Management of Dental Biofilm-Induced Gingivitis: Oral Hygiene Instruction, Behavioural Strategies and Self-Performed Mechanical Oral Hygiene-A Systematic Review and Meta-Analysis.

Background

Effective self-performed oral hygiene is fundamental to the prevention and control of dental biofilm-induced gingivitis. While reinforcement strategies and behavioural interventions (including technologies/digital adjuncts) may improve adherence, advances in oral hygiene devices may enhance the mechanical efficacy of plaque removal. This systematic review evaluated the effects of (1) enhanced oral hygiene instruction, (2) behavioural/motivational/technology interventions and (3) oral hygiene devices on gingival inflammation in adults with gingivitis.

Materials And Methods

Electronic searches identified randomised controlled trials comparing enhanced versus standard oral hygiene instruction (PICOS 1), behavioural/motivational/technological adjuncts versus standard instruction (PICOS 2) and power versus manual toothbrush devices (PICOS 3). Primary outcome was bleeding on probing (BoP) at a minimum of 3 months. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses and, where appropriate, network meta-analyses were performed.

Results

Thirty-seven randomised controlled trials (RCTs) were included (PICOS 1: n = 7, PICOS 2: n = 9, PICOS 3: n = 21). Enhanced oral hygiene instruction produced a statistically significant but modest reduction in gingival bleeding compared with standard instruction. Behavioural/motivational/technological interventions yielded small but statistically significant and consistent benefits, with low-to-moderate heterogeneity. In contrast, powered toothbrushes demonstrated substantially greater reductions in gingival bleeding and plaque compared with manual brushing. Network meta-analysis ranked oscillating-rotating and high-frequency sonic powered toothbrushes as the most effective interventions, with large effect sizes and consistent findings across studies.

Conclusions

Reinforced instruction and behavioural interventions produce meaningful improvements in gingival inflammation. Powered toothbrushes consistently provide improvements in gingival health over manual toothbrushes. While effective powered devices have a strong influence on gingival therapeutic outcomes, the foundation of long-term oral health lies in well-instructed, consistent self-care.