“Our study shows that to achieve the highest standard of interdental cleaning, interdental brushes or rubber interdental picks are the most effective devices.” Filippo Graziani, Professor of Periodontology at the Unit of Dentistry and Oral surgery (Sub-Unit of Periodontology, Halitosis, Periodontal Medicine) University Hospital of Pisa, Italy
A newly published study compared the efficacy of four different oral hygiene devices in reducing plaque and gingival inflammation in periodontitis patients. The results showed that interdental brushes and rubber interdental picks are superior compared to toothbrushing alone and toothbrushing combined with floss.
The research, published in the International Journal of Dental Hygiene, has important implications for dental patients with periodontitis, the destructive inflammatory disease of the supporting tissues of the tooth and leading cause of tooth loss (1). As mentioned by the authors in their paper, research shows that approximately 30% of the adult population over the age of 50 are affected by this disease (2).
The study demonstrated that by using a toothbrush alone, or with the additional use of interdental devices, plaque levels and gingival inflammation can be reduced already. However, compared to the use of a toothbrush alone, or in combination with dental floss, further benefits were also seen in reduction of plaque and inflammation when interdental brushes and rubber picks were used instead. Although this is in line with previous studies findings (3,4), those were not restricted to periodontitis patients only, which makes the current study unique.
The study was led by researchers and clinicians from the Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy, at the Sub-Unit of Periodontology, Halitosis, Periodontal Medicine. The rubber interdental picks were provided by international oral healthcare company Sunstar.
Patients were randomly allocated to four groups of 15 participants each – a manual toothbrush group (TB), toothbrush plus dental floss group (TB/F), toothbrush plus interdental brushes group (TB/IDB) and toothbrush plus rubber interdental picks (TB/RIDB). Oral hygiene instructions were provided at baseline (T-7) at one week (T0) and then bi-weekly (T14/T28). At (T0) supragingival professional cleaning was delivered. Plaque and bleeding indexes were taken at all time-points by a single calibrated examiner, blind to group allocation.
The findings corroborate current periodontal treatment recommendations and could have important implications for daily practice, as explained by principal investigator Filippo Graziani, Professor of Periodontology at the Unit of Dentistry and Oral surgery (Sub-Unit of Periodontology, Halitosis, Periodontal Medicine),the University Hospital of Pisa, Italy: “Interdental cleaning is a crucial factor in the maintenance of periodontal health during and after treatment in patients affected by periodontitis. Our study shows that to achieve the highest standard of interdental cleaning, interdental brushes or rubber interdental picks are the most effective devices.”
Martijn Verhulst, Medical Liaison Manager at Sunstar Medical Affairs, adds: “We very much welcome the specific focus on periodontitis patients in this study. So far, evidence of the efficacy of different interdental cleaning tools has been quite conflicting for this population, and for rubber interdental picks even absent, so these results will help clinicians guiding their daily work.”
“The finding that rubber interdental picks and interdental brushes are most efficient at reducing plaque and gingival inflammation was in line with our own expectations. However, the findings are also significant in light of previous research and feedback we get from our consumers, showing that rubber interdental picks are usually considered to be easier to use compared to floss or even interdental brushes. It does remain important to respect dexterity and personal preferences of the patient.”
1.Borrell LN, Papapanou PN. Analytical epidemiology of periodontitis. J Clin Periodontol.
2. Albandar JM. Epidemiology and risk factors of periodontal diseases. Dent Clin North Am.
3. Worthington HV, MacDonald L, Poklepovic Pericic T, Sambunjak D, Johnson TM, Imai P,
Clarkson JE. Home use of interdental cleaning devices, in addition to toothbrushing, for
preventing and controlling periodontal diseases and dental caries. Cochrane Database of
Systematic Reviews 2019, Issue 4. Art. No.: CD012018. DOI:
4. Chapple ILC, Van der Weijden F, Doerfer C, et al. Primary prevention of periodontitis:
managing gingivitis. J Clin Periodontol. 2015;42(Suppl 1):S71-S76
5. Cepeda MS, Weinstein R, Blacketer C, Lynch MC. Association of flossing/inter-dental cleaning and periodontitis in adults. J Clin Periodontol. 2017;44(9):866-871. doi:10.1111/jcpe.12765