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Limited evidence shows that woodsticks as an adjunct to brushing reduce interdental bleeding

Susan Parker RDH, B.S., MEd, MBA .


Systematic Review Conclusion

Although woodsticks as adjunct to brushing reduce interproximal bleeding, they do not appear to have an effect on visible interdental plaque or gingival index.

Critical Summary Assessment

This systematic review followed acceptable methodological guidelines with most of the finally selected studies being randomized controlled trials, but with considerable heterogeneity in their study design, outcome variables and results.

Evidence Quality Rating

Limited Evidence

Structured Abstract

Clinical Questions:

Does a hand-held triangular woodstick as compared with no adjunct or another interdental cleaning device improve the clinical parameters of gingival inflammation (gingival index, interdental plaque and interdental bleeding) in patients who regularly use a toothbrush?

Review Methods:

The authors searched two electronic databases through February 2008. Eligibility criteria included randomized controlled clinical trials, studies on adults without systemic disorders, with gingival inflammation as an outcome. Studies included compared toothbrushing plus interdental woodstick against toothbrushing alone or toothbrushing plus interdental brush and/or dental floss. Independent screening yielded seven publications from eight clinical experiments (six randomized clinical trials and two controlled clinical trials) that met the selection criteria.

Main Results:

Of the eight clinical papers selected, seven (438 subjects aged from 18 to 81 years) met the eligibility criteria. Sample sizes ranged from 10 to 161 subjects. The seven papers presented eight experiments, of which six provided data on plaque scores. Three studies used bleeding scores to assesss gingival inflammation. . The evaluation period of the selected studies varied from three weeks to three and one-half months. The authors did not perform meta-analysis because of heterogeneity among studies. Three out of four studies reported that the adjunct use of woodsticks decreased interdental bleeding. . Five out of seven studies that quantified plaque did not find any difference. The study that quantified the gingival index did also not find any difference.


Evidence from controlled trials, almost all randomized but with significant heterogeneity between them, showed that woodsticks when used concurrently with manual toothbrushing do not appear to have an additional effect on visible interdental plaque or the gingival index, but they do appear to reduce interdental bleeding.

Source of Funding:

No source of funding was reported.


Importance and Context:

Daily oral hygiene controls plaque development, which is the key to preventing gingivitis and periodontitis. Toothbrushing is the most important and common oral hygiene practice. (1). Epidemiological data show that almost all patients have in their interdental areas, especially in the posterior regions, accumulations of hard and soft deposits. Therefore, oral hygiene programs have focused on the interdental and aproximal areas of the dentition (2). The clinical efficacy of interdental hygiene aids and practices should be evaluated.

Strengths and Weaknesses of the Systematic Review:

The authors of this systematic review followed accepted guidelines. Their reporting followed accepted standards. The review had the following minor limitations: the authors searched only two electronic databases; their searches were limited to English-only publications, the authors did not contact study authors to clarify or retrieve information; and the outcome difference between baseline and end points as reported in Table 3 is confusing.

Strengths and Weaknesses of the Evidence:

Only seven publications from eight clinical experiments (six RCTs and two CCTs) met the selection criteria. All studies used the interventions in conjunction with unsupervised manual toothbrushing.. Sample size was small in most of the studies which questions the statistical power to support the conclusions. Five studies compared woodsticks with dental floss and two studies evaluated the effectiveness of woodsticks as compared with interdental brushes. Different brands of woodsticks were used. One study failed to mention any aspect of gingival health at baseline, and two other studies had subjects who had received periodontal treatment. Three studies excluded patients with clinical signs of advanced periodontal disease, and one study only included subjects with wide-open interdental spaces. None of the studies provided information on the smoking habits of the participants. Four studies did not mention completeness of follow-up. The authors identified heterogeneity in the study methods, which precluded the pertinence of a meta-analysis.

Implications for Dental Practice:

Limited evidence suggests that interdental woodsticks as an adjunct to regular manual toothbrushing has little effect on interproximal plaque. However, also with limited evidence, they do appear to reduce interdental gingival bleeding in the interdental region. Whether this reduction is clinically significant is questionable. REFERENCES: (1)Berchier, Slot, Haps and Van der Weijden in Int J Dent Hygiene 2008;6: 265-279). (2)Journal of Periodontology, 1975; 46: 745-747

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019