Cephalometric changes associated with MAD therapy

Study objectives: The main objectives of this study were to assess the effect of mandibular advancement device (MAD) therapy on the upper airway morphology, as well as the occurence of dental and skeletal side effects following 1-year MAD therapy in patients with mild to moderate obstructive sleep apnea (OSA). Methods: In this study we included 15 patients with mild to moderate OSA treated with MAD therapy. All subjects underwent sleep study and lateral cephalometric radiography at baseline and at 1-year follow-up. Lateral cephalograms were analyzed with respect to relevant variables. Results: MAD therapy reduced apnea-hypopnea index (AHI) from 22.9±5.9 to 9.7±4.5 events/h (P<0.001) after 1-year of therapy. Oral area enclosure (3697.0±372.4 vs. 3381.5±336.4 mm2, P<0.001), superior airway space width (8.9±2.0 vs. 10.0±2.0 mm2, P=0.039), soft palate width (10.9±1.0 vs. 9.8±1.4, P=0.005) and length (45.4±3.8 vs. 43.9±4.2 mm, P=0.033) were significantly larger with the MAD intra-orally. Additionally, the tongue length decreased (84.1±5.3 vs. 80.7±5.9 mm, P=0.002), while the tongue height increased significantly (27.0±2.4 vs. 29.9±2.5 mm, P=0.003) with the MAD intra-orally. There were no significant changes in skeletal and dental cephalometric variables after 1 year of MAD therapy. Conclusions: Our results show significant enlargement of the upper airway dimensions with the MAD intra-orally in patients with mild to moderate OSA. Although there were no significant changes in skeletal and dental cephalometric variables after 1 year of MAD therapy, close follow-up during MAD therapy is advisable to prevent potentially relevant occlusal changes

Cochrane activities in Croatia

Ogranak Cochrane kolaboracije osnovan je u Hrvatskoj pri Medicinskom fakultetu u Splitu 2008. godine s ciljem promoviranja medicine utemeljene na dokazima i sustavnih pregleda u Hrvatskoj i regiji. Hrvatski Cochrane 2017. godine je postao punopravni samostalni Cochrane centar kao prvi i jedini takav centar u jugoistočnoj Europi. Hrvatski Cochrane ima brojne aktivnosti. Svake godine organizira Hrvatski Cochrane simpozij u Splitu i provodi brojne aktivnosti edukacije zdravstvenih radnika i laika. Kroz programe popularizacije znanosti organizirane su aktivnosti za udruge pacijenata, novinare i studente novinarstva te za širu javnost. Od 2013. godine prevode se laički sažetci Cochrane sustavnih pregleda na hrvatski jezik i do danas ih je prevedeno 2500. Hrvatski Cochrane potiče uvođenje principa medicine utemeljene na dokazima u formalno obrazovanje zdravstvenih radnika. Hrvatska Cochrane partnerska mreža uključuje profesionalna društva, državne institucije i udruge pacijenata iz Hrvatske i regije; ti partneri su se formalno pridružili Hrvatskom Cochraneu u promicanju zdravstvene skrbi utemeljene na dokazima. Broj Cochrane autora i Cochrane publikacija iz Hrvatske kontinuirano se povećava, što pokazuje da se hrvatski istraživači počinju uključivati u svjetske trendove istraživanja u području medicine utemeljene na dokazima. Sustavni pregledi mogu se usvojiti i kao model doktorata. U prvih deset godina od osnutka Hrvatski Cochrane u regiji je postigao zapažene rezultate u promoviranju medicine utemeljene na dokazima, što nije jednostavno s obzirom da su svi koji su angažirani oko Hrvatskog Cochranea i Cochrane aktivnosti u Hrvatskoj – volonteri. Nadamo da će se isti tempo i entuzijazam zadržati i u budućnosti.A branch of the Cochrane Collaboration was founded in Croatia at the University of Split School of Medicine in 2008 with the aim of promoting evidence-based medicine (EBM) and systematic reviews in Croatia and the region. In 2017, Cochrane Croatia became an independent Cochrane Center, the only such center in the South-East of Europe. Cochrane Croatia conducts numerous activities. A Croatian Cochrane Symposium is organized each year in Split, Croatia. Science popularization projects, funded by the Ministry of Science, Education and Sport, have enabled Cochrane Croatia to organise numerous educational activities for, patient groups, journalists, journalism students, health professionals and the lay public. Since 2013 Cochrane Croatia has been translating Plain Language Summaries (PLSs) of Cochrane Systematic Reviews; in May 2017 there were 2500 translated PLSs. Cochrane Croatia is actively encouraging the introduction of EBM principles into the curriculum for the formal education of healthcare professionals. Cochrane Croatia has a network of partners, including professional associations, government institutions and patient organizations from Croatia and the region. Those partners have formally joined Cochrane Croatia in promoting EBM. The number of Cochrane authors and Cochrane publications from Croatia is continuously increasing, which indicates that Croatian authors are joining international trends in EBM research. Systematic reviews can also be adopted as a model for a PhD thesis. In its first ten years since it was founded, Cochrane Croatia has achieved significant results in the whole region via promotion of EBM, which is not a simple achievement, given that all individuals affiliated with Cochrane activities in Croatia are volunteers. We hope that the same enthusiasm and progress will be sustained in the future

Znanje i stajališta doktora dentalne medicine u Hrvatskoj o propisivanju antibiotika u endodonciji: presječno istraživanje

Objectives: To assess dentists’ level of knowledge and practice concerning antibiotic usage in endodontics using the European Society of Endodontology position statement as a reference. Material and Methods: A cross-sectional study was conducted in the form of an electronic questionnaire consisting of 23 questions, including dentists’ demographic and professional characteristics, attitudes as well as experiences regarding antibiotics in endodontics. Data were evaluated by the Mann-Whit-ney test or the Kruskal Wallis 1-way ANOVA, α = 5%. Results: The overall mean self-reported knowl-edge of antibiotics usage in endodontics was 11.7±2.5 points, out of a maximum possible score of 23. The factors associated with a higher knowledge were: age (P≤0.001), clinical experience (P≤0.001), specialist training (P=0.008), and adherence to the guidance on the use of systemic antibiotics in endodontics (P=0.006). Dentists who specialized in endodontics (16.1±2.2) achieved higher levels of knowledge. Conclusion: Knowledge on antibiotic usage in endodontics among dentists in Croatia is insufficient. There is a need for continuing education on the use of antibiotics among general dentists.Ciljevi: Procijeniti razinu znanja i iskustva stomatologa o primjeni antibiotika u endodonciji koristeći se kao referencijom konsenzusom Europskoga endodontološkoga društva. Materijal i metode: Ovo presječno istraživanje provedeno je na temelju elektroničkoga upitnika sastavljenoga od 23 pitanja, uključujući demografske i profesionalne značajke doktora dentalne medicine, njihova stajališta i iskustva u vezi s korištenjem antibiotika u endodonciji. Podatci su analizirani Mann-Whitneyjevim testom ili Kruskal-Wallisovim jednosmjernim ANOVA testom – α = 5 %. Rezultati: Ukupna prosječna vrijednost znanja doktora dentalne medicine iznosila je 11,7 ± 2,5 bodova, od najviše mogućih 23. Čimbenici povezani s višim znanjem bili su dob (P ≤ 0,001), kliničko iskustvo (P ≤ 0,001), specijalističko usavršavanje (P = 0,008) te poštovanje smjernica o primjeni sistemskih antibiotika u endodonciji (P = 0,006). Doktori dentalne medicine koji su specijalizirali endodonciju (16,1 ± 2,2) postigli su višu razinu znanja. Zaključak: Znanje o primjeni antibiotika u endodonciji među doktorima dentalne medicine u Republici Hrvatskoj je nedostatno. Potrebna je stalna edukacija o upotrebi antibiotika među populacijom općih doktora dentalne medicine

Critical appraisal of systematic reviews of intervention studies in periodontology using AMSTAR 2 and ROBIS tools

Systematic reviews of intervention studies are used to support treatment recommendations. The aim of this study was to assess the methodological quality and risk of bias of systematic reviews of intervention studies in in the field of periodontology using AMSTAR 2 and ROBIS.Systematic reviews of randomized and non-randomized clinical trials, published between 2019 and 2020, were searched at MedLine, Embase, Web of Science, Scopus, Cochrane Library, LILACS with no language restrictions between October 2019 to October 2020. Additionally, grey literature and hand search was performed. Paired independent reviewers screened studies, extracted data and assessed the methodological quality and risk of bias through the AMSTAR 2 and ROBIS tools.One hundred twenty-seven reviews were included. According to AMSTAR 2, the methodological quality was mainly critically low (64.6%) and low (24.4%), followed by moderate (0.8%) and high (10.2%). According to ROBIS, 90.6% were at high risk of bias, followed by 7.1% low, and 2.4% unclear risk of bias. The risk of bias decreased with the increased in the impact factor of the journal.Current systematic reviews of intervention studies in periodontics were classified as low or critically low methodological quality and high risk of bias. Both tools led to similar conclusions. Better adherence to established reporting guidelines and stricter research practices when conducting systematic reviews are needed

What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews

BackgroundEvidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour.Methods and findingsThis is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up.ConclusionsTeaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments.Study registrationThe protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262.Update of the overviewYoung T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: .10.1371/journal.pone.0086706.</p

Evidence to decision frameworks enabled structured and explicit development of healthcare recommendations

Altres ajuts: Universidad Santo Tomás, Bogotá, Colombia (FODEIN project code: 2115005).Objective: The aim of this study is to identify and describe the processes suggested for the formulation of healthcare recommendations in healthcare guidelines available in guidance documents. Methods: We searched international databases in May 2020 to retrieve guidance documents published by organizations dedicated to guideline development. Pairs of researchers independently selected and extracted data about the characteristics of the guidance document, including explicit or implicit recommendation-related criteria and processes considered, as well as the use of evidence to decision (EtD) frameworks. Results: We included 68 guidance documents. Most organizations reported a system for grading the strength of recommendations (88%), half of them being the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Two out of three guidance documents (66%) proposed the use of a framework to guide the EtD process. The GRADE-EtD framework was the most often reported framework (19 organizations, 42%), whereas 20 organizations (44%) proposed their own multicriteria frameworks. Using any EtD framework was related with a more comprehensive set of recommendation-related criteria compared to no framework, especially for criteria like values, equity, and acceptability. Conclusion: Although limited, the use of EtD frameworks was associated with the inclusion of relevant recommendation criteria. Among the EtD structured frameworks, the GRADE-EtD framework offers the most comprehensive perspective for evidence-informed decision-making processes

COVID-19 Vaccines Safety Tracking (CoVaST): Protocol of a Multi-Center Prospective Cohort Study for Active Surveillance of COVID-19 Vaccines' Side Effects.

Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally. A multi-country, three-phase study including a cross-sectional survey to test for the short-term side effects of COVID-19 vaccines among target population groups. In the second phase, we will monitor the booster doses' side effects, while in the third phase, the long-term safety and effectiveness will be investigated. A validated, self-administered questionnaire will be used to collect data from the target population; Results: The study protocol has been registered at ClinicalTrials.gov, with the identifier NCT04834869. CoVaST is the first independent study aiming to monitor the side effects of COVID-19 vaccines following booster doses, and the long-term safety and effectiveness of said vaccines.This study protocol preparation was funded by Masaryk University, grant numbers MUNI/IGA/1543/2020 and MUNI/A/1608/2020.S

Addressing challenges when applying GRADE to public health guidelines: a scoping review protocol and pilot analysis

This is a protocol for a scoping review that aims to determine how guideline authors using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach have addressed previously identified challenges related to public health. The Joanna Briggs Institute (JBI) methodology for scoping reviews will be followed. We will search and screen titles of guidelines for all languages published in 2013−2021 in: the GIN library, BIGG database, Epistemonikos GRADE guidelines repository, GRADEpro Database, MAGICapp, NICE and WHO websites. Two reviewers will independently screen full texts of the documents identified. The following information will be extracted: methods used for identifying different stakeholders and incorporating their perspectives; methods for identification and prioritization of non-health outcomes; methods for determining thresholds for decision-making; methods for incorporating and grading evidence from non-randomized studies; methods for addressing concerns with conditional recommendations in public health; methods for reaching consensus; additional methodological concerns; and any modifications made to GRADE. A combination of directed content analysis and descriptive statistics will be used for data analysis, and the findings presented narratively in a tabular and graphical form. In this protocol, we present the pilot results from 13 identified eligible guidelines issued between January and August 2021. We will publish the full review results when they become available

Sredstva za interdentalno čišćenje u prevenciji parodontnih bolesti i zubnog karijesa : Cochrane sustavni pregled

Parodontne bolesti i zubni karijes među najučestalijim su oralnim bolestima i glavni razlog gubitka zuba. Prevencija ovih bolesti smatra se prioritetom jer je isplativija od njihova liječenja. Dentalni plak glavni je čimbenik nastanka i razvoja parodontnih bolesti i zubnoga karijesa. Svakodnevno mehaničko uklanjanje dentalnoga plaka četkanjem važan je dodatak profesionalnom čišćenju zubnih naslaga i ključna je strategija u očuvanju oralnoga zdravlja. No, četkice za zube ne mogu sasvim prodrijeti u interdentalne prostore, gdje su parodontne bolesti i zubni karijes najčešći. Zato se sredstva za interdentalno čišćenje preporučuju kao dodatak redovitom četkanju, a najčešće su to zubni konac i interdentalne četkice. S ciljem procjene učinkovitosti i sigurnosti uporabe zubnoga konca i interdentalnih četkica, uz četkanje zubi, u prevenciji i kontroli parodontnih bolesti i zubnoga karijesa u odraslih provedena su dva Cochrane sustavna pregledna rada. Metodologija korištena u oba rada temeljena je na eksplicitnim metodama opisanim u Cochrane Priručniku za sustavne preglede intervencija (135). Prema unaprijed određenim kriterijima uključenja, u sustavne preglede uključeni su isključivo radomizirani kontrolirani pokusi. 12 studija je uključeno u sustavni pregledni rad o učinkovitosti uporabe zubnoga konca sa 582 ispitanika u skupini koja je koristila četkicu za zube i zubni konac i 501 ispitanik u kontrolnim skupinama. Pronađeni su dokazi o učinkovitosti uporabe zubnoga konca uz četkanje u smanjenju gingivitisa nakon jednog, tri i šest mjeseci te slabi i vrlo nepouzdani dokazi o njegovoj koristi u smanjenju dentalnoga plaka nakon jednog i tri mjeseca. Sedam studija uključeno je u sustavni pregled o učinkovitosti uporabe interdentalnih četkica sa 197 ispitanika u skupini koja je koristila četkice za zube i interdentalne četkice i 195 ispitanika u skupini koja je koristila četkice za zube i zubni konac. Uporaba interdentalnih četkica uz četkanje pokazala se korisnijom od samog četkanja u smanjenju gingivitisa i dentalnoga plaka nakon mjesec dana. U usporedbi sa zubnim koncem, interdentalne su četkice učinkovitije u ublažavanju gingivitisa nakon mjesec dana. Što se tiče dentalnoga plaka, nema dostatnih dokaza kojima bi se potvrdila korist ijednog od navedenih sredstava. Zbog nedosljednosti u izvještavanju, analiza podataka o štetnim učincima nije bila moguća. Nisu pronađene studije o učinkovitosti uporabe zubnoga konca i interdentalnih četkica u prevenciji karijesa kod odraslih.Periodontal diseases and dental caries are among the most common oral diseases and the main reason for tooth loss. Prevention of these diseases is of high priority considering the high cost of its treatment. Dental plaque is the main factor in the development and progression of periodontal diseases and dental caries. Daily mechanical plaque removal by toothbrushing is an important addition to professional plaque removal techniques and a key strategy for oral health maintenance. However, toothbrushes alone are unable to adequately penetrate interdental areas where periodontal diseases and dental caries are most commonly found. Therefore, interdental cleaning aids, namely dental floss and interdental brushes, have been recommended in addition to regular toothbrushing. In order to assess the efficacy and safety of flossing and interdental brushing, in addition to toothbrushing, in the prevention and control of periodontal diseases and dental caries in adults two Cochrane systematic reviews have been conducted. The methodology used in both reviews is based on the explicit methods described in the Cochrane Handbook for Systematic Reviews of Interventions. According to the predefined inclusion criteria, only RCTs were included in the reviews. 12 studie were included in the Flossing review with 582 participants in the toothbrushing and flossing group and 501 participants in the toothbrushing only control groups. There is evidence of the efficiency of flossing, in addition to toothbrushing, in the reduction of gingivitis at one, three and six months. However, only weak and unreliable evidence of its benefit in the reduction of dental plaque after one and three months have been found. Seven studies were included in the Interdental brushing review with 197 participants enrolled in the interdental brushing plus toothbrushing study arms and 195 participants in the flossing plus toothbrushing control groups. The use of interdental brushes in addition to toothbrushing has proved to be more beneficial than toothbrushing alone, in the reduction of gingivitis after one month. When compared to dental floss, interdental brushes are more efficient in reducing gingivitis after one month. As for dental plaque, there was insufficient evidence to claim a benefit for either of the interdental aids. Due to inconsistency in reporting, data analysis concerning adverse effects was not possible. No studies examining the efficiency of dental floss and interdental brushes in the prevention of caries in adults have been found

Sredstva za interdentalno čišćenje u prevenciji parodontnih bolesti i zubnog karijesa : Cochrane sustavni pregled

Parodontne bolesti i zubni karijes među najučestalijim su oralnim bolestima i glavni razlog gubitka zuba. Prevencija ovih bolesti smatra se prioritetom jer je isplativija od njihova liječenja. Dentalni plak glavni je čimbenik nastanka i razvoja parodontnih bolesti i zubnoga karijesa. Svakodnevno mehaničko uklanjanje dentalnoga plaka četkanjem važan je dodatak profesionalnom čišćenju zubnih naslaga i ključna je strategija u očuvanju oralnoga zdravlja. No, četkice za zube ne mogu sasvim prodrijeti u interdentalne prostore, gdje su parodontne bolesti i zubni karijes najčešći. Zato se sredstva za interdentalno čišćenje preporučuju kao dodatak redovitom četkanju, a najčešće su to zubni konac i interdentalne četkice. S ciljem procjene učinkovitosti i sigurnosti uporabe zubnoga konca i interdentalnih četkica, uz četkanje zubi, u prevenciji i kontroli parodontnih bolesti i zubnoga karijesa u odraslih provedena su dva Cochrane sustavna pregledna rada. Metodologija korištena u oba rada temeljena je na eksplicitnim metodama opisanim u Cochrane Priručniku za sustavne preglede intervencija (135). Prema unaprijed određenim kriterijima uključenja, u sustavne preglede uključeni su isključivo radomizirani kontrolirani pokusi. 12 studija je uključeno u sustavni pregledni rad o učinkovitosti uporabe zubnoga konca sa 582 ispitanika u skupini koja je koristila četkicu za zube i zubni konac i 501 ispitanik u kontrolnim skupinama. Pronađeni su dokazi o učinkovitosti uporabe zubnoga konca uz četkanje u smanjenju gingivitisa nakon jednog, tri i šest mjeseci te slabi i vrlo nepouzdani dokazi o njegovoj koristi u smanjenju dentalnoga plaka nakon jednog i tri mjeseca. Sedam studija uključeno je u sustavni pregled o učinkovitosti uporabe interdentalnih četkica sa 197 ispitanika u skupini koja je koristila četkice za zube i interdentalne četkice i 195 ispitanika u skupini koja je koristila četkice za zube i zubni konac. Uporaba interdentalnih četkica uz četkanje pokazala se korisnijom od samog četkanja u smanjenju gingivitisa i dentalnoga plaka nakon mjesec dana. U usporedbi sa zubnim koncem, interdentalne su četkice učinkovitije u ublažavanju gingivitisa nakon mjesec dana. Što se tiče dentalnoga plaka, nema dostatnih dokaza kojima bi se potvrdila korist ijednog od navedenih sredstava. Zbog nedosljednosti u izvještavanju, analiza podataka o štetnim učincima nije bila moguća. Nisu pronađene studije o učinkovitosti uporabe zubnoga konca i interdentalnih četkica u prevenciji karijesa kod odraslih.Periodontal diseases and dental caries are among the most common oral diseases and the main reason for tooth loss. Prevention of these diseases is of high priority considering the high cost of its treatment. Dental plaque is the main factor in the development and progression of periodontal diseases and dental caries. Daily mechanical plaque removal by toothbrushing is an important addition to professional plaque removal techniques and a key strategy for oral health maintenance. However, toothbrushes alone are unable to adequately penetrate interdental areas where periodontal diseases and dental caries are most commonly found. Therefore, interdental cleaning aids, namely dental floss and interdental brushes, have been recommended in addition to regular toothbrushing. In order to assess the efficacy and safety of flossing and interdental brushing, in addition to toothbrushing, in the prevention and control of periodontal diseases and dental caries in adults two Cochrane systematic reviews have been conducted. The methodology used in both reviews is based on the explicit methods described in the Cochrane Handbook for Systematic Reviews of Interventions. According to the predefined inclusion criteria, only RCTs were included in the reviews. 12 studie were included in the Flossing review with 582 participants in the toothbrushing and flossing group and 501 participants in the toothbrushing only control groups. There is evidence of the efficiency of flossing, in addition to toothbrushing, in the reduction of gingivitis at one, three and six months. However, only weak and unreliable evidence of its benefit in the reduction of dental plaque after one and three months have been found. Seven studies were included in the Interdental brushing review with 197 participants enrolled in the interdental brushing plus toothbrushing study arms and 195 participants in the flossing plus toothbrushing control groups. The use of interdental brushes in addition to toothbrushing has proved to be more beneficial than toothbrushing alone, in the reduction of gingivitis after one month. When compared to dental floss, interdental brushes are more efficient in reducing gingivitis after one month. As for dental plaque, there was insufficient evidence to claim a benefit for either of the interdental aids. Due to inconsistency in reporting, data analysis concerning adverse effects was not possible. No studies examining the efficiency of dental floss and interdental brushes in the prevention of caries in adults have been found