BACKGROUND Accumulation of plaque on tooth surfaces that have fixed orthodontic appliances is increased. Effective removal is essential to maintain oral health but it is unclear whether the use of interdental or interspace brushes is useful. OBJECTIVE To compare the effectiveness of standard toothbrushes with combined standard toothbrushes and interdental/interspace brushes used by patients during fixed orthodontic appliances therapy in relation to plaque removal, the health of dental and supporting tissues, dependability, cost and adverse effects. METHODS We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE and CINAHL. Schools of dental hygiene were contacted for additional data. No language restrictions were applied. Handsearching of the relevant journals was carried out. Most recent search: January 2006. METHODS Randomised controlled trials (RCTs) including the following criteria: participants - patients with fixed orthodontic appliances and uncompromised manual dexterity; intervention - unsupervised toothbrushing with standard toothbrush alone versus standard toothbrush and interdental/interspace brush. Primary outcomes were differences in plaque control, gingival health and decalcification. METHODS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently. Trials were to be grouped in terms of their interventions and outcome measures. Results were to be expressed as random-effects models using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated. RESULTS No studies were identified to support or contest the null hypothesis. CONCLUSIONS The present practice of recommending the use of interdental/interspace brushes in addition to standard toothbrushes is not supported by clinical investigations. Interdental brushes and normal toothbrushes wear is increased during orthodontic treatment and brushes need to be replaced more frequently. This increases the economic burden of oral hygiene products for the patient. Well designed RCTs are required to provide evidence for determining clinical practice in this area.