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Title Use of Inter-dental Brush with Toothbrushing Reduces Plaque and Periodontal Inflammation Better Than Toothbrushing Alone
Clinical Question In dentulous patients, does the use of inter-dental brushes in adjunct to toothbrushing reduce plaque and periodontal inflammation to a greater extent as compared with toothbrushing alone?
Clinical Bottom Line In dentulous patients, the use of inter-dental brushes in addition to toothbrushing is better at removing plaque and reducing periodontal inflammation as compared to toothbrushing alone. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19138177Slott/2008Patients greater than 18yo and no systemic disorder.Systematic Review
Key resultsIn this systematic review, a total of 9 articles met the inclusion criteria. However, the aim of this systematic review was broader than the PICO question. In fact, Slot and coworkers assessed the effectiveness of the inter-dental brushes adjunct to the use of toothbrush in terms of plaque and clinical parameters of periodontal inflammation compared to toothbrushing alone or toothbrushing in combination with floss or woodsticks. Therefore, only three studies out of nine (Bassiouny and Grant 1981, Kiger et al. 1991, and Jared et al. 2005) had the inter-dental brushes adjunct to the use of toothbrushing and toothbrushing alone as comparison groups. No meta-analysis could be performed since each of these three studies used a different plaque assessment index.Bassiouny and Grant (1981) reported a trend (not statistically significant) for better plaque control when inter-dental brushes were used as an adjunct to toothbrushing. The two other studies reported statistically significantly better plaque control when inter-dental brushes were used as an adjunct to toothbrushing compared to toothbrushing alone (Kiger et al. 1991, and Jared et al. 2005). Only two studies (Kiger et al. 1991, and Jared et al. 2005) reported on gingival index values, and only one study (Jared et al. 2005) found a significantly better gingival index in the group using inter-dental brushes.
Evidence Search Search periodontal inflammation #2 Search plaque#1 Search interdental brushes
Comments on
The Evidence
In Slot’s review, a comprehensive detailed search of all randomized clinical trials and validity assessment of each included trial were performed. Even though no meta-analysis could be performed to address the clinical question, the evidence is derived from 3 randomized clinical trials (RCTs). Considering that RCTs represent the highest level of evidence when performing clinical trials, these findings are certainly valid.
Applicability According to these studies, there are benefits in reducing plaque and periodontal problems for patients using inter-dental brushes as an adjunct to toothbrushing. The use of this device is different and will take time for patients to get used to, but it will help to remove plaque more efficiently and improve oral hygiene.
Specialty/Discipline (Public Health) (General Dentistry) (Periodontics) (Dental Hygiene)
Keywords Interdental Brushes, toothbrushes, floss, plaque, periodontal inflammation, periodontal disease, gingivitis, periodontitis
ID# 771
Date of submission: 03/15/2011spacer Revised: 03/20/2012
E-mail nguyenhc@livemail.uthscsa.edu
Author Hieu Nguyen
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huynh-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Charles Reyes, Benjamin Hanks (San Antonio, TX) on 01/09/2014
After doing Pubmed and TRIPS database searches on January 6, 2014, more recent publications were found (PMIDs # 22726785 and # 24353078 ) supporting the findings in this respective CAT. Although some data suggests that there is no statistically significant improvement, most studies reported a statistically significant improvement in plaque control when using an interdental brush in addition to tooth brushing.

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