Reports & Studies

Interdental care – what is the best option?

PD Dr. Kristina Bertl, PhD MSc MBA

Whether manual, sonic or electric, a toothbrush on its own is unfortunately insufficient to achieve perfect oral hygiene, because it is simply unable to penetrate the interdental spaces deeply enough. But what advice should we give to our patients?

Dental floss, mouth wash, interdental brush, toothpick, interspace tip... – what works best to prevent gingivitis? This question was investigated by researchers from Germany and the Netherlands, who summarized all the available literature on this topic (Sälzer et al. 2015). Enough articles were available about the following aids to be able to make an assessment that was as reliable and evidence-based as possible: interdental brushes, dental floss, oral/interdental irrigator and triangular toothpicks.

  • Dental floss: Regularly using dental floss has a statistically significant but small effect on preventing gingivitis.
  • Triangular toothpicks & oral/interdental irrigator: Evidence regarding the use of toothpicks & oral/interdental irrigators varies. In general, the evidence is rather weak and only occasionally shows advantages regarding bleeding indices and prevention of gingivitis.
  • Interdental brushes: Using interdental brushes achieves a significantly greater reduction in plaque values and in the incidence of gingivitis than brushing alone does. For both parameters, this additional reduction was almost 35%!

What do these conclusions mean for us? In general, it is best not to recommend too many different interdental aids. Whenever possible and appropriate, interdental brushes of the right size are the best option and should be our number 1 recommendation for our patients. However, depending on the patient’s dexterity, motivation and dental anatomy, this choice may of course need to be adapted or used in combination with other aids.


  1. Sälzer S, Slot DE, Van der Weijden FA, Dörfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis – a meta-review. J Clin Periodontol 2015; 42 (Suppl. 16): S92–S105. doi: 10.1111/jcpe.12363.