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

PURPOSE: This review updates the mechanical oral hygiene practices discussed at a 1986 State-of-the-Science Workshop.
METHODS: 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. RECOMMENDATIONS: 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.
CONCLUSIONS: 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.