Title Interdental Toothbrushes Are Favorable to Floss for Patients With Periodontal Disease
Clinical Question In adult patients, are interdental toothbrushes more effective at interproximal plaque removal than traditional dental floss?
Clinical Bottom Line In adult patients with periodontal disease or interdental recession, interdental brushes (IDBs) can be more effective than traditional dental floss at reducing interproximal plaque, gingival inflammation, and bleeding. They consistently provide better plaque control and improved gingival health, especially in patients with widened interdental spaces where floss may be less effective. Interdental brushes also tend to have higher patient compliance and ease of use, enhancing their clinical effectiveness.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29520910Georgios/2018Adults in 22 trialsMeta-Analysis
Key resultsA network meta-analysis of 22 randomized trials evaluated the effectiveness of interdental brushes (IB) and floss (FL) on key clinical outcomes in patients with periodontitis. IB showed statistically greater reductions in gingival inflammation and plaque compared to FL. Specifically, IB achieved a mean Gingival Index (GI) reduction of 0.23 (95% CI: 0.09 to 0.37), significantly outperforming FL, which had a lower GI reduction (data not explicitly provided but ranked fifth with SUCRA 0.473 vs. IB’s 0.908). For Plaque Index (PI), IB showed a mean reduction of 0.34 (95% CI: 0.12 to 0.56), ranking highest among tested aids, whereas FL ranked lower (SUCRA 0.521). Regarding Probing Depth (PD), IB also had superior efficacy with a mean rank SUCRA of 0.904 compared to FL’s 0.55. In Bleeding on Probing (BOP), IB ranked better than FL (SUCRA 0.685 vs. 0.38), while FL’s effect size on BOP reduction was modest (5.1% to 10.3% vs. control). These results demonstrate that IB provides significantly greater improvements than FL in managing gingival inflammation, plaque accumulation, and probing depth in periodontitis.
19138177Slot/2008Adults in 9 trialsSystematic review of randomized trials
Key resultsThis systematic review and meta-analysis evaluated the efficacy of interdental brushes (IDB) compared to dental floss and other interdental aids in plaque, gingival inflammation, bleeding on probing (BOP), and probing pocket depth (PD) outcomes. Across multiple studies, IDB consistently showed a statistically significant greater reduction in plaque scores compared to floss, with a weighted mean difference (WMD) in plaque index favoring IDB of -0.48 (95% CI: -0.65 to -0.32, p < 0.00001). Patient preference favored IDB over floss, citing ease of use and greater perceived efficacy in plaque removal.
35014192Gennai/2022Adults with periodontitis and interdental recession, N=60Randomized Controlled Trial
Key resultsIn a randomized controlled trial of 60 patients with periodontitis, interdental brushes (IB) demonstrated significantly greater reductions in plaque and gingival inflammation compared to dental floss (FL). At 28 days, full-mouth plaque scores decreased by 53% (SD 34%) in the IB group versus 39% (SD 27%) in the FL group (p < 0.05). Similarly, gingival inflammation measured by interdental gingival index reduced more with IB (mean reduction 0.72, SD 0.50) compared to FL (mean reduction 0.70, SD 0.53), though this difference was not statistically significant. Importantly, bleeding indices (Angulated Bleeding Index and Interdental Angulated Bleeding Index) showed significant improvement with IB (reductions up to 22%, p < 0.05), whereas FL did not demonstrate significant bleeding reduction. These results suggest that interdental brushes are more effective than floss in reducing plaque and gingival inflammation in periodontitis patients, supporting current clinical recommendations favoring IB use in this population.
29520910Ng/2019General adult populationNarrative Review
Key resultsAlthough a narrative review, Ng et al. summarized multiple studies indicating that interdental brushes are clinically superior to floss in reducing plaque and gingivitis, particularly in periodontal patients. The review highlights that interdental brushes have better patient acceptance and compliance than floss, which enhances their clinical effectiveness. It also discusses the mechanical advantage of interdental brushes in accessing wider embrasures that floss cannot clean effectively.
Evidence Search (“Interdental Brush, Dental Floss”), ("Periodontitis, Gingivitis"), ("InterProximal/Interdental Cleaning")
Comments on
The Evidence		 The diverse, peer-reviewed studies cited, include an network meta-analysis, systematic review, randomized controlled trial (RCT), and narrative review. The meta-analysis chosen (Georgios/2018) included 22 RCTs, encompassing 1,735 total participants, providing a robust comparison across several types of interproximal cleaning devices. Similarly, the systematic review (slot/2008) included a final review of 9 studies which focused on interdental brush interventions. These studies included both Randomized and Controlled Clinical designs. The RCT selected (Gennai/2022) enrolled 60 patients, all of which possessed periodontal disease and interdental recession, and displayed statistically significant differences in plaque reduction, favoring interdental brushes. Although the narrative review chosen (Ng/2019) does not explicitly state the number of studies included in the final review, which is typical of narrative reviews, the search pool included 105 total articles. The combination of study types—particularly the inclusion of large scale and high level evidence supports the validity and clinical applicability of the findings favoring interdental brushes over floss.
Applicability Findings apply to adult patients including those with periodontal disease, interdental recession, or widened embrasures. Interdental brushes are particularly suitable for patients with periodontal attachment loss or inflammation where floss may be less effective. For very tight contacts, alternative methods might still be required. Patient dexterity and preference should guide device selection to optimize compliance.
Specialty (General Dentistry) (Periodontics)
Keywords Interdental Brush, Interproximal cleaning, periodontitis, periodontal disease, interdental recession, plaque index, gingival inflammation, Floss
ID# 3584
Date of submission 01/21/2026
E-mail Rhuddleston0148@gmail.com
Author Ryan Huddleston
Co-author(s)
Co-author(s) e-mail
Faculty mentor Jeffery Hicks
Faculty mentor e-mail HICKSJ@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
spacer
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
None available