A network meta‐analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation
Open accessAbstract
Background: A wide selection of Interdental Oral Hygiene (IOH) aids is available to consumers. Recommendations for selection are, however, limited by the lack of direct comparisons in available studies. We aimed to assess the comparative efficacy of IOH aids using Bayesian Network Meta‐Analysis (BNMA). Methods: Two independent reviewers performed a systematic literature review of randomized clinical trials assessing IOH aids, based on a focused question. Gingival inflammation (Gingival Index (GI), Bleeding‐on‐probing (BOP)) was the primary outcome and plaque and probing depth were secondary outcomes A random‐effects arm‐based BNMA model was run for each outcome; posterior medians and 95% credible‐intervals (CIs) summarized marginal distributions of parameters. Results: A two‐phase selection process identified 22 trials assessing 10 IOH aids as brushing adjuncts. Interdental brushes (IB) yielded the largest reduction in GI (0.23 [95% CI: 0.09, 0.37]) as toothbrushing adjuncts, followed by water‐jet (WJ) (0.19 [95% CI: 0.14, 0.24]). Rankings based on posterior probabilities revealed that IB and WJ had the highest probability of being “best” (64.7% and 27.4%, respectively) for GI reduction, whereas the probability for toothpick and floss being the “best” IOH aids was near zero. Notably, except for toothpicks, all IOH aids were better at reducing GI as compared with control. Conclusions: BNMA enabled us to quantitatively evaluate IOH aids and provide a global ranking of their efficacy. Interdental brushes and water‐jets ranked high for reducing gingival bleeding, whereas toothpicks and floss ranked last. The patient‐perceived benefit of IOH aids is not clear because gingival inflammation measures are physical indicators of periodontal health.
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The oral irrigator has been demonstrated to improve gingival health when compared with toothbrushing alone but does not concomitantly appear to reduce visible plaque.
“The oral irrigator has been demonstrated to improve gingival health when compared with toothbrushing alone but does not concomitantly appear to reduce visible plaque.23,24”
From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [24]
The Results (Results of NMA; page not available) report that water-jet irrigation, used alongside brushing, reduced gingival bleeding and gingival inflammation compared with toothbrushing controls. The copy assesses plaque as a secondary outcome but does not establish that water-jet irrigation fails to reduce visible plaque compared with brushing alone. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA network meta-analysis concluded that unsupervised flossing does not yield a substantial reduction in gingival inflammation.
“Correspondingly, a network meta-analysis concluded that unsupervised flossing does not yield a substantial reduction in gingival inflammation.24”
From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [24]
Interdental brushes seem to be the most effective method for removing interdental plaque and improving gingival health.
“Interdental brushes seem to be the most effective method for removing interdental plaque 23,24 and improving gingival health.24”
From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [24]
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- Authors
- Kotsakis, G. A., Lian, Q., Ioannou, A. L., Michalowicz, B. S., John, M. T., & Chu, H.
- Affiliations
- University of Washington (US)
- University of Minnesota (US)
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Kotsakis, Georgios A.
- ORCID
- Venue
- Journal of Periodontology
- Publisher
- Wiley
- Published
- 2018-05
- Volume
- 89
- Issue
- 5
- Pages
- 558-570
- ISSN
- 0022-3492 (ISSN-L)
- 1943-3670
- PMC
- PMC5984142
- OpenAlex
- W2791403402
- Cited by
- 97
- References
- 58
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 9 · 2023: 10 · 2022: 19 · 2021: 13 · 2020: 14 · 2019: 5 · 2018: 3
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Periodontology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Dental and Craniofacial Research (R03DE024750)
- U.S. National Library of Medicine (R21LM012197)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Dentistry › Oral Surgery › Dental Implant Techniques and Outcomes
- Keywords
- interdental brushes, water jet cleaning, toothpicks, dental floss, gingivitis, gingival index, bleeding on probing, dental plaque, probing depth, periodontal health
- MeSH terms
- Network Meta-Analysis, Bayes Theorem, Dental Devices, Home Care, Dental Plaque Index, Gingivitis, Humans, Inflammation, Oral Hygiene, Toothbrushing
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