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REVIEWER
Joan I. Gluch, RDH, PhD
PURPOSE/QUESTION
To determine the effect of
interdental brushes (IDBs) as an
adjunct to tooth brushing compared
with tooth brushing alone or other
interdental oral hygiene devices on
plaque, gingival inflammation,
bleeding, and pocket depth
SOURCE OF FUNDING
Information not available
TYPE OF STUDY/DESIGN
The key study factor was use of IDBs among adults with sufficient interdental space to use an IDB. Eight different brands of conical or cylindrical IDBs
were used in the 9 studies in this review. Six studies noted that study product and/or financial support was received from industry.
LEVEL OF EVIDENCE
Level 2: Limited-quality patientoriented evidence
STRENGTH OF
RECOMMENDATION GRADE
Grade B: Limited-quality patientoriented evidence
Main Results
When comparing IDBs as an adjunct to brushing to brushing alone, 2 of
the 3 studies showed reduction of plaque scores for groups using IDBs,
and 1 of 3 studies showed reduction in gingival index.
When comparing IDBs to other oral hygiene interventions, 5 studies showed greater plaque reduction with
IDBs as an adjunct to brushing as compared with combination use of dental floss and brushing. Three studies
showed no significant difference in gingival index and
5 studies showed no significant difference in bleeding
scores between IDBs and dental floss. Two of 3 studies
showed that IDBs significantly reduced pocket depth as
compared with floss. One study showed IDB reduces
more dental plaque than woodsticks.
Meta analysis was completed by the authors to pool data
for the comparison of IDBs with floss. The IDB group
showed greater plaque reductions than the floss group
in the 2 studies that used the Silness and Loe plaque index, with no significant difference in the other 2 studies
measuring plaque, and no significant difference in bleeding on probing or pocket depth in the meta analysis comparing IDBs with floss.
Conclusions
The authors conclude that IDBs remove more dental plaque as an adjunct to toothbrushing than brushing alone,
with inconclusive evidence available on the effect of IDB
on gingival inflammation. In addition, the authors found
that IDBs in combination with toothbrushing removes
more plaque as compared with dental floss or woodsticks
and found inconclusive evidence in comparing the effect
of IDBs and floss on the measures of gingival inflammation. However, use of IDBs does result in more pronounced reduction of pocket depth than dental floss as
an adjunct to toothbrushing.
antimicrobial products used by patients. Power toothbrushes were included in 1 study in the review that used
only the plaque index as an outcome measure. Further
recommendations for study include the inclusion of
power toothbrushing and/or antimicrobial toothpastes/
rinses in study design to simulate the common practice
of recommending multiple products with patients to improve measures of periodontal health.
REFERENCES
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REVIEWER
Joan I. Gluch, RDH, PhD
Associate Dean for Academic Policies, Director of Community
Health and Adjunct Associate Professor, University of
Pennsylvania School of Dental Medicine, 240 S. 40th St,
Philadelphia, PA 19104, Phone: 215-898-5279
gluchj@dental.upenn.edu
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