Home use of interdental cleaning devices and toothbrushing and their role in disease prevention.,Evidence-Based Dentistry

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Home use of interdental cleaning devices and toothbrushing and their role in disease prevention.
Evidence-Based Dentistry Pub Date : 2019-12-01 , DOI: 10.1038/s41432-019-0069-7
Amanda Gallie ₁

Affiliation

Objectives The primary objective of this review was to determine the effectiveness of interdental cleaning per se as a stand-alone treatment, and then with the addition of tooth-brushing or a brushing device as a comparator. The ecological plaque model within which biofilm modification is key to stabilisation of periodontal inflammation. Thus, the control of plaque biofilms has a positive impact on reducing periodontal diseases and caries in the population.1 A secondary objective of the review was to carry out cross-sectional analysis of the effectiveness of different interdental cleaning aid groups (ICA) to ascertain which ICA emerged as the most effective in removing bacterial plaque.Study selection criteria Studies of a four-week duration or longer were included. Randomised controlled trials (RCTs) that compared tooth-brushing and a home-use interdental cleaning device versus tooth-brushing alone were selected.Data extraction and synthesis No exclusion criteria regarding date or language were given. Two of the authors independently screened the search results, selected relevant studies, extracted data, assessed the primary studies for sources of bias and graded and assessed the quality of the evidence.Results 35 RCTs (3929 randomised adult participants) were included in this review. The participants could not be blinded and therefore the level of performance bias was probably high. Only two of the RCT studies included could report low performance bias. The data was analysed and comparisons made between mean differences (MD)and standardised mean differences (SMDs). The interdental cleaning aids (ICAs) included in this systematic review were:1. Floss (15 trials)2. Interdental brushes (2 trials)3. Wooden sticks (2 trials)4. Rubber/elastomer sticks (2 trials)5. Oral irrigator (5 trials)The evidence collected was relatively weak in terms of robustness and the studies were all of a fairly short duration. Interestingly, none of the studies adequately described the periodontal health of the participants and the base line diagnosis for the periodontal condition of these patients was noticeably absent. Baseline levels of inflammation were, however, recorded, and in the majority of the studies, participants exhibited low levels of gingival inflammation. Periodontal disease and status were not assessed and recorded in any of the studies. Gingivitis was recorded at base line and after testing, using the Silness and Loe scoring system. A percentage bleeding score was available in some of the included studies. None of the trials elicited interproximal caries status. Plaque levels were recorded at base line and completion using the Quigley Hein index. Measures of caries activity and presence of interproximal caries were absent.Conclusions The question of whether interdental cleaning aids improve oral health cannot be answered by this systematic review. More work needs to be done to develop the tools to evidence whether caries and periodontal disease can be controlled by the use of interdental cleaning aids.But from the results of this study we can ascertain that interdental cleaning aids are augmented in their effectiveness by the addition of a toothbrush; conversely a toothbrush has less effect on reducing plaque and inflammation levels when used alone. A combination of the brushing and interdental cleaning improves oral health outcomes.The best performing interdental aid was the interdental brush (low certainty evidence), the use of which was associated with reduced inflammation and reduction in bleeding scores; statistically this gave slightly better results than other cleaning aids such as floss.Floss (low-certainty evidence) showed some indication of reducing gingivitis at 1 month. However, the bleeding site and plaque score information was difficult to interpret.An oral irrigator showed no real benefit over brushing alone at three months.Rubber/elastomer sticks reduced plaque scores but not gingivitis at one month (very low certainty evidence.) Safety: None of the studies included in the review tested compared the degree of gingival irritation caused by the ICAs.

中文翻译：

牙间清洁器和牙刷的家庭使用及其在疾病预防中的作用。

目的这篇综述的主要目的是确定齿间清洁本身作为独立治疗的有效性，然后增加刷牙或刷牙设备作为比较器。生态斑块模型中的生物膜修饰是稳定牙周炎症的关键。因此，斑块生物膜的控制对减少人群中的牙周疾病和龋齿有积极影响。1审查的第二个目的是对不同的齿间清洁辅助剂组（ICA）的有效性进行横断面分析，以确定研究选择标准包括持续四周或更长时间的研究。选择将牙刷和家用牙间清洁器与单独刷牙进行比较的随机对照试验（RCT）。数据提取和综合没有给出有关日期或语言的排除标准。两位作者独立筛选了搜索结果，选择了相关研究，提取了数据，评估了偏倚来源的初次研究，并对证据的质量进行了分级和评估。结果纳入了35篇RCT（3929例随机成人受试者）。参与者不会视而不见，因此表现偏见的水平可能很高。所包括的RCT研究中只有两项可以报告较低的绩效偏见。分析数据并在均值差（MD）和标准均值差（SMD）之间进行比较。本系统评价中包括的齿间清洁辅助剂（ICAs）为：1。牙线（15次试用）2。齿间刷（2次试验）3。木棍（2次试用）4。橡胶/弹性棒（2次试验）5。口腔冲洗器（5个试验）就鲁棒性而言，收集的证据相对较弱，且研究时间均较短。有趣的是，没有一项研究能够充分描述参与者的牙周健康状况，并且明显缺乏这些患者牙周状况的基线诊断。然而，记录了炎症的基线水平，并且在大多数研究中，参与者表现出低水平的牙龈炎症。在任何一项研究中均未评估和记录牙周疾病和状态。在基线和测试后记录了牙龈炎，使用Silness and Loe评分系统。在其中包括的一些研究中可获得百分比出血分数。这些试验均未引起近邻龋病状态。使用Quigley Hein指数在基线和完成时记录斑块水平。缺乏龋齿活动度和近邻龋齿的测量。结论本系统评价不能回答有关齿间清洁助剂是否能改善口腔健康的问题。需要做更多的工作来开发工具来证明龋齿和牙周疾病是否可以通过使用齿间清洁剂来控制。但是从这项研究的结果，我们可以确定，通过添加齿间清洁剂可以增强其有效性。牙刷相反，当单独使用牙刷时，牙刷对减少牙菌斑和炎症水平的作用较小。刷牙和齿间清洁相结合可以改善口腔健康状况。最佳的齿间辅助工具是齿间刷（确定性较低的证据），其使用可减少发炎和降低出血分数。从统计学上讲，与使用牙线等其他清洁助剂相比，它的效果要好一些。牙线（低确定性证据）显示出1个月时牙龈炎减轻的迹象。但是，出血部位和牙菌斑分数信息难以解释。三个月时，口服冲洗器没有显示比单独刷牙有任何真正的好处;橡胶/弹性体棒在一个月时降低了牙菌斑分数，但没有降低牙龈炎（非常低的确定性证据）。安全性：

更新日期：2019-12-20

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