Data sources: The National Library of Medicine (Washington DC; to access Medline-PubMed) and the Cochrane Central Register of Controlled Trials were searched for articles dated from 1965 up to November 2007.
Study selection: Two independent reviewers assessed studies for inclusion, aiming to identify appropriate randomised controlled clinical trials and controlled clinical trials. Studies were selected if they were conducted in humans, and included subjects of over 18 years of age in good general health with sufficient interdental space to use an interdental brushes. The articles were limited to English-language publications. Case reports, letters and narrative or historical reviews were excluded.
Data extraction and synthesis: As there was considerable heterogeneity in the design of the studies, a meta-analysis was only conducted for the comparison of the interdental brush with floss, with weighted mean differences (WMD) calculated using a random effects model. Descriptive comparisons were presented for brushing alone, brushing and flossing or brushing and woodsticks where appropriate.
Results: After searching the literature, 234 titles and abstracts required screening, resulting in 18 full-text articles. Based on the full texts, another five articles were excluded and finally nine studies were identified as eligible. Two were of crossover design, three of a split-mouth design and four were parallel design. The longest study duration was 12 weeks.
Conclusions: The evidence showed that interdental brush use as an adjunct to toothbrushing removes more dental plaque than brushing alone, being even more effective than dental floss or woodsticks in removing dental plaque. The evidence available for the effect on gingival inflammation is less conclusive. The reduction of pocket depth after the use of the interdental brush is more pronounced than with floss.