Comparison of interdental brush to dental floss for reduction of clinical parameters of periodontal disease: A systematic review

background: Daily oral biofilm disruption by clients is recommended by oral health professionals to prevent oral diseases and to maintain optimal oral and overall health. since periodontal diseases and caries are prevalent interproximally, the adjunctive use of interdental aids is highly recommended. objectives: to evaluate the effectiveness of interdental brushing as an adjunct to toothbrushing for the primary outcome of interproximal gingival bleeding and a secondary outcome of interproximal plaque. Methods: only randomized controlled trials were included. studies were included irrespective of publication status and language. Hand searching was conducted in two peer reviewed journals, with references mined. Pharmaceutical companies that develop and manufacture interdental brushes were also contacted for unpublished or ongoing clinical trials. sixty-two studies were retrieved from the literature with seven studies meeting the inclusion/ exclusion criteria. forest plots and Chi-square tests were used to determine the presence of heterogeneity. random effects model, relative risk and 95% confidence intervals were used in the analysis. results: four studies were included in the meta analysis for bleeding outcome. although some heterogeneity was present among the studies, the interdental brush groups demonstrated statistical significance for reducing interproximal bleeding compared to the dental floss groups, p = 0.003. Plaque outcomes were analyzed using seven studies, with interdental brush demonstrating statistically significant differences to dental floss, p = 0.024. Conclusion: interdental brush is an effective alternative to dental floss for reducing interproximal bleeding and plaque in clients with filled or open embrasures. INTRODUCTION Periodontal disease, which is a large family of pathological conditions affecting the supporting structures of the teeth, is a common oral ailment seen in dental hygiene practice.1 Established oral biofilms, commonly known as dental plaque, cause and exacerbate gingival inflammation.2–4 If left untreated, periodontal disease may lead to tooth loss.5 Periodontal therapy usually consists of professional debridement and client oral self care. Professional scaling and root planing have been shown to reduce the clinical parameters of gingival bleeding and mean pocket depths by removing the subgingival bacterial population and rendering the environment significantly less pathogenic; however, the microflora gradually shift back to a pathogenic supportive environment over three months.6 Daily oral self care to control the supragingival plaque tHis is a Peer revieWeD artiCle. submitted 15 July 2011; revised 8 oct. 2011; accepted 20 oct. 2011 university of british Columbia * Doctoral student in statistics § associate Professor & Chairman of the Division of oral & Maxillofacial radiology Correspondence to: Pauline H. imai; [email protected] ∆ Dental Program Coordinator, Mti Community College, vancouver, bC