An update of mechanical oral hygiene practices: evidence-based recommendations for disease prevention

This review updates the mechanical oral hygiene practices discussed at a 1986 State-of-the-Science Workshop.

The 1984-1995 MEDLINE database was searched and appropriate studies that used disease outcome measurements were located and selected. Recommendations were made based on the levels of evidence concept.

1) There is good evidence to recommend: toothbrushing twice daily with fluoridated toothpaste; using oscillating-rotating or counter-rotational-action electric toothbrushes; flossing for adults; personal supragingival irrigation as an adjunct to toothbrushing; and scaling of disease active sites for the treatment of periodontal diseases. 2) There is moderate evidence to recommend: using any soft-bristled manual toothbrush; using wooden interdental cleaners; scaling of disease active sites every three to four months for patients with histories of moderate/severe periodontitis; scaling of disease active sites at intervals of > or = 6 months for most patients, based on patient need; and removal of restoration overhangs. 3) There is moderate evidence to not recommend: use of vibrating, rotating or sonic action electric toothbrushes; using foam brushes; flossing for children; using interdental brushes; gingival massage; and tongue brushing or scraping. 4) There is good evidence to not recommend: subgingival scaling for patients with no signs of active disease; and polishing for disease prevention.

Consistent with the 1986 workshop report, the 1996 recommendations emphasize the importance of personal oral hygiene and the provision of professional treatment when personal care fails to prevent disease.