The present BNMA enabled us to quantitatively evaluate OH aids and provide a global ranking of their efficacy. Among 10 IOH aids, interdental brushes and water-jets ranked high among the aids for reducing gingival bleeding. Unsupervised flossing did not yield substantial reductions in gingival inflammation. The present findings are aligned with the recommendations set forth following a consensus meeting during the 11th European Workshop in Periodontology3 that forced the periodontal community to rethink the recommendation for flossing across groups and levels of periodontal health. The present work corroborates the recommendations derived from the workshop proceedings, which state that flossing cannot be generally recommended for managing gingivitis except for sites where the interdental space is too limited to allow the passage of an interdental brush without trauma. In fact, our meta-analysis did not limit the selection to interproximal hygiene aids to interdental brushes and floss but also suggested that water-jet devices and potentially toothpicks, when used under intensive oral hygiene instruction, may be beneficial homecare aids in the management of gingivitis. Given the prevalence of gingivitis, providing the general public with efficacious alternatives to flossing would likely have significant public health impact.
Flossing has received the most attention among IOH aids and is highly recommended by dentists and dental associations alike due to its conceptually superior capability of removing plaque for interdental areas.50 Therefore, a word of caution regarding the interpretation of findings from the present study is important. The present NMA does not refute the efficacy of flossing for removing interproximal plaque around teeth. The challenge of performing a technically-demanding OH habit51 such as flossing may help explain it’s relatively poor ranking against other IOH aids. When performed effectively, flossing is likely an efficacious approach against gingival inflammation and potentially dental caries.52 For example, one study confirmed that daily (weekdays) professional flossing can prevent the incidence of caries in schoolchildren by 40%.52 Nevertheless, trials assessing the efficacy of self-administered flossing and dental caries have largely failed to show any effect.53 These findings support the hypothesis that flossing is indeed efficacious, but its effective application is elusive. Our results support that dental floss is not the quintessential IOH method. Persons that are effectively using floss should not be instructed to discontinue their OH habits. Importantly, as suggested by our findings, other OH adjuncts actually have an increased likelihood of being effective in reducing gingival inflammation, such as interdental brushes, waterjet devices and dental toothpicks with the appropriate OH instruction.
I personally use a water-jet (Waterpik) and it works well for me in terms of both hedonics and dental health results. (I googled for “waterpik meta analysis” and this paper was the first result that came up.)
From A Network Meta-analysis of Interproximal Oral Hygiene Methods in the Reduction of Clinical Indices of Inflammation:
I personally use a water-jet (Waterpik) and it works well for me in terms of both hedonics and dental health results. (I googled for “waterpik meta analysis” and this paper was the first result that came up.)