Interdental Brushes – A Summary of Scientific Articles

Interdental Brushes – A Summary of Scientific Articles

Anna Nilvéus Olofsson, DDS, Manager Odontology and Scientific Affairs, TePe

Interdental Brushes: A Summary of Scientific Articles includes five especially important studies in support of interdental brushes, selected and summarized by Anna Nilvéus Olofsson, DDS, Manager Odontology and Scientific Affairs, TePe.
Please also see the extensive compilation of references below, Interdental Brushes: A Reference List of Scientific Articles

Slot DE et al.
Int J Dent Hyg. 2008 Nov;6(4):253-64.

This systematic review is conducted to assess the effectiveness of the interdental brush used as an adjunct to a toothbrush, compared to toothbrushing without any interdental cleaning, or in combination with dental floss or woodsticks. To assess the effect, plaque and clinical parameters of periodontal inflammation were used as factors evaluated. The results are based on 9 articles, all experimental clinical studies, which met the criteria to be included in the review. In the majority of the studies, the study population consisted of patients enrolled in a periodontal maintenance program. From these studies, it was concluded that interdental brushes used as an adjunct to toothbrushing remove more plaque than just toothbrushing, and that dental floss and woodsticks are surpassed by interdental brushes in plaque removal. Furthermore, the review showed a positively significant difference in using interdental brushes with respect to plaque scores, bleeding scores and probing pocket depth.

Imai PH et al.
Can J Dent Hygiene. 2012;46,no.1:63-78.

The purpose of this systematic review was to evaluate the efficiency of interdental brushes and dental floss as adjuncts to toothbrushing for reducing gingival bleeding and dental plaque. Included studies were randomized controlled trials, including split mouth and crossover trials. Four papers were included for the analysis on bleeding outcome and seven papers for the analysis on plaque outcome. The results indicate that the interdental brush is more efficient than dental floss for reducing both bleeding and plaque.

The article presents an instructive flowchart, containing practical guidelines for choosing interdental cleaning device for the patient with interdental inflammation. First, assess the patient’s level of dexterity and motivation for daily interdental self-care. If the patient has good dexterity and/or is motivated, the next step is to determine the embrasure type. For patients with type I embrasures, dental floss should be recommended. With embrasures of type II or III, the interdental brush is the correct choice.

If the patient, on the other hand, has poor dexterity and/or lacks motivation, the appropriate recommendation is interdental brushes, regardless of type I, II or III embrasures. The authors conclude that the interdental brush is an effective alternative to dental floss, for reducing interproximal bleeding and plaque in booth filled and open embrasures.

Chapple IL et al.
J Clin Periodontol. 2015 Apr;42 Suppl 16:S71-6.

This is a report from the 11th European Workshop in Periodontology on primary prevention of periodontitis. The working group has focused on four different approaches: mechanical self-administered plaque control regimes, self-administered interdental mechanical plaque control, adjunctive chemical plaque control and anti-inflammatory approaches.A number of conclusions are drawn in this report. It is implied that professional oral hygiene instruction contributes to plaque and gingivitis reduction, and that reinforcement of the instruction may lead to enhanced results.

Concerning interdental brushes, they have shown the highest efficacy in plaque removal and are also shown to be the most accepted interdental cleaning devices among patients. Regarding the use of floss, most studies cannot show a general effectiveness in plaque removal or reduction of gingival inflammation. According to the working group, interdental brushes are the preferred choice for interdental cleaning. Floss can be an alternative only when sites are too narrow for the interdental brush and show gingival and periodontal health. It is stressed that any method chosen for interproximal cleaning should be preceded by professional instruction.

Sälzer S et al.
J Clin Periodontol. 2015 Apr;42 Suppl 16:S92-105.

This meta-review, a systematic review including only systematic reviews, compiled the effect of dental floss, woodsticks, interdental brushes and an oral irrigator used for interdental plaque removal in managing gingivitis. Six systematic reviews were included – regarding dental floss (2 studies), woodsticks (1 study), interdental brushes (2) and oral irrigator (1).

The magnitude of the effect of floss was small and unclear regarding woodsticks and oral irrigator, but for interdental brushes, it was large. The body of evidence was greatest for interdental brushes.

Besides the efficacy of the interdental cleaning device, patient compliance is also an important factor to value when choosing device. Compliance is highly dependent on preference and manual skills of the individual patient. Interdental brushes are shown to be considered easier to use by patients, than floss.

There is not one single interdental cleaning device which suits all patients and interdental spaces. Several factors need to be considered; among them scientific evidence. This meta-review concludes that there is consistent evidence for interdental brushes being the most effective devices for interdental plaque removal. They are also the most appreciated devices for interdental cleaning among patients.

Larsen HC et al.
Int J Dent Hyg. 2016 Jan 11. doi: 10.1111/idh.12189.

In this randomized controlled clinical study the aim was to compare the effectiveness of conical and cylindrical interdental brushes in respect to plaque and bleeding scores. The subjects included in the study were patients enrolled in a supportive periodontal maintenance program for at least one year after treatment of periodontitis.

The patients were randomly selected to use either a conical or a cylindrical interdental brush. The right size was tried out and instructions were given on how to use the brush. The interdental brush was used from the buccal site. Plaque scores, bleeding upon probing and probing pocket depth were registered at base-line and at the 3-month follow-up. Six sites per tooth, disto-vestibular, vestibular, mesio-vestibular, disto-lingual, lingual and mesio-lingual, in the 51 participating subjects were analyzed. All approximal sites with the appropriate size for an interdental brush were included.

A statistically significant difference was shown in plaque and bleeding scores at lingual approximal sites, disto-lingual and mesio-lingual sites, due to an increase in plaque and bleeding scores at these sites during the test period in the group allocated to the conical interdental brushes. The authors declare the results as being dependent on the geometric differences in the shape of conical and cylindrical interdental brushes, in favour of the cylindrical shape.