Which interdental cleaning aids for managing gingivitis?


Effective toothbrushing is important for managing gingivitis. However, a range of interdental aids; floss, tape, interdental brushes, woodsticks and oral irrigators have been developed to remove plague teeth. The aim of this review was to summarize and appraise the evidence emerging from systematic reviews on the efficacy of various inter-dental devices for mechanical plaque control in managing gingivitis.


Searches were conducted in Medline, the Cochrane Library, the ADA Evidence-based Dentistry database and the PROSPERO database for systematic reviews in English, German, French or Dutch evaluating inter-dental self-care products for controlling plaque and/or managing gingivitis. Studies involving orthodontic or dental implants were excluded. Two reviewers independently screened studies, abstracted data and assessed study quality. The overall body of evidence was assessed using the GRADE approach.


  • 6 reviews were included; 2 for dental floss; 2 for interdental brushes; and one each for woodsticks and oral irrigators.
  • 2 reviews were considered to be at low risk of bias and 4 at moderate risk of bias.
  • A narrative summary of the reviews is presented.
  • There is moderate evidence to support the efficacy of inter-dental brushes on plaque removal and reduction of gingivitis.
  • There is weak evidence supporting the use of dental floss, woodsticks and the oral irrigator.


The authors concluded:

Evidence suggests that inter-dental cleaning with IDBs is the most effective method for inter-dental plaque removal. The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal. All investigated devices for inter-dental self-care seem to support the management of gingivitis, however, to a varying extent.


This meta-review provides a very useful summary of the currently available review on inter-dental cleaning aids. The quality of the meta-review depends on the quality of the individual reviews, which are in turn dependent of the original study quality. The authors have helpfully provided a clear table that summarises their quality assessments together with their overall assessment of bias. They also provide a table summarising their GRADE assessment. This meta-review included two Cochrane reviews, Sambunjak et al 2011 on the use of dental floss (Dental Elf – 12th Dec 2011) and Poklepovic et al 2013 on interdental brushing (Dental Elf – 6th Jan 2014). Both of these Cochrane reviews postdate the other available reviews and both grade the available evidence as very low, which suggests that according the interdental brush a moderate level of evidence may not be appropriate.


Sälzer S, Slot DE, Van der Weijden FA, Dörfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis – a meta-review. J Clin Periodontol. 2015 Apr;42 Suppl 16:S92-S105. doi: 10.1111/jcpe.12363. PubMed PMID:25581718.

Dental Elf – 6th Jan 2014 – Only low quality evidence available for effectiveness of interdental toothbrushes

Dental Elf – 12th Dec 2011 – People who brush and floss regularly have less gum bleeding compared to toothbrushing alone


PROSPERO database

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