Comparative Efficacy of Interdental Brushes, Dental Floss, and Dental Tape in Plaque Control and Periodontal Health: A Systematic Review of Clinical Evidence

Background: Effective interdental biofilm control is critical for preventing gingivitis and periodontitis. While dental floss has long been considered the gold standard for interdental cleaning, its efficacy depends heavily on patient compliance and dexterity. Dental tape, a broader variant of floss, may improve comfort in tight contacts, while interdental brushes have gained prominence for their superior mechanical plaque removal. Comparative evidence on these devices remains heterogeneous. Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Scopus was performed up to August 2025 using MeSH and free-text terms (“interdental brush,” “proximal brush,” “dental floss,” “dental tape,” “interdental cleaning,” “biofilm control,” “periodontal health”). Eligible studies included randomized controlled trials (RCTs), controlled clinical trials, systematic reviews, and meta-analyses comparing interdental brushes, floss, or dental tape as adjuncts to toothbrushing. Results: The search strategy identified RCTs evaluating interdental cleaning devices, while additional scoping reviews and systematic analyses included systematic reviews and several controlled trials. Across these studies, interdental brushes consistently demonstrated greater reductions in plaque and gingival inflammation compared with floss, particularly in patients with periodontal attachment loss, prosthetic restorations, or orthodontic appliances. Dental floss and dental tape showed comparable efficacy when used correctly, though tape was reported as more comfortable in tight interproximal contacts. Patient adherence and technique emerged as critical determinants of effectiveness, irrespective of the device used. Conclusion: Interdental brushes outperform floss and tape in plaque removal and gingival inflammation reduction, especially in patients with larger interdental spaces. Floss and tape remain useful for tight contacts but are highly technique-dependent. Individualized recommendations should guide clinical practice, considering anatomical factors, manual dexterity, and patient preference. High-quality, long-term RCTs directly comparing floss, tape, and interdental brushes are still required to strengthen clinical guidelines.