Cepillado interdental para la prevención y el control de las periodontopatías y caries dental en adultos
Información
- DOI:
- https://doi.org/10.1002/14651858.CD009857.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 18 diciembre 2013see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud oral
- Copyright:
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- Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
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Conceiving, designing and co‐ordinating the review: Peter Tugwell (PT), Tina Poklepovic (TP), Dario Sambunjak (DS), Helen Worthington (HW).
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Designing search strategies and undertaking searches: DS, TP, Trevor Johnson (TJ).
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Screening search results and retrieved papers against inclusion criteria: DS, TP.
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Appraising quality of papers: DS, TP, HW, TJ.
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Extracting data from papers: HW, TP, TJ.
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Writing to authors of papers for additional information: TP, Pauline Imai (PI), TJ.
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Data management for the review and entering data into RevMan: TP, TJ, HW, DS.
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Analysis and interpretation of data: HW, TP, TJ.
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Providing a clinical perspective: TP, PI, TJ, Jan Clarkson (JC).
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Writing the review: TP, TJ, PI, HW.
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Providing general advice on the review: PT, HW, JC.
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Performing previous work that was the foundation of the current review: HW, PT, JC.
Sources of support
Internal sources
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The University of Manchester, UK.
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MAHSC, UK.
The Cochrane Oral Health Group is supported by the Manchester Academic Health Sciences Centre (MAHSC) and the NIHR Manchester Biomedical Research Centre.
External sources
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National Institute for Health Research (NIHR), UK.
CRG funding acknowledgement:
The NIHR is the largest single funder of the Cochrane Oral Health Group.Disclaimer:
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health. -
Cochrane Oral Health Group Global Alliance, UK.
All reviews in the Cochrane Oral Health Group are supported by Global Alliance member organisations (British Association of Oral Surgeons, UK; British Orthodontic Society, UK; British Society of Paediatric Dentistry, UK; British Society of Periodontology, UK; Canadian Dental Hygienists Association, Canada; National Center for Dental Hygiene Research & Practice, USA; Mayo Clinic, USA; New York University College of Dentistry, USA; and Royal College of Surgeons of Edinburgh, UK) providing funding for the editorial process (http://ohg.cochrane.org/).
Declarations of interest
Two review authors (Pauline Imai and Helen Worthington) were also authors of the included trials but they were not involved in the risk of bias assessments of these trials. This review will be used by some of the authors as part of other research projects. None of the authors has any other interests related to this review.
Acknowledgements
We would like to thank the Cochrane Oral Health Group editorial base for their support during the completion of this review. We would also like to thank the following referees for their helpful, constructive comments on the review: Anne Littlewood, Phil Riley, Ian Needleman, Tanya Walsh, Aubrey Sheiham and Edward Lo.
Version history
| Published | Title | Stage | Authors | Version |
| 2019 Apr 24 | Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults | Review | Tina Poklepovic Pericic, Helen V Worthington, Trevor M Johnson, Dario Sambunjak, Pauline Imai, Janet E Clarkson, Peter Tugwell | |
| 2013 Dec 18 | Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults | Review | Tina Poklepovic, Helen V Worthington, Trevor M Johnson, Dario Sambunjak, Pauline Imai, Jan E Clarkson, Peter Tugwell | |
| 2012 May 16 | Interdental brushing for the management of periodontal diseases and dental caries in adults | Protocol | Tina Poklepovic, Dario Sambunjak, Trevor M Johnson, Pauline Imai, Peter Tugwell, Jason W Nickerson, Jan E Clarkson, Helen V Worthington | |
Differences between protocol and review
No major changes have been made to the methods used.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Dental Caries [*prevention & control];
- Dental Devices, Home Care [adverse effects];
- Dental Plaque [prevention & control];
- Gingivitis [prevention & control];
- Oral Hygiene [adverse effects, methods];
- Periodontal Diseases [*prevention & control];
- Randomized Controlled Trials as Topic;
- Toothbrushing [adverse effects, instrumentation, *methods];
Medical Subject Headings Check Words
Adult; Humans;
Study selection flow diagram.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Interdental brushing versus flossing, Outcome 1 Gingivitis at 1 month.
Comparison 1 Interdental brushing versus flossing, Outcome 2 Gingivitis at 3 months.
Comparison 1 Interdental brushing versus flossing, Outcome 3 Plaque at 1 month.
Comparison 1 Interdental brushing versus flossing, Outcome 4 Plaque at 3 months.
| Interdental brushing for periodontal diseases and dental caries in adults | ||||||
| Patient or population: Adults, 16 years and older | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| No IDB | IDB | |||||
| Gingivitis | The mean gingivitis in the control group was 1.56 | The mean gingivitis in the intervention groups was 0.53 lower (95% CI 0.23 to 0.83) | 62 | ⊕⊝⊝⊝ | 34% reduction in gingivitis | |
| Periodontitis | Not estimable | 0 | See comment | No included study assessed periodontitis as an outcome | ||
| Plaque | The mean plaque in the control groups was | The mean plaque in the intervention groups was 0.95 lower (95% CI 0.56 to 1.34) | 62 | ⊕⊝⊝⊝ | 32% reduction in plaque | |
| Interproximal caries | Not estimable | 0 | See comment | No included study assessed caries as an outcome | ||
| Harms and adverse outcomes | Not estimable | 0 | See comment | Only 1 study reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids | ||
| Bad breath (halitosis) | Not estimable | 0 | See comment | No included study assessed bad breath as an outcome | ||
| Quality of life | Not estimable | 0 | See comment | No included study assessed quality of life as an outcome | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Single study at high risk of bias. | ||||||
| Interdental brushing compared to flossing for periodontal diseases and dental caries in adults | ||||||
| Patient or population: Adults, 16 years and older | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Flossing | IDB | |||||
| Gingivitis | The mean gingivitis in the flossing groups was | The mean gingivitis in the intervention groups was | 390 | ⊕⊕⊝⊝ | The estimate is for the 1‐month (4 to 6 weeks) time point and converts back to 52% reduction (of control mean) for IDB (based on 1 study). Results (based on 2 studies, very low‐quality evidence) at 3 months show a large SMD but we are unable to draw conclusions on the effect due to the wide confidence interval including no effect | |
| Periodontitis | Not estimable | 0 | See comment | No included study assessed clinical attachment loss, a measure of progression of periodontitis | ||
| Plaque | The mean plaque in the flossing groups was | The mean plaque in the intervention groups was | 326 | ⊕⊕⊝⊝ | The estimate is for the 1‐month (4 to 6 weeks) time point, and converts back to 2% reduction (of control mean) for IDB (based on 1 study). The effect for the 3 months time point somewhat differs, with a large SMD but we are unable to draw conclusions on the effect due to the wide confidence interval including no effect (based on 2 studies, very low‐quality evidence) | |
| Interproximal caries | Not estimable | 0 | See comment | No included study assessed caries as an outcome | ||
| Harms and adverse outcomes | Not estimable | 0 | See comment | 2 studies reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids. We were unable to pool data | ||
| Bad breath (halitosis) | Not estimable | 0 | See comment | No included study assessed bad breath as an outcome | ||
| Quality of life | Not estimable | 0 | See comment | No included study assessed quality of life as an outcome | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Re‐expressed from SMD into Eastman Interdental Bleeding Index score. The results should be interpreted with caution since back‐translation of the effect size is based on the results of only one study (Jackson 2006). The estimate is for the one‐month time point with a SMD of ‐0.53. A larger effect was observed for the three months time point with a SMD of ‐1.98. | ||||||
| Study | Time | Interdental brushing | Floss | ||||
| n | Mean | SD | n | Mean | SD | ||
| 6 weeks | 26 | 0.83 | 0.18 | 26 | 0.86 | 0.15 | |
| 6 weeks | 29 | 0.11 | 0.03 | 29 | 0.17 | 0.04 | |
| 12 weeks | 30 | 0.08 | 0.02 | 30 | 0.2 | 0.04 | |
| 4 weeks | 10 | 0.056 | 0.0479 | 10 | 0.081 | 0.0506 | |
| 6 weeks | 39 | 0.14 | 0.15 | 38 | 0.23 | 0.22 | |
| 12 weeks | 39 | 0.1 | 0.11 | 38 | 0.16 | 0.17 | |
| 4 weeks | 30 | 1.03 | 0.57 | 29 | 1.29 | 0.7 | |
| 4 weeks | 31 | 1.21 | 0.27 | 31 | 1.41 | 0.39 | |
| 6 weeks | 31 | 0.78 | 0.83** | 31 | 0.95 | 0.83* | |
| 28 | 0.91 | 0.79* | |||||
| *Split‐mouth studies. **The standard deviations in the Yost 2006 study were calculated from standard errors reported within graphs in the study report. | |||||||
| Study | Time | Interdental brushing | Floss | ||||
| n | Mean | SD | n | Mean | SD | ||
| 6 weeks | 26 | 2.15 | 0.99 | 26 | 2.47 | 0.86 | |
| 6 weeks | 29 | 1.23 | 0.18 | 29 | 1.23 | 0.18 | |
| 12 weeks | 30 | 1.26 | 0.24 | 30 | 1.28 | 0.22 | |
| 4 weeks | 10 | 0.057 | 0.0221 | 10 | 0.053 | 0.0306 | |
| 6 weeks | 39 | 0.68 | 0.28 | 38 | 1 | 0.36 | |
| 12 weeks | 39 | 0.72 | 0.37 | 38 | 0.96 | 0.4 | |
| 4 weeks | 30 | 2.02 | 0.77 | 29 | 2.23 | 0.83 | |
| 4 weeks | 31 | 1.67 | 0.29 | 31 | 1.71 | 0.28 | |
| 6 weeks | 31 | 1.84 | 1.1** | 31 | 2.06 | 1.1* | |
| 28 | 1.98 | 1.05* | |||||
| *Split‐mouth studies. **The standard deviations in the Yost 2006 study were calculated from standard errors reported within graphs in the study report. | |||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Gingivitis at 1 month Show forest plot | 7 | Std. Mean Difference (Random, 95% CI) | ‐0.53 [‐0.81, ‐0.24] | |
| 1.1 Trained interdental brushing | 6 | Std. Mean Difference (Random, 95% CI) | ‐0.52 [‐0.83, ‐0.21] | |
| 1.2 Untrained interdental brushing | 1 | Std. Mean Difference (Random, 95% CI) | ‐0.62 [‐1.13, ‐0.11] | |
| 2 Gingivitis at 3 months Show forest plot | 2 | Std. Mean Difference (Random, 95% CI) | ‐1.98 [‐5.42, 1.47] | |
| 3 Plaque at 1 month Show forest plot | 7 | Std. Mean Difference (Random, 95% CI) | 0.10 [‐0.13, 0.33] | |
| 3.1 Trained interdental brushing | 6 | Std. Mean Difference (Random, 95% CI) | 0.13 [‐0.12, 0.38] | |
| 3.2 Untrained interdental brushing | 1 | Std. Mean Difference (Random, 95% CI) | ‐0.14 [‐0.63, 0.36] | |
| 4 Plaque at 3 months Show forest plot | 2 | Std. Mean Difference (Random, 95% CI) | ‐2.14 [‐5.25, 0.97] | |
