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Systematic review suggests interdental brushes may reduce plaque and inflammation in orthodontic patients compared with other methodsInterdental brushes might help reduce plaque and gum inflammation for patients with braces

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Key Takeaway
Consider interdental brushes for orthodontic patients, but note low-certainty evidence and short follow-up.

This systematic review examined the use of interdental brushes (IDB) in orthodontic patients. The scope included comparisons against toothbrushing alone, floss, orthodontic toothbrushes, monotufted brushes, and oral irrigators. The analysis covered 442 participants and assessed primary outcomes of periodontal condition measured by periodontal indices, along with secondary outcomes of plaque and gingival inflammation. Follow-up periods were generally short across the included trials.

The main results suggest that IDB may reduce plaque and gingival inflammation compared with toothbrushing alone or floss. When combined with orthodontic toothbrushes, greater benefits were observed. However, no consistent advantage was demonstrated for monotufted brushes or oral irrigators. The review did not report specific effect sizes, absolute numbers, or p-values for these outcomes.

Significant limitations include clinical and methodological heterogeneity, substantial variation in outcome measures and indices, and rarely reported safety outcomes. These factors restricted the ability to pool results and lowered the certainty of evidence. The authors note that high-quality, multicenter trials with standardized protocols and longer follow-up are needed to guide clinical recommendations. Safety data were rarely reported, and serious adverse events were not reported.

This review looked at how interdental brushes work for people wearing fixed braces. The main goal was to see if these small brushes help keep gums healthy and clean. They compared using these brushes to just flossing or using special orthodontic toothbrushes.

The results showed that adding interdental brushes could reduce plaque and gum inflammation. This effect was even better when combined with special orthodontic toothbrushes. However, using monotufted brushes or water flossers did not show clear advantages over other methods.

Safety issues were rarely reported in the studies. The main problem is that the studies were very different from each other. They used different ways to measure gum health and followed patients for only a short time. This makes it hard to be sure about the best treatment.

More high-quality studies with longer follow-up are needed. Doctors need better data before making strong recommendations. Right now, the information only gives us a tentative idea of what might work best.

What this means for you:
Interdental brushes may help clean braces better, but more consistent studies are needed to confirm this benefit.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
An interdental brush (IDB) is an adjunctive oral-hygiene tool designed to clean interproximal spaces and remove dental plaque. This study systematically evaluated its effectiveness for improving oral hygiene and periodontal health among orthodontic patients. A systematic search was conducted across five databases including PubMed, EMBASE, Cochrane, Web of Science, Scopus up to 30 August 2025. Randomized controlled trials enrolling orthodontic patients that compared IDB with other adjunctive oral-hygiene aids or with no adjunctive were included. The primary endpoint was periodontal condition, measured by periodontal indices. We assessed risk of bias with the Cochrane risk of bias tool. Given clinical and methodological heterogeneity, findings were synthesized narratively following SWiM guidance. The certainty of evidence for primary outcomes was evaluated using the GRADE framework. Six studies with a total of 442 orthodontic patients were included in the systematic review. Low-certainty evidence from individual studies suggested that IDB may reduce plaque and gingival inflammation compared with toothbrushing alone or floss. Greater benefits were observed when IDBs were combined with orthodontic toothbrushes, whereas no consistent advantage was demonstrated over monotufted brushes or oral irrigators. Outcome measures and indices varied substantially across trials, follow-up periods were generally short, and safety outcomes were rarely reported. These limitations restricted the ability to pool results and lowered the certainty of evidence. Low-certainty evidence from a limited number of heterogeneous trials provides only tentative indications that interdental brushes may help improve gingival health and plaque control in orthodontic patients—particularly when used with orthodontic toothbrushes. High-quality, multicenter trials with standardized protocols and longer follow-up are needed to guide clinical recommendations. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251136657, identifier CRD420251136657.
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