Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Toothbrushing and flossing | Toothbrushing is effective in preventing gingivitis. Patients who are not motivated or dextrous may not comply. Flossing is ineffective in preventing gingivitis in children. | Randomized controlled trial <10> (I); descriptive study <1> (III) | Fair evidence to recommend toothbrushing for
prevention of gingivitis. (B)
|
| Flossing is ineffective in preventing gingivitis in children. | Randomized controlled trials <11,12,15> (I) | Flossing is recommended to develop the skill and establish a habit but poor evidence to include or exclude (C) Good evidence to recommend flossing in adults. (A) | |
| Flossing is effective in preventing gingivitis in adults. | Randomized controlled trial <14> (I) | ||
| Brushing and flossing may prevent periodontitis.
High risk groups: There is no evidence that brushing or flossing is effective. |
Cohort studies <8,9> (II-2) | Supervised toothbrushing and flossing is recommended for patients with malocclusion, diabetes or HIV infection based on poor evidence. (C) | |
| Use of electrically powered toothbrushes. | Electric toothbrushes are not superior to manual toothbrushes; the benefit to those with limited dexterity or motivation must be weighed against cost. | Randomized controlled trials <16-19> (I) | Fair evidence not to recommend (D) for general population but recommended for patients with limited dexterity based on poor evidence. |
| Professional scaling and prophylaxis. | In periodontally healthy patients: Intensive professional oral hygiene and prophylaxis prevents chronic gingivitis and periodontitis. Annual scaling provides no additional benefit for those who maintain good oral hygiene. | Randomized controlled trials <13,20-26> (I) | Fair evidence to recommend professional scaling and prophylaxis depending on the periodontal disease status of the patient. (B) |
| Use of chlorhexidine oral rinse as adjunct to toothcleaning. | Effective in preventing gingivitis and as an antimicrobial. Reduces supragingival plaque but increases calculus formation. Rinse has bad taste and stains teeth. | Randomized controlled trials <27-29> (I) | Good evidence to recommend twice daily use of 0.12% chlorhexidine rinse* (A) for those with difficulty cleaning teeth (e.g patients with disability, cancer). |
| Use of listerine® oral rinse. | Less effective than chlorohexidine but effective in preventing gingivitis with over 6 months of use. Poor taste and burning sensation in mouth. | Randomized controlled trials <30,31> (I) | Fair evidence to recommend use by patients with severe gingivitis. (B) |
| Use of other over-the-counter oral rinses. | No long-term studies of effectiveness and alternatives available. | Fair evidence not to use. (D) | |
| Toothbrushing with anticalculus dentifrice. | Effectiveness in preventing gingivitis not documented. Effectiveness in reducing supragingival calculus; no long-term evaluation. | Randomized controlled trials <32-34> (I) | No evidence to recommend for general population (C); fair evidence to recommend for patients at risk of calculus formation. (B) |
| Antibiotic prophylaxis | No evidence of effectiveness in preventing gingivitis or periodontitis in the general population. | Good evidence not to recommend antibiotics for preventive use because of side effects. (E) | |
| Smoking cessation | Eliminates increased risk of periodontal disease due to smoking. | Cross-sectional and cohort studies <2-7> (II-2) | Fair evidence to recommend smoking cessation to prevent periodontal disease. (B) |
| Screening for periodontal disease by physicians (reports of gingival bleeding during toothbrushing). | Not evaluated | Insufficient evidence to evaluate but recommended in areas with no dental services. (C) |
* Not marketed for dental use in Canada but dentists and physicians can prescribe it if indicated.
Link to Full Text of this review
Link to Structured Abstract of this review
Link to Selected References list of this review
Reprinted in modified format by the Canadian
Task Force on Preventive Health Care
with permission.
Original Copyright
© 1994 Minister of Supply and Services Canada.
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Last modified March 27, 1998.
