Systematic review suggests interdental brushes may reduce plaque and inflammation in orthodontic patients compared with other methods

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Frontiers in Medicine Published May 7, 2026 Medically reviewed May 7, 2026 Study authors: Xinyue Ji, Qiao Zou, Lei Tian DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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.

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.