| 47
SANZ et al .
Background
Risk of bias Study quality assessment showed that all studies at high risk of bias.
Intervention See previous section.
Consistency The summary of findings table shows that the body of evidence is rather consistent. Clinical relevance and effect size No differences could be found. The statistically established clinical evidence was calculated for one study and showed no clinically rel - evant effect size.
Available evidence Scarcity or a lack of evidence does not necessarily imply that prod - ucts may not be effective. Dental care professionals in clinical practice should tailor the best oral hygiene devices and methods according to patients' skill levels and preferences because patient acceptance is cru - cial for sustained long-term use (Steenackers, Vijt, Leroy, De Vree, & De Boever, 2001). Clinical evidence indicates that the efficacy of interden - tal brushes depends on the relation between the size of the brush and the size and shape of the interdental space. Interdental spaces underlay a high variety regarding size and morphology, and interdental brushes have to be selected specific to the individual interdental space. The number of devices has to be limited to a certain number with respect to the ability of the patient to cope with this diversity. To reach this goal, compromises have to be found to achieve the individual optimum.
Balance of benefit and harm The adverse events were not evaluated.
Economic considerations A manual toothbrush is less expensive than a power toothbrush.
Patient preferences No data on patient preference arrive from the current review.
R4.5 | Should we recommend a powered or a manual toothbrush?
Applicability The guideline can be applied to patients attending a periodon - tal maintenance program. There is an abundance of toothbrushes available.
Evidence-based recommendation (4.5) The use of a powered toothbrush may be considered as an alternative to manual tooth brushing for periodontal maintenance patients. Supporting literature Slot et al. (2020) Quality of evidence Five RCTs (216 patients) with high risk of bias Grade of recommendation Grade 0—↔ Strength of consensus Strong consensus (22.5% of the group abstained due to potential CoI)
R4.6 | How should interdental cleaning be performed?
Evidence-based recommendation (4.6) If anatomically possible, we recommend that tooth brushing should be supplemented by the use of interdental brushes. Supporting literature Slot et al. (2020) Quality of evidence Seven comparisons from four RCTs (290 patients) with low to unclear risk of bias Grade of recommendation Grade A—↑↑ Strength of consensus Unanimous consensus (5.4% of the group abstained due to potential CoI)
Background
Intervention See previous sections.
Background
Available evidence Based on the evidence from the systematic reviews underly - ing this guideline, toothbrushing is effective in reducing levels of dental plaque (Van der Weijden & Slot, 2015). Toothbrushes vary in size, design and the length, hardness and arrange - ment of the bristles. Some manufacturers have claimed supe - riority in modifications such as bristle placement, length and stiffness. Powered toothbrushes with various mechanical mo - tions and features are available. The evidence that emerged from the search provided eight papers describing five CCT/RCT com - parisons. In total, the studies evaluated 216 patients. The qual - ity of the evidence for the statement was assessed according to GRADE.
Intervention See previous sections.
Available evidence The underlying systematic review (Slot et al., 2020) found evidence for a significantly better cleaning effect of interdental cleaning de - vices as adjuncts to tooth brushing alone, and a significantly better cleaning effect of interdental brushes than of flossing. Both the de - scriptive analysis and the NMA indicate that IDBs are the first choice for periodontal maintenance patients. Seven comparisons from four RCTs (290 patients) were identified.
Made with FlippingBook Annual report