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Nov 15, 2020

Interdental Oral Hygiene: Stay on Top of the Evidence

Over the last few decades and in more recent years, several studies have looked at the relative efficacy of commonly available interdental cleaning devices – interdental brushes (IDBs), rubber interdental cleaners (RICs) and floss – for the prevention and treatment of periodontal disease. The question is, how effective is each of these tools and which one is most likely to drive patient compliance? To find out, read on and watch our Virtual Training modules which include two landmark studies and expert commentary from Dr. Filippo Graziani, Professor of Periodontology at the University of Pisa and past President of the EFP. 

GUM® SOFT-PICKS®, GUM TRAV-LER® or floss, what is the best tool?

Only best-in-class evidence

When it comes to interdental cleaning devices, the oral health profession is not poor in data. Cognizant of this, we chose to give you an overview of the state of the evidence on interdental cleaning devices with an exclusive focus on best-in-class clinical data, meaning randomized controlled trials (RCTs), systematic reviews and meta-analyses. We selected studies that focused on commonly available interdental cleaning devices, namely floss, IDBs and RICs. Water- and air-driven options were not considered because of their higher cost and more limited availability. Papers were selected according to whether they compared the efficacy of the devices at controlling plaque for prevention of gum disease in individuals with healthy mouths or in treating gum disease in patients with gingivitis or periodontitis [1].

Research on papers and clinical studies

Ease of use and effectiveness of IDBs and RICs are leading to a new standard of care

The evidence reviewed is unequivocal – IDBs and RICs are better than floss [2] [3] [4] [5] [6]. Indeed, both tools are associated with a significant reduction in interdental plaque and gingival inflammation. Moreover, evaluation of patient acceptance has revealed that patients find IDBs and RICs easier to use than floss [3] [4] [5] [6]. What could be the implications for clinical practice? If the aim is to increase patient adoption of interdental cleaning and to improve outcomes, IDBs and RICs are probably first choice, while recommending floss might be limited to the tightest interdental spaces.

Interdental brushes and rubber picks are more effective than floss

Want to learn more about today’s evidence base and the science of oral hygiene clinical studies? Watch Module 1 of our animated Virtual Training on interdental cleaning. 

Module 1 Interdental Cleaning Virtual Training

For the prevention of gum disease, IDBs and RICs yield better outcomes than floss

In young periodontally healthy subjects, studies have confirmed that space permitting, IDBs [7] [8] and RICs are more effective than floss in preventing gum disease [4] [6] [9]. An intervention with IDBs and RICs has an impact on all clinically relevant parameters, from interdental plaque to gum bleeding and gum inflammation. 

Filippo Graziani study that shows that interdentals are more effective

A large body of evidence demonstrates that periodontally healthy patients can benefit from interdental cleaning, and that – interdental space permitting – IDBs and RICs might be recommended to all periodontally healthy patients.

To review the evidence on the effectiveness of IDBs and RICs in preventing periodontal disease, watch Module 2 of our Virtual Training.

Module 2 Interdental Cleaning Virtual Training

IDBs and RICs are both effective in reducing clinical signs of gum disease

Well-designed RCTs and the latest evidence-based guidelines from the EFP indicate that IDBs are the gold standard – the ‘best’ interdental cleaning tool – in particular when it comes to treating periodontal disease [5]. IDBs are the tool that can best fill the interdental space and the most effective for plaque removal. Their efficacy clearly stands out when compared with floss [1] [2] [3] [4] [5] [6] [7] [8].

TRAV-LER interdental brush is the best in class interdental tool

A 2018 landmark RCT [6] in patients with experimental gingivitis, showed that RICs can yield similar outcomes to IDBs in the management of gum disease. RICs, however, were found to be more effective in reducing gingival inflammation in the approximal sites accessible by both RICs and IDBs, caused less abrasion of the gingiva, and were appreciated more by the participants. The study authors concluded that their effectiveness was closely tied to their ease of use

SOFT-PICKS is more effective in reducing gingival inflammation

A combination of RICs and IDBs might be the best recommendation for more compliant patients. For the less compliant, easier-to-use RICs – associated with less bleeding and less gingival abrasion – may help to promote early adoption.

Want to take a closer a look at the effectiveness of IDBs and RICs in the management of gum disease? Watch Module 3 of our Virtual Training.

Module 3 Interdental Cleaning Virtual Training

The compliance challenge – ease of use is key 

While we know that IDBs are the ‘best’ interdental tool in absolute terms, what can we expect in terms of everyday compliance? A particular interdental tool might be the ‘best’ objectively, but when you factor in patient preferences and behaviours, the picture may start to look a bit different…

As you well know, ensuring patient compliance with interdental cleaning recommendations is one of the biggest challenges in oral care [10]. From lack of motivation to dexterity, there are many factors which can impact a patient’s level of compliance.

Oral care professional wondering how to ensure patient compliance with interdental cleaning

To date, several studies [6] [11] [12] [13] have evaluated patient acceptance of interdental devices, with the evidence indicating that ease of use increases patient acceptance, thus driving compliance with interdental cleaning recommendations.

Easier is better than better

Indeed, in the latest guidelines from the EFP, Professor Mariano Sanz and co-authors remind us that “patient acceptance is crucial for sustained long-term use of interdental cleaning devices”, and that “the number of devices has to be limited with respect to the ability of the patient to cope with this diversity” [5].

RICs are the patient-preferred tool as they are even easier to use than gold standard IDBs

Two recent RCTs suggest that patient acceptance is even greater with RICs than with IDBs, for both periodontally healthy patients [4] and patients with gum disease [6]. Indeed, they are as effective as IDBs in removing plaque while causing less abrasion than other tools.

Patient acceptance is greater with picks and interdental brushes

Significantly, new RCT evidence suggests that RICs are even easier and more comfortable to use and cause less pain on tender gums than IDBs [4] [6] [14]. Finally, guidelines agree that RICs “are highly accepted by patients” [5].

Want to find out more about how ease of use drives compliance and what this means for dental practice? Watch Module 4 of our animated Virtual Training.

Module 4 Interdental Cleaning Virtual Training