Prevent Cavities with a Toothbrush and Interdental Brush

Here is a paper that may be good news for those who are skeptical like me.

Tooth decay (cavities) and

periodontal disease (gingivitis and periodontitis) affect a large proportion of the world's population, and the cost of treatment places a heavy burden on health services. Tooth decay and gum disease can cause pain, difficulty in eating and speaking, low self-esteem, and even tooth loss and the need for surgery.

This is a dental problem that is not only a disease but also an etiquette problem.

Plaque is said to be the most common cause of this problem.

There are a lot of products out there that say, "Use this toothbrush and you can brush all the crevices! There are a lot of products out there that say, "This toothbrush will help you brush your teeth.

I've read this paper because I was wondering if toothbrushes alone can solve this problem.

There were 35 RCTs with 

3929 participants, but because of the difficulty of blinding, there was a high risk of bias and two studies with low involvement of bias.

And it appears that many of the participants had low-level gingivitis.

To counter tooth brushing...

Flossing.

Interdental brushes

Wooden cleaning sticks

Rubber/elastomer interdental cleaning sticks

Oral rinses

The results of the study were compared and contrasted with each of the following

Tooth brushing + flossing (SMD -0.58, 95% confidence interval (CI) -1.12 to -0.04, 8 trials 585 participants)

(SMD -0.58, 95% confidence interval (CI) -1.12 to -0.04, 8 trials, 585 participants) This may have the potential to reduce gingivitis in one month.

Brushing + interdental brush (MD -0.53, 95% CI -0.83 to -0.23, 1 trial, 62 participants) It could reduce gingivitis in 1 month, but there was no difference in bleeding sites, and it seemed to remove plaque well.

Toothpaste + wooden cleaning stick (MD -0.25, 95% CI -0.37 to -0.13, 1 trial, 24 participants) It was suggested that the bleeding sites could be reduced in 3 months.

Toothpaste + rubber/elastomer interdental cleaning stick (MD -0.22, 95% CI -0.41 to -0.03) suggested that plaque could be reduced in 1 month.

Toothpaste plus mouthwash (MD-0.00, 95% CI -0.07 to 0.06; 2 trials, 126 participants) did not seem to reduce bleeding sites after more than 1 month.

Flossing or interdental brushing in addition to toothbrushing can reduce gingivitis or plaque, or both, better than toothbrushing alone.

An interdental brush may be more effective than flossing.

Available evidence for tooth cleaning sticks and oral rinses is limited and contradictory.

Results were measured primarily over a short period of time, and most study participants had low levels of baseline gingivitis.

Overall, the evidence is very low to very low certainty, and the observed effect sizes may not be clinically important.

Future trials should report the periodontal status of participants according to the new periodontal classification and continue long enough to measure adjacent interdental caries and periodontitis.

If this is the conclusion, 

I think I'll just use a toothbrush and interdental brush for now. I'm not sure.

Worthington HV, MacDonald L, Poklepovic-Perrick T, Sambunchuk D, Johnson TM, Imai P, Clarkson JE. Home use of interdental cleaning devices in addition to tooth brushing to prevent and manage periodontal disease and tooth decay. Cochrane Database of Systematic Reviews 2019, No. 4. Number: CD012018. doi: 10.1002 / 14651858.CD012018.pub2.