Priority 21 from the Oral and Dental Health PSP

UNCERTAINTY: Is cleaning in between teeth needed for maintaining good oral health? (JLA PSP Priority 21)
Overall ranking 21
JLA question ID 0079/21
Explanatory note

Not available for this PSP


Numerous systematic reviews of interdental brushing (IDB) and flossing of varying quality. All based on trials of unclear/high risk of bias.

Flossing: people who brush and floss regularly have less gum bleeding compared to toothbrushing alone. There was weak evidence of a possible small reduction in plaque. No information on other measurements such as tooth decay because the trials were not long enough.
IDB: low quality evidence that IDB reduces gingivitis (gum inflammation) more than flossing. Some low quality evidence that inter-dental cleaning with IDBs is the most effective method for inter-dental plaque removal.

For full details of the evidence checked, please see the spreadsheet of data held on the JLA website.

Health Research Classification System category Oral and gastrointestinal
Extra information provided by this PSP
Original uncertainty examples Original questions covered the role of flossing or interdental brushes. What is the effectiveness/relative effectiveness of different interdental cleaning methods? If flossing is used, how often? Is it useful for the 'average' patient, not prone to periodontal disease, with minimal instruction? Does flossing help with the prevention of tooth decay, gum disease, dementia, heart disease or other conditions?
Submitted by  10 x patients, carers or members of public, 9 x health professionals, 1 x other
PSP information
PSP unique ID 0079
PSP name Oral and Dental Health
Total number of uncertainties identified by this PSP 38  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 12 December 2018