 versus 32); 354 participants analysed overall. Aged 18 to 75 years; 63% female, 37% male. Three studies included patients with moderate to severe periodontitis, two with gingivitis, and two did not report oral health status. Conducted in the USA (3), UK (2), Canada (1) and the Netherlands (1)
Intervention	Combination of toothbrushing and any interdental brushing procedure (self-performed, supervised or unsupervised); primary intervention self-performed unsupervised interdental brushing plus toothbrushing	Interdental brushing plus toothbrushing (n=197)
Comparison	Toothbrushing alone; Toothbrushing and flossing	Flossing plus toothbrushing (n=195); Toothbrushing alone (n=32)
Outcomes	Gingivitis (gingival and bleeding indices); Periodontitis (clinical attachment loss); Interproximal caries (progression into enamel/dentine, D(M)FS index, radiographic evidence); Plaque indices; Harms and adverse effects; Bad breath (halitosis); Quality of life	Gingivitis (n=7); Plaque (n=7); Harms and adverse effects (n=5)
Study designs	Randomised controlled trials (including split-mouth and cross-over trials) and cluster-randomised trials; cross-over trials included only with a minimum two-week washout period	Randomised controlled trial, parallel-group (n=4); Randomised controlled trial, split-mouth (n=3)
Timing	Minimum intervention duration 4 weeks; four to six-week (combined) and 12-week (or nearest) time points for gingivitis and plaque; clinical attachment loss at >=6 months; interproximal caries at >=1 year	One month / four to six weeks (n=7); Three months / 12 weeks (n=2)

Search date: 2013-03. Databases: Cochrane Oral Health Group's Trials Register; 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; US National Institutes of Health Trials Register…

Questions and results

Current version only

Interdental brushing plus toothbrushing vs Toothbrushing alone

Population: Dentate adults aged 16 years and older

CD009857.PUB2 (current) · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Harms and adverse effects same question in other reviews	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
Bad breath (halitosis) same question in other reviews	Not estimable. No included study assessed bad breath as an outcome. (See comment)	0 studies	No studies
Gingivitis (Loe-Silness gingival index, interproximal; scale 0 to 4) 4 weeks (1 month) same question in other reviews	MD -0.53 [-0.83, -0.23]	1 study · 62 participants	Very low Downgraded: risk of bias
Quality of life same question in other reviews	Not estimable. No included study assessed quality of life as an outcome. (See comment)	0 studies	No studies
Interproximal caries same question in other reviews	Not estimable. No included study assessed caries as an outcome. (See comment)	0 studies	No studies
Periodontitis (clinical attachment loss) same question in other reviews	Not estimable. No included study assessed periodontitis as an outcome. (See comment)	0 studies	No studies
Plaque (Quigley & Hein plaque index, Turesky modification; scale 0 to 5) 4 weeks (1 month) same question in other reviews	MD -0.95 [-1.34, -0.56]	1 study · 62 participants	Very low Downgraded: risk of bias

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

Population: Dentate adults aged 16 years and older

CD009857.PUB2 (current) · 9 questions

Outcome	Effect	Evidence	Status / GRADE
Gingivitis (bleeding and gingival indices; standardised across indices) 1 month (4 to 6 weeks) same question in other reviews	SMD -0.53 [-0.81, -0.24] -0.12 [-0.18, -0.05] Eastman Interdental Bleeding Index points (re-expressed via Jackson 2006; 52% reduction of…	7 studies · 326 participants	Low Downgraded: risk of bias, inconsistency
Plaque (plaque indices; standardised across indices) 1 month (4 to 6 weeks) same question in other reviews	SMD 0.10 [-0.13, 0.33] 0.02 [-0.02, 0.06] Silness & Loe Plaque Index points (re-expressed via Imai 2011; 2% reduction of control mean)	7 studies · 326 participants	Low Downgraded: risk of bias, inconsistency
Gingivitis (bleeding and gingival indices; standardised across indices) 3 months (12 weeks) same question in other reviews	SMD -1.98 [-5.42, 1.47]	2 studies · 107 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Bad breath (halitosis) same question in other reviews	Not estimable. No included study assessed bad breath as an outcome. (See comment)	0 studies	No studies
Quality of life same question in other reviews	Not estimable. No included study assessed quality of life as an outcome. (See comment)	0 studies	No studies
Interproximal caries same question in other reviews	Not estimable. No included study assessed caries as an outcome. (See comment)	0 studies	No studies
Harms and adverse effects same question in other reviews	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
Plaque (plaque indices; standardised across indices) 3 months (12 weeks) same question in other reviews	SMD -2.14 [-5.25, 0.97]	2 studies · 107 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Periodontitis (clinical attachment loss) same question in other reviews	Not estimable. No included study assessed clinical attachment loss, a measure of progression of periodontitis. (See comment)	0 studies	No studies

Interdental brushing plus toothbrushing vs Toothbrushing alone

Population: Dentate adults aged 16 years and older

CD009857 · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Quality of life	no estimate extracted	NR	No studies
Bad breath (halitosis)	no estimate extracted	NR	No studies
Interproximal caries (progression into enamel/dentine, D(M)FS index, radiographic evidence) >=12 months; planned	no estimate extracted	NR	No studies
Periodontitis (clinical attachment loss) >=6 months; planned	no estimate extracted	NR	No studies
Plaque (plaque indices) 1, 3 and 6 months (or nearest); planned	no estimate extracted	NR	No studies
Gingivitis (gingival and bleeding indices) 1, 3 and 6 months (or nearest); planned	no estimate extracted	NR	No studies
Harms and adverse effects	no estimate extracted	NR	No studies

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

Population: Dentate adults aged 16 years and older

CD009857 · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Harms and adverse effects	no estimate extracted	NR	No studies
Periodontitis (clinical attachment loss) >=6 months; planned	no estimate extracted	NR	No studies
Gingivitis (gingival and bleeding indices) 1, 3 and 6 months (or nearest); planned	no estimate extracted	NR	No studies
Plaque (plaque indices) 1, 3 and 6 months (or nearest); planned	no estimate extracted	NR	No studies
Bad breath (halitosis)	no estimate extracted	NR	No studies
Quality of life	no estimate extracted	NR	No studies
Interproximal caries (progression into enamel/dentine, D(M)FS index, radiographic evidence) >=12 months; planned	no estimate extracted	NR	No studies