A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush

Objective: To assess the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush with respect to the level of plaque and gingivitis in controlled studies of at least 6 months duration. Search: Medline-PubMed up to and including September 2004. Results: Out of 3223 titles and abstracts, 33 trials were found for data extraction. A meta-analysis was conducted of studies (n = 9) in which, for the manual toothbrush group at baseline, only a professional prophylaxis provided. The weighted mean differences (WMD) between baseline and end-trial for the Quigley & Hein plaque index was 0.28 and 0.21 for the Gingival Index (p < 0.05). Eight studies provided both a professional OHI and prophylaxis at baseline. The WMD for the Silness & Loe Plaque Index was 0.10 (ns). The WMD of the proportion of bleeding sites was 5.84% (p < 0.05). Conclusion: In adults with gingivitis the quality of self-performed mechanical plaque removal is not sufficiently effective and should be improved. Based on studies >= 6 months of duration, it appears that a single oral hygiene instruction, describing the use of a mechanical toothbrush, in addition to a single professional 'oral prophylaxis' provided at baseline, had a significant, albeit small, positive effect on the reduction of gingivitis.