An Overview of Different Interdental Cleaning Aids and Their Effectiveness
Abstract
:1. Introduction
2. Materials and Methods
3. Dental Floss
4. Interdental Brushes (IDBs)
4.1. Adjunctive Use of Interdental Brushes
4.2. Choosing an Appropriate Interdental Brush
4.3. Floss vs. Interdental Brushes
5. Wooden Interdental Aids
6. Oral Irrigators
7. Summary
Author Contributions
Funding
Conflicts of Interest
References
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Study | Study Design and Evaluation Period | Intervention | Primary Outcome Measures | Outcome |
---|---|---|---|---|
Berchier et al. [22] | Systematic review, 11 studies, 559 subjects, 1–6 months | Dental floss as an adjunct to brushing | Plaque index, gingival index | Flossing provides no additional benefit to brushing for the removal of plaque and reduction of gingivitis |
Sambunjak et al. [23] | Systematic review, 12 studies, 1083 subjects, 1–6 months | Dental floss as an adjunct to brushing | Plaque index, gingival index | Significant benefit associated with flossing as an adjunct in reducing gingivitis. Insufficient evidence for reducing plaque |
Kiger et al. [26] | Crossover study, 30 previously treated periodontal subjects, 3 months | Brushing vs. brushing + floss or interdental brushes as an adjunct | Gingival index, proximal plaque scores, buccal and lingual plaque index | The use of floss as an adjunct did not result in significant differences for any of the parameters |
Graziani et al. [25] | Randomised clinical trial, 60 periodontally healthy subjects, 1 month | Brushing vs. brushing + floss or interdental brushes or rubber interdental brushes | Full-mouth bleeding scores, full-mouth plaque scores, probing pocket depth, recession, angulated bleeding score | The use of floss did not result in significant benefits over brushing alone |
Blanck et al. [30] | Two-phase crossover study, 26 subjects, study duration not mentioned | Floss vs. floss holder | Plaque index | Both products removed statistically significant amounts of plaque compared to pre-treatment levels |
Kleber et al. [31] | Survey, 32 respondents, 6 months after completion of a flossing study | Floss vs. floss holder | Number of participants flossing regularly and with which method after study completion | Floss holders are more effective in helping patients establish a regular flossing habit |
Pucher et al. [29] | Comparative study, 36 dental students and 26 adult patients undergoing periodontal maintenance, 6 weeks | Floss vs. floss holder | Plaque index, gingival index | Both methods are effective in reducing interproximal plaque and gingivitis |
Study | Study Design and Evaluation Period | Intervention | Primary Outcome Measures | Conclusion |
---|---|---|---|---|
Imai et al. [36] | Randomised clinical trial, split mouth, 30 subjects, 12 weeks | Floss vs. IDB | Plaque index, bleeding index | No difference between both methods for plaque removal. IDBs are superior for reducing bleeding |
Noorlin et al. [45] | Clinical trial, split mouth, 10 subjects with untreated periodontal disease, 1 month | Floss vs. IDB | Approximal plaque scores, bleeding on probing, probing depth | Both devices result in similar beneficial effects on plaque scores. Bleeding and mean probing depth reduction was significantly reduced compared to floss sites |
Christou et al. [10] | Randomised clinical trial, split mouth, 26 subjects with untreated periodontal disease, 6 weeks | Floss vs. IDB | Plaque scores, probing depth, periodontal pocket bleeding index, angulated bleeding index | No difference between floss and IDB for bleeding indices. IDBs are more effective in plaque removal |
Jackson et al. [44] | Randomised clinical trial, 77 subjects with untreated periodontal disease, 12 weeks | Floss vs. IDB | Plaque index, bleeding index, bleeding on probing at interdental sites, relative interdental papillae level | More improvements in the IDB group for every parameter |
Kiger et al. [26] | Crossover study, 30 previously treated periodontal subjects, 3 months | Brushing only vs. brushing + floss or IDB as adjunct | Gingival index, proximal plaque scores, buccal and lingual plaque index | IDBs as an adjunct are superior to floss for proximal plaque removal |
Rosing et al. [46] | Comparative study, 55 subjects on a maintenance program, no follow-up period | Floss vs. IDB | Plaque index | IDBs are superior to floss for removal of interdental plaque |
Graziani et al. [25] | Randomised clinical trial, 60 periodontally healthy subjects, 1 month | Brushing vs. brushing + floss or interdental brushes or rubber interdental brushes | Full-mouth bleeding scores, full-mouth plaque scores, probing pocket depth, recession, angulated bleeding score | Adjunctive use of IDBs or rubber picks reduces more interdental plaque than brushing alone or flossing |
Hennequin-Hoenderdos et al. [42] | Randomised clinical trial, split-mouth, 42 subjects, 1 month | Conventional IDBs vs. rubber bristles | Bleeding on marginal probing, plaque index, gingival abrasion score | Rubber bristles were more effective in reducing gingival inflammation. They were associated with less gingival abrasion and better received by participants |
Bourgeois et al. [37] | Randomised clinical trial, 46 subjects, 3 months | IDBs vs. brushing | Frequency of interdental bleeding | IDBs resulted in significantly less interdental bleeding (plaque scores not evaluated) |
Abouassi et al. [41] | Randomised clinical trial, crossover design, 39 subjects, 1 month | Conventional IDBs vs. rubber bristles | Plaque index, bleeding index, patient satisfaction questionnaire | Rubber bristles were as effective as conventional IDBs with the added benefit of more comfort |
Jordan et al. [38] | Randomised clinical trial, 128 subjects, 12 days | Straight vs. angled IDBs | Modified proximal plaque index | Straight IDBs were better at removing interproximal plaque, especially for posterior teeth |
Chongcharoen et al. [39] | Randomised clinical trial + crossover study, 8 subjects post-initial periodontal therapy, 3 weeks | Straight vs. waist-shaped IDBs | Plaque index | Waist-shaped IDB had lower plaque scores than straight IDBs |
Slot et al. [34] | Systematic review, 9 studies, 510 subjects, 1–3 months | IDBs as an adjunct to brushing | Plaque index, gingival index, bleeding on probing, probing depth | IDBs as an adjunct to brushing showed significant reductions in plaque scores, bleeding scores, and probing depth |
Poklepovic et al. [35] | Systematic review, 7 studies, 354 subjects, 1–3 months | IDBs and flossing as adjuncts to brushing | Gingival index, plaque index | Adjunctive use of IDBs results in significant improvements in gingival and plaque indexes compared to brushing alone. There is some evidence that IDBs reduce gingivitis at 1 month compared to flossing. More evidence needed for 3 months. No conclusions could be drawn for a difference for plaque index |
Luz et al. [47] | Clinical trial, crossover study, 12 subjects, 2 months | Floss vs. IDB (around implants) | Plaque index | IDBs are more efficacious in removing proximal biofilm around implants |
Study | Study Design and Evaluation Period | Intervention | Primary Outcome Measures | Outcome |
---|---|---|---|---|
Hoenderdos et al. [51] | Systematic review, 7 studies, 438 subjects, 3–14 weeks | Woodsticks as an adjunct to brushing | Plaque index, gingival index | No significant advantage on plaque removal, but reduces gingival bleeding tendency |
Schmid et al. [52] | Clinical trial, crossover study, 21 periodontally healthy subjects, 2 weeks | Toothbrush vs. floss vs. toothpicks | Plaque index | No differences for visible proximal surfaces. Brushing was superior on buccal surfaces. Toothpicks were as efficient as brushing on lingual surfaces |
Zanatta et al. [50] | Clinical trial, split mouth, 15 subjects | Toothpicks vs. woodsticks | Plaque index | No differences found between round toothpicks and triangular woodsticks for supragingival plaque removal |
Study | Study Design and Evaluation Period | Intervention | Primary Outcome Measures | Outcomes |
---|---|---|---|---|
Cutler et al. [59] | Clinical trial, crossover study, 52 subjects, 2 weeks | Oral irrigator vs. brushing | Probing pocket depth, bleeding on probing, gingival index, plaque index, IL-1β and PGE2 levels | Improvement in all clinical parameters with oral irrigation. A reduction in pro-inflammatory cytokine profile in gingival crevicular fluid |
Al-Mubarak et al. [60] | Randomised clinical trial, 52 diabetic subjects with adult periodontitis, 12 weeks | Oral irrigator vs. brushing | Modified gingival index, probing pocket depth, plaque index, clinical attachment level, bleeding on probing, reactive oxygen species generation, cytokines (TNF-α, IL-1β, IL-10, PGE2), and HbA1c | Significant reduction in plaque index, gingival index, bleeding on probing, and reactive oxygen species generation compared to brushing. Significant reduction in IL-1β, and PGE2 from baseline within test group |
Newman et al. [68] | Multi-centre randomised clinical trial, 155 subjects receiving supportive periodontal therapy, 6 months | Regular oral hygiene vs. oral irrigation with water vs. oral irrigation with water and zinc sulphate solution | Bacterial measurements, gingival index, bleeding on probing | Oral irrigation with water was superior to regular oral hygiene and additional irrigation with zinc sulphate for reducing gingival inflammation. Oral irrigation with water significantly reduced bleeding on probing compared to regular oral hygiene |
Barnes et al. [69] | Randomised clinical trial, 105 subjects, 1 month | Manual toothbrush + floss vs. manual toothbrush + oral irrigator vs. sonic toothbrush + oral irrigator | Bleeding index, gingival index, plaque index | Irrigation groups were more effective in reducing bleeding index and gingival index. The manual toothbrush + floss group was less effective than the sonic toothbrush + irrigation for reducing plaque |
Rosema et al. [75] | Randomised home-use experiment, 108 subjects, 1 month | Oral irrigator vs. floss | Bleeding index, plaque index | Oral irrigator is superior to floss in reducing gingival bleeding |
Goyal et al. [70] | Randomised clinical trial, 70 subjects, single use | Oral irrigator vs. floss | Plaque index | Oral irrigator as an adjunct is superior to floss as in plaque removal |
Husseini et al. [77] | Systematic review, 7 studies, 590 subjects, 2–6 months | Oral irrigators vs. brushing | Plaque index, bleeding index, gingival index, probing pocket depth | Oral irrigators do not have a beneficial effect in reducing visible plaque. However, there is a trend of improving gingival health by reducing bleeding |
Goyal et al. [71] | Randomised clinical pilot study, 28 subjects, two weeks | Oral irrigator vs. IDBs | Plaque index, bleeding on probing | Oral irrigators are more effective than IDBs for reducing gingival bleeding. No difference for plaque index |
Lyle et al. [73] | Randomised pilot study, 28 subjects, single-use | Oral irrigator vs. IDBs | Plaque index | Oral irrigators as adjuncts remove significantly more plaque than IDBs after a single use |
Stauff et al. [67] | Randomised clinical trial, 60 subjects, 4 weeks | Phillips Airfloss (microdroplet device) vs. floss | Papilla bleeding index, modified proximal plaque index, amount of gingival crevicular fluid | Microdroplet device was more effective at reducing plaque, with the added benefit of comfort of use |
Goyal et al. [72] | Randomised clinical trial, 69 subjects, 1 month | Waterpik vs. Sonicare Air Floss Pro | Bleeding on probing, modified gingival index, plaque index | Waterpik is significantly more effective than Sonicare in reducing bleeding and gingivitis |
Sharma et al. [74] | Randomised clinical trial, 82 subjects, single-use | Waterpik vs. Sonicare Airfloss | Plaque index | Waterpik removes significantly more plaque from tooth surfaces than Sonicare |
Magnuson et al. [76] | Randomised clinical trial, 40 implants, 1 month | Oral irrigator vs. floss (around implants) | Bleeding on probing | Oral irrigator demonstrated significantly greater reduction in bleeding than floss |
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Ng, E.; Lim, L.P. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent. J. 2019, 7, 56. https://doi.org/10.3390/dj7020056
Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry Journal. 2019; 7(2):56. https://doi.org/10.3390/dj7020056
Chicago/Turabian StyleNg, Ethan, and Lum Peng Lim. 2019. "An Overview of Different Interdental Cleaning Aids and Their Effectiveness" Dentistry Journal 7, no. 2: 56. https://doi.org/10.3390/dj7020056