A total of 35 randomized clinical trials were included in this review from Cochrane evaluating the effectiveness of interdental cleaning devices for home-use, in addition to toothbrushing compared to toothbrushing alone.

 

The results of the included studies are mainly based on populations with a low level of gingival inflammation at baseline that are followed over a relatively short period of time. Studies based on a population where the majority was diagnosed with severe periodontal diseases were excluded from the analysis.

 

Used in addition to toothbrushing, floss, interdental brushes, wooden cleaning sticks, and oral irrigators showed a reduction in gingivitis compared to toothbrushing alone. However, the evidence varied from low to very low-certainty due to the study designs.

 

A comparison of the different devices with each other was also performed. When comparing the impact of floss and interdental brushes with respect to the reduction of gingivitis, floss was surpassed by interdental brushes. When comparing floss to wooden or rubber/elastomeric cleaning sticks, no difference was shown concerning the reduction of gingivitis. There was, however, some support for the oral irrigator being more efficient than floss, measured as gingivitis reduction. No support for a difference in gingivitis reduction between rubber/elastomeric cleaning sticks and interdental brushes was presented, though based on very low-certainty evidence. None of the studies reported any impact on interproximal caries.

 

The authors state that there is a need for research within this scope using the new classification for periodontal disease as well as prolonging the intervention period to enable measuring interproximal caries and periodontitis.