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

∆, DipDH, BDSc(DH), MSc(Dent Sc), RDH; Xiaoli Yu*, MSc; David MacDonald § , BDS, BSc(Hons.), LLB(Hons.), MSc, DDS(Edin.), DDRRCR, FDSRCPS, FRCD(C). Abstr ACt 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 Pharmaceutical companies that develop and manufacture interdental brushes were also contacted for unpublished or ongoing clinical trials.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.