Title	Weak Evidence that Combining Oral Irrigation With Brushing Improves Gingival Health
Clinical Question	Does the use of oral irrigators in adjunct to tooth brushing improve gingival health and reduce periodontal inflammation as compared to tooth brushing alone.
Clinical Bottom Line	There is weak evidence that the use of oral irrigators in conjunction with tooth brushing improves gingival health and reduces periodontal inflammation as compared with tooth brushing alone.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 19138181 Hussein/2008 Non-edentulous patients older than 18 years of age Systematic Review Key results In this systematic review, 813 relevant papers were sorted and 7 ultimately fit their criteria for inclusion in this review. There is a positive trend (not statistically significant) that adding oral irrigation to tooth brushing will improve gingival health as compared to tooth brushing alone. Interestingly, oral irrigation did not provide any reduced visible plaque with any beneficial results.
Evidence Search	("Toothbrushing"[Mesh] AND "Periodontitis"[Mesh]) AND "Therapeutic Irrigation"[Mesh].
Comments on The Evidence	In this systematic review, the large majority of potential papers were excluded because they were lacking in such reasons as length of time of study, irrigation performed by professionals, non-human trials and discontinuous irrigation usage. 4 out of the 7 acceptable papers were randomized controlled trials, increasing the likelihood of validity of the results. According to this review, patients may benefit from an increased likelihood of maintaining good gingival health by adding an oral irrigator to their tooth-brushing regimen. However, the evidence is weak to support a consistent implementation of oral irrigation in addition to an individual’s daily oral hygiene routine in order to reduce gingival inflammation.
Applicability	Results indicate a statistically insignificant positive trend towards improved gingival health when combining oral irrigators and tooth brushing, these findings do not merit a professional recommendation to patients.
Specialty	(General Dentistry) (Periodontics) (Dental Hygiene)
Keywords	Oral irrigator, toothbrushes, gingivitis, periodontitis, gingival health
ID#	2261
Date of submission	04/12/2012
E-mail	delacruzw@livemail.uthscsa.edu
Author	Wendell Dela Cruz
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Guy Huynh-Ba, DDS
Faculty mentor 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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Vincent Vo, David Hoeks (San Antonio, TX) on 11/28/2017 A PubMed search on oral irrigation and gingivitis was conducted on 11/26/17 to confirm the conclusion found in this CAT. An article published in 2013 by Rosema (PMID: 21387981) supports this conclusion. This randomized controlled trial was conducted on 108 subjects and concluded that oral irrigation combined with manual toothbrushing daily was more effective at reducing gingivitis than dental floss with manual toothbrushing daily. This study also concluded that there was no significant difference in plaque reduction between oral irrigation and dental flossing. Another recent article (Drisko 2013, PMID 23574470) was found that supported the same conclusion, that oral irrigation in addition to toothbrushing did not reduce visible plaque but led to reduced inflammation.