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Memflos untuk pengendalian penyakit periodontium dan karies dalam kalangan orang dewasa.

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Abstract

Background

Good oral hygiene is thought to be important for oral health. This review is to determine the effectiveness of flossing in addition to toothbrushing for preventing gum disease and dental caries in adults.

Objectives

To assess the effects of flossing in addition to toothbrushing, as compared with toothbrushing alone, in the management of periodontal diseases and dental caries in adults.

Search methods

We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 17 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE via OVID (1950 to 17 October 2011), EMBASE via OVID (1980 to 17 October 2011), CINAHL via EBSCO (1980 to 17 October 2011), LILACS via BIREME (1982 to 17 October 2011), ZETOC Conference Proceedings (1980 to 17 October 2011), Web of Science Conference Proceedings (1990 to 17 October 2011), Clinicaltrials.gov (to 17 October 2011) and the metaRegister of Controlled Clinical Trials (to 17 October 2011). We imposed no restrictions regarding language or date of publication. We contacted manufacturers of dental floss to identify trials.

Selection criteria

We included randomised controlled trials conducted comparing toothbrushing and flossing with only toothbrushing, in adults.

Data collection and analysis

Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. The effect measure for each meta‐analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random‐effects models. We examined potential sources of heterogeneity, along with sensitivity analyses omitting trials at high risk of bias.

Main results

Twelve trials were included in this review, with a total of 582 participants in flossing plus toothbrushing (intervention) groups and 501 participants in toothbrushing (control) groups. All included trials reported the outcomes of plaque and gingivitis. Seven of the included trials were assessed as at unclear risk of bias and five were at high risk of bias.

Flossing plus toothbrushing showed a statistically significant benefit compared to toothbrushing in reducing gingivitis at the three time points studied, the SMD being ‐0.36 (95% CI ‐0.66 to ‐0.05) at 1 month, SMD ‐0.41 (95% CI ‐0.68 to ‐0.14) at 3 months and SMD ‐0.72 (95% CI ‐1.09 to ‐0.35) at 6 months. The 1‐month estimate translates to a 0.13 point reduction on a 0 to 3 point scale for Loe‐Silness gingivitis index, and the 3 and 6 month results translate to 0.20 and 0.09 reductions on the same scale.

Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.

None of the included trials reported data for the outcomes of caries, calculus, clinical attachment loss, or quality of life. There was some inconsistent reporting of adverse effects.

Authors' conclusions

There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Memflos untuk mengurangkan penyakit gusi dan kerosakan gigi.

Adalah dianggap bahawa pembuangan plak (lapisan bakteria dalam matriks organik yang terbentuk pada gigi) akan membantu mencegah penyakit gusi (gingivitis) dan kerosakan gigi (karies gigi). Penyakit gusi yang menampakkan kemerahan, gusi berdarah, boleh menyumbang kepada kehilangan gigi. Kerosakan gigi yang tidak dirawat boleh menyebabkan kehilangan gigi. Memberus gigi membuang sedikit plak, namun tidak dapat membersihkan kawasan antara gigi, yang mana penyakit gusi dan kerosakan gigi kerap terjadi. Ulasan ini melihat kepada manfaat tambahan memflos gigi dalam kalangan orang yang memberus gigi secara tetap, untuk mencegah penyakit gusi dan kerosakan gigi.

Dua‐belas kajian yang melaporkan data berkenaan dua hasil (plak gigi dan penyakit gusi) dimasukkan dalam ulasan ini. Kajian‐kajian adalah berkualiti rendah dan rumusan dianggap sebagai tidak boleh terima. Ulasan ini menunjukkan orang yang memberus dan memflos secara tetap mengalami kurang gusi berdarah berbanding dengan memberus gigi sahaja. Bukti kemungkinan pengurangan plak yang kecil adalah lemah dan tidak boleh diterima. Tiada maklumat tentang ukuran lain misalnya kerosakan gigi kerana kajian tidak mempunyai cukup jangkamasa dan pengesanan peringkat awal kerosakan di antara gigi adalah sukar.