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Comparison Between Interdental Brush and Dental Floss for Controlling Interproximal Biofilm in Teeth and Implants

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The presence of dental biofilm is the primary etiological factor in the development of periodontal disease. Dental floss and interdental brushes as adjuncts to dental hygiene provides a greater benefit for disrupting the oral biofilm in the interproximal areas. To compare the use of an interdental brush and dental floss for controlling the dental biofilm around teeth and implants, twelve volunteers (men and women) aged 18 to 50 years were randomly selected. During the first thirty days, patients used the conventional Bass method of brushing associated with cleaning the interproximal space only with dental tape. At the end of this month, a new plaque index was measured. At the beginning of the second month, the patients were instructed to use conventional brushing, and then only interproximal cleaning with interdental. At the end of this second month, a new plaque index was measured. The analysis of variance for randomized blocks revealed a significant difference in the effectiveness of the two cleaning methods used for controlling the interproximal biofilm (p=0.023), showing that the plaque index was significantly lower (39.6%) with the interdental brush than when dental floss was used (58.3%).We concluded that, compared with using dental floss, interdental brushes is more effective at controlling the interproximal dental biofilm around teeth and implants.
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Luz et al., Dent Health Curr Res 2016, 2:3
DOI: 10.4172/2470-0886.1000119
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Review Article
Comparison between Interdental
Brush and Dental Floss for
Controlling Interproximal
Biolm in Teeth and Implants
Mariana Luz1, Maria Fátima Guarizo Klingbeil2, Paulo
Henriques3* and Hugo Roberto Lewgoy4
*Corresponding author: Paulo Henriques, Institute and Research Center,
Campinas, São Paulo, Brazil, E-mail: phenriques@mpc.com.br
Received: June 08, 2016 Accepted: August 11, 2016 Published: August 16,
2016
Introduction
Brushing is the most practiced oral hygiene method for plaque
removal [1]. e presence of dental plaque is the primary etiological
factor in the development of periodontal disease, which is dened as
an inammatory response in the gingival tissue [2]. e prevalence
of plaque associated with periodontal disease in adults aged 35 to
44 years is 99% for gingivitis and up to 52.7% for periodontitis [3].
Brushing only is not sucient for removing plaque, especially at the
gingival margin and interproximal region [4].
Conventional toothbrushes are not capable of reaching the
proximal surfaces as eectively as the buccal, lingual and occlusal
surfaces, nor can they reach the interproximal areas of adjacent
teeth. Some studies point to large regions of plaque stagnation, such
Abstract
The presence of dental biolm is the primary etiological factor in the
development of periodontal disease. Dental oss and interdental
brushes as adjuncts to dental hygiene provides a greater benet for
disrupting the oral biolm in the interproximal areas. To compare
the use of an interdental brush and dental oss for controlling the
dental biolm around teeth and implants, twelve volunteers (men
and women) aged 18 to 50 years were randomly selected. During
the rst thirty days, patients used the conventional Bass method
of brushing associated with cleaning the interproximal space only
with dental tape. At the end of this month, a new plaque index was
measured. At the beginning of the second month, the patients were
instructed to use conventional brushing, and then only interproximal
cleaning with interdental. At the end of this second month, a new
plaque index was measured. The analysis of variance for randomized
blocks revealed a signicant difference in the effectiveness of the
two cleaning methods used for controlling the interproximal biolm
(p=0.023), showing that the plaque index was signicantly lower
(39.6%) with the interdental brush than when dental oss was used
(58.3%).We concluded that, compared with using dental oss,
interdental brushes is more effective at controlling the interproximal
dental biolm around teeth and implants.
Keywords
Dental oss; Toothbrushes; Interproximal brushes; Oral biolm
a SciTechnol journal
as interproximal spaces, gingival margins and areas with defects [5].
erefore, additional methods have been used to assist in controlling
plaque in places with dicult access [6,7]. Individuals who only use
conventional brushes oen have residual interproximal plaque in
their molars and premolars. Plaque removal from these surfaces is
crucial because patients susceptible to periodontal disease, gingivitis
and periodontitis have a more pronounced accumulation of plaque in
these interdental areas [8].
ese regions are protected against the natural cleaning
mechanisms of the oral tissues; thus emphasis should be placed on the
importance of the devices used to facilitate oral hygiene in these areas
[9]. Conventional brushes do not adequately penetrate these regions,
preventing complete cleaning [1]. e use of dental tape as an adjunct
to brushing provides a greater benet for disrupting biolm, especially
in the interproximal region [10,11]. In addition to being an integral and
eective part of a broader regime of daily self-care, the use of conventional
toothbrushes is fundamental to maintaining oral health [12].
Biolm accumulation, which results in the development
of periodontal disease, also aects dental implants. Implants are
currently the standard treatment for rehabilitating totally or partially
edentulous patients due to the mechanical and biological characteristics
that contribute to their increasing success rates [13]. Despite these
advantages, there are still many losses of implants, and the major causes
are inammation of the mucosa and peri-implantitis [14].
According to the literature, approximately 79% of individuals
rehabilitated with implants are aected by mucositis, and 50% of
implants are aected [15]. e prevalence of peri-implantitis also
shows alarming rates of 5% to 15% [16,17].
e correct mechanical disruption of the oral biolm [the
preconized clinical protocol of sanitization for rehabilitation with
endosseous dental implants] should be performed with the use of
small head brushes with medium-sized and extra-so (ultraso)
bristles. [18]. Moreover, patients should be instructed to perform the
modied Bass technique. To achieve high standards of hygiene, both
in teeth and implants, the use of dental oss or interdental brushes
is important (added to brushing) for eective biolm removal [19].
Careful plaque removal techniques can modify both the quantity
and the composition of the gingival plaque, changing the composition
of the micro biota of the pocket and reducing the percentage of
periodontal bacteria [20].
e increased use of oral hygiene products and investments in
advertisements directed at consumers [21] is evidence of the increased
awareness of the value of good oral care.
e ideal brushing technique is one that allows for complete
plaque removal in the shortest time possible, without causing tissue
damage [22]. us, a comparison between the eectiveness of dental
oss versus the interdental brush is crucial.
Aim
e aim of this study was to evaluate the ecacy of an interdental
brush compared with dental tape for controlling interproximal
plaque around teeth and dental implants.
Page 2 of 4
doi: 10.4172/2470-0886.1000119
Volume 2 • Issue 3 • 1000119
Citation: Luz M, Klingbeil MFG, Henriques P, Lewgoy HR (2016) Comparison between Interdental Brush and Dental Floss for Controlling Interproximal
Biolm in Teeth and Implants. Dent Health Curr Res 2:3.
e best method for cleaning the oral spaces that have dicult
access must be dened for each patient. e method selection
depends on the size and shape of the interdental space, as well as the
morphology of the proximal surface of the tooth. us, interdental
plaque removal, which cannot be performed with conventional
toothbrushes, is paramount to most patients [35].
Among all the methods used for interproximal plaque removal,
dental oss is the most common. Some studies have shown that when
dental oss is used in addition to a toothbrush, a greater amount of
interproximal plaque is removed compared with using conventional
brushes alone [36,37]. Waerhaug [38] states that when dental oss is
properly used, it removes more than 80% of the interproximal plaque.
Moreover, dental oss can even remove sub gingival plaque if it is
introduced 2.0 to 3.5 mm into the gingival sulcus.
Studies that compare the use of dental oss with interdental
brushes are still scarce in the literature. e sole use of toothbrushes
is not indicative of high standards of oral hygiene. In adults, most
studies have demonstrated that conventional toothbrushes are not
as eective in plaque removal as would be expected. Jepsen [39]
demonstrated that most individuals remove only 50% of plaque with
conventional brushing, whereas Lindheand and Lang [35] asserted
that most people do not properly perform oral hygiene and most
likely carry much plaque on their teeth, although they brush their
teeth at least once a day.
Regarding the results obtained in this study, a statistical analysis
demonstrated a signicantly lower rate of plaque with the use of
interdental brushes compared with dental oss, which corroborates
the ndings of Christou et al. [40] and Jackson et al. [41]. Christou
demonstrated that patients with moderate to severe periodontitis who
used an interdental brush [to remove plaque and reduce periodontal
pockets] obtained a higher ecacy than those individuals who used
dental oss. Jackson, in his most recent work, observed a signicant
greater reduction in all parameters [plaque index, level of papillae
and probing depth] in the group using interdental brushes compared
Methods
is study was approved by the Research Ethics Committee of
the Faculty of Dentistry and CPO São Leopoldo Mandic (approval
number 280.809).
is study was performed in the Clinic of Periodontology of the
College of Dentistry São Leopoldo Mandic in Campinas, Brazil.
In total, 12 volunteers of both genders, with ages between 18
and 50 years, were selected. All volunteers met the inclusion criteria
and did not meet any of the exclusion criteria. e inclusion criteria
were as follows: good health; age between 18 and 50 years; having
sucient motor skills for the suggested interproximal cleaning;
plaque index greater than 20%; presence of premolar and molar teeth
or the correspondent implants; interproximal space that allowed
entry of interdental brushes; and diagnosis of periodontitis and
peri-implantitis. e exclusion criteria were as follows: smoking;
decompensated diabetics; low motor skills; plaque index lower than
20%; missing posterior teeth or implants that made interproximal
contacts impossible; patients who did not wish to participate; patients
who showed no motivation; and patients who did not commit
to following the recommended daily use of the dental tape and
interproximal brush. An informed consent form was signed by all the
volunteers.
e medical history and plaque index [23] were assessed during
the rst and second months. During the rst thirty days, patients
used the conventional Bass method of brushing associated with
cleaning the interproximal space only with dental tape. At the end
of the month, a new plaque index was measured. At the beginning of
the second month, the patients were instructed to use conventional
brushing, and then only interproximal cleaning with interdental
brushes 07 (access diameter of 0.7 mm and eectiveness diameter
of 2.5 mm) and 09 (access diameter of 0.9 mm and eectiveness
diameter of 4.0 mm) (CURADEN, Switzerland). At the end of this
second month, a new plaque index was measured. e study used the
plaque index data collected in the rst and second months and thus
can be considered a crossover study. e statistical calculations were
performed with the statistical package SPSS 20 (SPSS Inc., Chicago,
IL, USA), and the level of signicance was 5%.
Results
e analysis of variance for randomized blocks revealed a
signicant dierence in the eectiveness of the two cleaning methods
used for controlling the interproximal biolm (p=0.023). Table 1 and
Figure 1 show that the plaque index was signicantly lower (39.6%)
with the interdental brush than when dental oss was used (58.3%).
Discussion
e periodontal and peri-implant diseases and their incidence
have been studied over the years, and the presence of an oral biolm
has been characterized as the main etiological factor of these diseases
[24-31].
Maintaining good oral hygiene is essential for promoting oral
health and prevention of these diseases [32]. Although some studies
have shown that plaque and gingivitis/periodontitis are safely
controlled with brushing and interproximal cleaning [7,33,34], there
are still questions as to which interproximal cleaning method is the
most eective. Nonetheless, in the eld of implants, virtually nothing
has been studied [18].
100
90
80
70
60
50
40
30
20
10
0
Interdental Brush Dental Floss
Figure 1: Plaque index according to the cleaning method used for
controlling the interproximal biolm (vertical bars indicate the standard
deviations).
Interproximal biolm
Mean
Standard Minimum Maximum
Cleaning method Deviation
value
value
Interdental brush
39.6% A
17.4%
7.4%
64.4%
Dental oss
58.3% B20.0%
24.0%
99.1%
Obs: Standard deviation in parenthesis. The means followed by different letters
indicate statistically signicant differences between the methods.
Table 1: Means and standard deviations of the plaque index according to the
cleaning method used to control the interproximal biolm.
Page 3 of 4
doi: 10.4172/2470-0886.1000119
Volume 2 • Issue 3 • 1000119
Citation: Luz M, Klingbeil MFG, Henriques P, Lewgoy HR (2016) Comparison between Interdental Brush and Dental Floss for Controlling Interproximal
Biolm in Teeth and Implants. Dent Health Curr Res 2:3.
12. Garcia RI (2008) Automated ossing device reduces plaque but not gingivitis.
J Evid Based Dent Pract 8: 78-80.
13. Casado PL, Guerra RR, Fonseca MA, Costa LC, Granjeiro
JM, et al. (2011) Tratamento das doençasperi-implantares:
experiênciaspassadaseperspectivasfuturas. Uma revisão de literatura. Braz
J Periodontol 21: 25-35.
14. Esposito M, Grusovin MG, Worthington HV (2011) Interventions for replacing
missing teeth: treatment of peri-implantitis. Cochrane Database Syst Rev 1:
CD004970.
15. Roos-Jansåker AM, Lindah lC, Renvert H, Renvert S (2006) Nine- to fourteen-
year follow-up of implant treatment. part II: Presence of peri-implant lesions. J
ClinPeriodontol 33:290-295.
16. Mombelli A, Lang NP (1998) The diagnosis and treatment of peri-implantitis.
Periodontol 2000 17: 63-76.
17. Brägger U, Karoussis I, Persson R, Pjetursson B, Salvi G, et al. (2005)
Technical and biological complications/failures with single crowns and xed
partial dentures on implants: a 10-year prospective cohort study. Clin Oral
Implants Res 16: 326-334.
18. Lewgoy HR, Matson MR, Matsushita MM, Forger SI, Tortamano P, et al.
(2012) Estabelecimento de um protocolo de higienização para prevenção de
mucositeseperi-implantites. Implant News 9: 11-19.
19. Chapple LCI, Hill K (2008) Getting the message across to periodontitis
patients: the role of personalised biofeedback. Int Dent J 58: 294-306.
20. Dahlén G, Lindhe J, Sato K, Hanamura H, Okamoto H (1992) The effect of
supragingival plaque control on the subgingival microbiota in subjects with
periodontal disease. J Clin Periodontol 19: 802-809.
21. Bakdash B (1995) Current patterns of oral hygiene product use and practices.
Periodontol 2000 8: 11-14.
22. Hansen F, Gjermo P (1971) The plaque-removing effect of four tooth brushing
methods. Scand J Dent Res 79: 502-506.
23. O’Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J
Periodontol 43: 38.
24. Lindhe J, Hamp SE, Löe H (1975) Plaque induced periodontal disease in
beagle dogs. A 4-year clinical, roentgenographical and histometrical study. J
Periodontal Res 10: 243-255.
25. Berglundh T, Lindhe J, Marinello C, Ericsson I, Liljenberg B (1992) Soft tissue
reaction to de novo plaque formation on implants and teeth. An experimental
study in the dog. Clin Oral Implants Res 3: 1-8.
26. Berglundh T, Gislason O, Lekholm U, Sennerby L, Lindhe J (2004)
Histopathological observations of human periimplantitis lesions. J Clin
Periodontol 31: 341-347.
27. Susin C, Dalla Vecchia CF, Oppermann RV, Haugejorden O, Albandar
JM (2004) Periodontal attachment loss in an urban population of Brazilian
adults: effect of demographic, behavioral, and environmental risk indicators.
J Periodontol 75: 1033-1041.
28. Covani U, Marconcini S, Crespi R, Barone A (2006) Bacterial plaque
colonization around dental implant surfaces. Implant Dent 15: 298-304.
29. Greenstein G, Cavallaro J Jr, Tarnow D (2010) Dental implants in the
periodontal patient. Dent Clin North Am 54: 113-128.
30. Heitz-Mayeld LJ, Salvi GE, Botticelli D, Mombelli A, Faddy M, et al. (2011)
Anti-infective treatment of peri-implant mucositis: a randomised controlled
clinical trial. Clin Oral Implants Res 22: 237-241.
31. Lang NP, Bosshardt DD, Lulic M (2011) Do mucositis lesions around implants
differ from gingivitis lesions around teeth? J Clin Periodontol 38 Suppl 11:
182-187.
32. Chu R, Craig B (1996) Understanding the determinants of preventive oral
health behaviours. Probe 30: 12-18.
33. Hujoel PP, Löe H, Anerud A, Boysen H, Leroux BG (1998) Forty-ve-year
tooth survival probabilities among men in Oslo, Norway. J Dent Res 77: 2020-
2027.
34. Axelsson P, Nyström B, Lindhe J (2004) The long-term effect of a plaque
control program on tooth mortality, caries and periodontal disease in adults.
Results after 30 years of maintenance. J Clin Periodontol 31: 749-757.
with the group that used dental oss, aer 12 weeks of observation.
Waerhaug [42,43] also showed that individuals who habitually
employed interdental brushes were able to keep the proximal
supragingival surface free of plaque and even remove some of the sub
gingival plaque. In addition to the results found in our study, patient
compliance is to be evaluated with regard to the long-term use of
interproximal cleaning devices.
e ease of using an interdental brush compared with dental
oss, as reported by the patients, might have been instrumental in the
results. is is an important factor to be considered, as it highlights
the major diculties reported by our patients regarding using dental
oss. We must also note that even patients with lower motor skills can
consider interdental brushes easier to use; thus, their use should be
encouraged.
e method of interproximal cleaning with interdental brushes
can be used with condence for biolm removal in the proximal
region because no articles in the literature contradict this idea.
However, employing any of the two methods associated with
brushing with the Bass technique provides more complete oral
hygiene, thereby leading to a lower risk for developing periodontal
and peri-implant disease, especially in the interproximal space-which
was the focus of this study.
Compared with dental oss, the use of an interdental brush showed
greater ecacy in controlling the interproximal biolm around teeth
and dental implants. us, we must educate and encourage our
patients to use these specic methods of interdental cleaning on a daily
basis for eective biolm control. Because of the lack of publications
on this subject, further clinical trials should be conducted to discuss
and improve the use of these interproximal cleaning methods.
References
1. Hotta M, Imade S, Kotake H, Sano A, Yamamoto K (2009) Articial plaque
removal from interproximal tooth surfaces (maxillary premolar and molar) of a
jaw model. Oral Health Prev Dent 7: 283-287.
2. Kornman KS, Löe H (1993) The role of local factors in the etiology of
periodontal diseases. Periodontol 2000 2: 83-97.
3. Micheelis W, Reiter F (2006) Sociodemographic and behavior related
aspects of oral risk factors in four age cohorts. In: MicheelisW, SchiffnerU
(eds). Fourth German Oral Health Study (DMS IV) Köln, Germany:
DeutscherZahnärzteVerlag 375-398.
4. Bergenholtz A, Gustafsson LB, Segerlund N, Hagberg C, Ostby N (1984) Role
of brushing technique and toothbrush design in plaque removal. Scand J Dent
Res 92: 344-351.
5. Perry DA, Schmid MO (1995) Plaque control. In: CarranzaFA, NewmanMG
(eds). Clinical Periodontology (8th edtn.), Chicago: WB Saunders Co 493-508.
6. Lang NP, Cumming BR, Löe HA (1977) Oral hygiene and gingival health in
Danish dental students and faculty. Community Dent Oral Epidemiol 5: 237-
242.
7. Hugoson A, Koch G (1979) Oral health in 1000 individuals aged 3--70 years in
the community of Jönköping, Sweden. A review. Swed Dent J 3: 69-87.
8. Löe H (1979) Mechanical and chemical control of dental plaque. J Clin
Periodontol 6: 32-36.
9. Echeverria JJ, Sanz M (2003) Mechanical supragingival plaque control.
In: LindheJ, KarringT, LangNP (eds). Clinical Periodontology and Implant
Dentistry. (4th edtn.), Munksgaard, Denmark: Blackwell Publishing.
10. Kiger RD, Nylund K, Feller RP (1991) A comparison of proximal plaque
removal using oss and interdental brushes. J Clin Periodontol 18: 681-684.
11. Biesbrock A, Corby PM, Bartizek R, Corby AL, Coelho M, et al. (2006)
Assessment of treatment responses to dental ossing in twins. J Periodontol
77: 1386-1391.
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doi: 10.4172/2470-0886.1000119
Volume 2 • Issue 3 • 1000119
Citation: Luz M, Klingbeil MFG, Henriques P, Lewgoy HR (2016) Comparison between Interdental Brush and Dental Floss for Controlling Interproximal
Biolm in Teeth and Implants. Dent Health Curr Res 2:3.
35. Lindhe J, Lang NP (2010) Tratado de Periodontia Clínicae Implantologia
Oral. (5th edtn.), Rio de Janeiro: Guanabara Koogan.
36. Reitman WR, Whiteley RT, Robertson PB (1980) Proximal surface cleaning
by dental oss. Clin Prev Dent 2: 7-10.
37. Kinane DF, Jenkins WM, Paterson AJ (1992) Comparative efcacy of
the standard ossing procedure and a new oss applicator in reducing
interproximal bleeding: a short-term study. J Periodontol 63: 757-760.
38. Waerhaug J (1981) Effect of tooth brushing on sub gingival plaque formation.
J Periodontol 52: 30-34.
39. Jepsen S (1998) The role of manual toothbrushes in effective plaque control:
advantages and limitations. In: LangNP, AttströmR, LöeH (eds).Proceedings
of the European Workshop on Mechanical Plaque Control. London:
Quintessence 121-137.
40. Christou V, Timmerman MF, Van der Velden U, Van der Weijden FA (1998)
Comparison of different approaches of interdental oral hygiene: interdental
brushes versus dental oss. J Periodontol 69: 759-764.
41. Jackson MA, Kellett M, Worthington HV, Clerehugh V (2006) Comparison
of interdental cleaning methods: a randomized controlled trial. J Periodontol
77: 1421-1429.
42. Waerhaug J (1976) The interdental brush and its place in operative and
crown and bridge dentistry. J Oral Rehabil 3: 107-113.
43. Silverstein LH, Kurtzman GM (2006) Oral hygiene and maintenance of dental
implants. Dent Today 25: 70-75.
Author Afliation Top
1Periodontist, São Leopoldo Mandic School of Dentistry, Brazil
2Institute of Energy and Nuclear Research, IPEN/CNEN- SP, Brazil
3Institute and Research Center, Campinas, São paulo Brazil
4São Leopoldo Mandic School of Dentistry, Brazil
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... The analysis of variance for randomized blocks revealed a significant difference in the effectiveness of the two cleaning methods used for controlling the interproximal biofilm (P = 0.023), showing that the PI was significantly lower (39.6%) with the interdental brush than with dental floss was used (58.3%). [6] Routine use of dental floss is low, ranging between 10% and 30% among adults. [7] The low compliance observed among adults could be because flossing is a technically challenging task. ...
... This is in line with the research we carried out directly linked to interproximal cleaning with three distinct methods aimed at the thought of dental tape, where the Flosser® (dental floss holder) showed significant statistical results in decreasing the PI. [6] Flosser® demonstrates its ability to reduce biofilm and consequently gingival inflammation, as demonstrated in this study, in which Flosser® showed a better result both in relation to the control of the BI and the index of plate when compared with the initial indexes. [7] This confirms that Flosser® was at least as efficient as conventional yarn. ...
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Objectives The most effective way to control gingivitis and periodontitis is biofilm mechanical removal. The aim of this randomized and clinical study was to compare the efficacy of three different methods of controlling interproximal biofilm: Dental tape, Dental floss holder (Flosser®), and Superfloss ® . Materials and Methods This study was approved by the Research Ethics Committee (CAAE 29376820.8.0000.5374) and consisted of 15 volunteers, of both genders, with ages between 18 and 50 years who present at Dental School São Leopoldo Mandic, having sufficient motor skills for the oral hygiene suggested and with plaque index greater than 20%. All participants received instructions to brush using Bass technique as well the correct way to practice interproximal cleaning. The bleeding index (BI) using the periodontal millimeter probe and the plaque index (PI) through disclosing agents were taken in the five phases of the study (baseline, 15,30,45 and 60 days). Randomly, the 15 volunteers were divided in three Groups with three specific apparatus (A-Dental tape, B-Flosser®, and C-Superfloss®). At the 15 subsequent days, Groups A, B, and C, through a new randomized drawing, received an original tool . There was a 15-day Washout period between the second and the third method, in which the volunteer could choose to use the cleaning apparatus they preferred among the two previously used. Results The variance analyses for randomized blocks indicated a statistically significance difference in PI ( P < 0.001) and bleeding index ( P = 0.011), better to Flosser®, compared others. During the washout period, the most of volunteers opted by Flosser®, reporting great ease and practicality. Conclusion Despite the bleeding and PI reduction with the different devices, the dental floss holder (Flosser®) is a viable alternatives to manual flossing, still being preferred by volunteers.
... Studies reported that, according to the American Dental Association (ADA), dental floss can eliminate up to 80% of interproximal plaque, being able to penetrate narrow spaces. 43,44 Besides dental floss, oral irrigation is an efficient method of plaque control. 45 In their review, Botelho et al. showed that after oneyear, the cantilever FDPs have survived by a percentage of over 97%, and there was no record of deterioration of dental tissue after debonding of the prosthesis, such as abutment fracture, caries or vitality loss due to the minimally invasive approach. ...
... Studies reported that, according to the American Dental Association (ADA), dental floss can eliminate up to 80% of interproximal plaque, being able to penetrate narrow spaces. 43,44 Besides dental floss, oral irrigation is an efficient method of plaque control. 45 In their review, Botelho et al. showed that after oneyear, the cantilever FDPs have survived by a percentage of over 97%, and there was no record of deterioration of dental tissue after debonding of the prosthesis, such as abutment fracture, caries or vitality loss due to the minimally invasive approach. ...
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Key Clinical Message The principles of tissue preservation, minimally invasiveness and approaching different clinical situations biologically rather than surgically govern today's dentistry. Thus, different clinical scenarios require procedures that offer the dentist and the patient the possibility to choose the more invasive treatment options later in life. Subsequently, the case reported refers to a minimally invasive technique that treats single tooth edentulism using single partial retainer FDPs fabricated from monolithic zirconia. This approach is conservative, biocompatible, aesthetic, strong, rapidly obtained through CAD/CAM techniques and cost‐effective.
... 97,98 Embrasure spaces in implant restorations should be designed such that interproximal brushes can be inserted effectively without causing mechanical trauma to the mucosal tissues with limited evidence showing that this may be more effective than flossing ( Figure 13). 97,99,100 In planning for full arch implant rehabilitation, there has been many debates on whether fixed prosthesis is superior to removable prosthesis. It is a common outcome of studies that patient feels more comfortable with fixed solution but finding removable prosthesis to be easier to clean. ...
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Over the past decade, emerging evidence indicates a strong relationship between prosthetic design and peri‐implant tissue health. The objective of this narrative review was to evaluate the evidence for the corresponding implant prosthodontic design factors on the risk to peri‐implant tissue health. One of the most important factors to achieve an acceptable implant restorative design is the ideal implant position. Malpositioned implants often result in a restorative emergence profile at the implant‐abutment junction that can restrict the access for patients to perform adequate oral hygiene. Inadequate cleansability and poor oral hygiene has been reported as a precipitating factors to induce the peri‐implant mucositis and peri‐implantitis and are influenced by restorative contours. The implant–abutment connection, restorative material selection and restoration design are also reported in the literature as having the potential to influence peri‐implant sort tissue health.
... 50 Interdental brushes have been found to be more effective for interproximal plaque removal around dental implants in comparison to floss. 51 A single-tufted brush may also be of benefit, depending on the design of the prosthesis ( Figure 14). ...
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With dental implants becoming a more common treatment option for the replacement of missing teeth, and with survival rates upwards of 90% after 10 years, it is likely that primary care dentists and dental care professionals will encounter patients presenting with problems. The second article in this two-article series outlines common biological and mechanical complications arising with dental implants and their component parts, and how to manage them. CPD/Clinical Relevance: This article highlights important aspects the primary care practitioner should consider when examining and maintaining dental implants, and provides an overview of common biological and mechanical complications associated with implant-retained restorations.
... Brushing only is not sufficient for removing plaque, especially at the gingival margin and interproximal region Compared with dental floss, the use of an interdental brush showed greater efficacy in controlling the interproximal biofilm around teeth and dental implants. Thus, we must educate and encourage our patients to use these specific methods of interdental cleaning on a daily basis for effective biofilm control [21]. ...
... Brushing only is not sufficient for removing plaque, especially at the gingival margin and interproximal region Compared with dental floss, the use of an interdental brush showed greater efficacy in controlling the interproximal biofilm around teeth and dental implants. Thus, we must educate and encourage our patients to use these specific methods of interdental cleaning on a daily basis for effective biofilm control [21]. ...
Article
Blood glucose control, quit smoking, practice physical exercises, and decrease the plaque index through a rigorous daily oral hygiene program with brushing, flossing, interdental brushes and tongue cleaning after main meals, will represent in this delicate moment of the pandemic(mainly in older individuals and comorbidities like diabetes, cardiovascular and respiratory diseases), an important immunological differential that can save lives. This reinforces the major rule of preventive oral health care and health promotion that should be implemented by dentists and related professionals.
... Brushing only is not sufficient for removing plaque, especially at the gingival margin and interproximal region Compared with dental floss, the use of an interdental brush showed greater efficacy in controlling the interproximal biofilm around teeth and dental implants. Thus, we must educate and encourage our patients to use these specific methods of interdental cleaning on a daily basis for effective biofilm control [21]. ...
Article
Blood glucose control, quit smoking, practice physical exercises, and decrease the plaque index through a rigorous daily oral hygiene program with brushing, flossing, interdental brushes and tongue cleaning after main meals, will represent in this delicate moment of the pandemic(mainly in older individuals and comorbidities like diabetes, cardiovascular and respiratory diseases), an important immunological differential that can save lives. This reinforces the major rule of preventive oral health care and health promotion that should be implemented by dentists and related professionals.
... Brushing only is not sufficient for removing plaque, especially at the gingival margin and interproximal region Compared with dental floss, the use of an interdental brush showed greater efficacy in controlling the interproximal biofilm around teeth and dental implants. Thus, we must educate and encourage our patients to use these specific methods of interdental cleaning on a daily basis for effective biofilm control [21]. ...
Article
Full-text available
Blood glucose control, quit smoking, practice physical exercises, and decrease the plaque index through a rigorous daily oral hygiene program with brushing, flossing, interdental brushes and tongue cleaning after main meals, will represent in this delicate moment of the pandemic covid19(mainly in older individuals and comorbidities like diabetes, cardiovascular and respiratory diseases), an important immunological differential that can save lives. This reinforces the major rule of preventive oral health care and health promotion that should be implemented by dentists and related professionals.
Article
Background: Flossing is considered to be an integral component of oral hygiene. The authors evaluated trends in daily flossing and their associations with sociodemographic variables. Methods: The authors used data from the 2009-2020 National Health and Nutrition Examination Surveys, accounting for survey weights in all analyses. Descriptive statistics were computed for all study variables. Pooled univariable and multivariable logistic regression were performed to evaluate which sociodemographic factors were associated with daily flossing and to assess potential interactions with survey periods. Multivariable logistic regression was performed and stratified according to survey period. Results: This study included 26,624 adults. Although the prevalence of daily flossing increased from 29.4% in 2009 through 2010 to 34.8% in 2017 through 2020, this increase was not significant after multivariable adjustment. Results of the pooled survey logistic regression also showed that participants who were older, female, Hispanic, and had a higher income to poverty ratio had higher odds of daily flossing. The interaction between education and survey period was significantly associated with daily flossing (P = .012). Logistic regression for each survey period corroborated the pooled model results. Conclusions: Approximately 1 in 3 adults in the United States reported flossing daily (32.7%). Although the prevalence of daily flossing increased from 2009 through 2020, this change was not significant after controlling for sociodemographic variables. Practical implications: The nonsignificant changes in flossing behavior from 2009 through 2020 suggest that messaging to encourage adults to floss daily has had little effect. Although the authors did not elucidate the benefits of flossing, dental providers should continue to consider encouraging patients to floss until new evidence suggests otherwise.
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abstract This survey attempted to determine the status of oral cleanliness and gingival health in 150 dental students and 101 faculty members in a dental school. Without advance notice, plaque deposits were scored, using the Plaque Index System, and gingival health was determined using the criteria of the Gingival Index System. The 1st-year students had the poorest hygiene and gingival health. An improvement (P < 0.01) was noted in the 2nd-year students who were still not in clinical training but had completed a course in preventive dentistry including oral hygiene techniques. Further improvement (p < 0.05) was found in students participating in the clinical courses (3rd and 4th years). However, some deterioration of both hygiene and gingival status occurred in the senior 5th year. Among the faculty, the best oral hygiene and gingival state were found in members of departments in which clinical work centered around patient motivation toward prevention and tooth conservation. The scores for plaque and gingivitis were worse in the departments of oral surgery, dental materials, orthodontics and the basic science departments. Almost all departments and every class showed a few individuals with very poor oral hygiene. It is suggested that regular patient contact influences the personal attitude toward oral hygiene, and that professional activity and emphasis on different aspects of the curriculum may be reflected in the attitude of health professionals toward oral health.
Article
The aim of this study was to compare the ability of the bristles of newly developed toothbrushes in removing artificial plaque deposits from the interproximal areas of a jaw model. Four toothbrushes were evaluated in this study: A, two differences in level patterns, combination of flat and extremely high-tapered filaments; B, one difference in level pattern, combination of flat and extremely high-tapered filaments; C, rippled pattern and high-tapered filaments; and D, rippled pattern and tapered filaments. The brushing simulator was adjusted to provide a horizontal brushing stroke of 20 mm at a rate of 190 strokes per minute for a duration of 1 min. A 200-g force was applied to the brush head. A plaque-like substrate was placed in the facial and the interproximal sides of the artificial teeth that had the cross-sectional dimensions of mesial face in the maxillary right first molar and distal face in the second premolar. The results were photographed, and the area of penetration and the cleaning effectiveness were calculated for each picture by computer digital image analysis. This test was repeated five times for the toothbrush for each design that was evaluated. The resulting data were analysed using ANOVA and the Scheffe test. The rate of plaque removal was the highest with toothbrush A that gave a significantly greater removal of the artificial plaque than the other three toothbrushes on the maxillary right first molar mesial surface (P < 0.05). These results suggest that toothbrush A was more effective in plaque removal in this in vitro model used for determining the interproximal penetration of the four bristle designs.
Article
The effect of the interdental brush was evaluated on sixty-seven extracted teeth which were stained and examined under the stereomicroscope. Thirty-one of the teeth were totally covered with plaque when the interdental brush was used on them immediately before extraction. Thirty-six of the teeth were from patients who had used the interdental brush routinely for several years. The interdental brush was found to have an excellent effect both in the central part of the interdental space and on the embrasures. However, the most noteworthy finding was that it removes plaque as far as 2-2 1/2 mm below the gingival margin. This means that restorations can be kept free of plaque, even if they are extended into the pocket. In modern dentistry 'extension for prevention of dental caries' has become a controversial principle because subgingival restorations retain plaque which induces destructive periodontal disease. In many cases this problem can be solved by introducing the interdental brush.
Article
This was a parallel stratified study which examined the effect on gingival health of a new floss holder and applicator, designed to deliver a 25 microliters dose of 0.1% chlorhexidine solution to each interdental embrasure during the flossing procedure. Fifty-two patients with simple chronic gingivitis were stratified according to age, sex, and baseline interdental bleeding score and then assigned to one of three treatment groups. One of the following interdental cleaning agents was used once daily during a 2-week period: conventional floss; a flossing device with chlorhexidine; or a flossing device with placebo solution. Gingival health was assessed using the interdental bleeding index (IBI); i.e., the ratio of bleeding sites to the number of sites tested by stimulation with an interdental cleaner. The percentage reduction in bleeding amounted to 38.3% for conventional floss, 51.5% for the flossing device with chlorhexidine, and 51.4% for the flossing device with placebo. The reductions in both flossing device groups were significantly greater than that of the conventional floss group as determined by one-way ANOVA (F = 4.0; P = 0.024) and multiple range tests. There were no statistically significant differences between the two flossing device groups. There was no difference in patients' perception of ease of use of their respective materials; however, 72% of chlorhexidine users and 94% of placebo users, but only 24% of conventional floss users, felt that their interdental cleaning regimens left their mouths feeling fresher. It is therefore postulated that the pleasant tasting spray may have been an important stimulus to extended use of the new device and may explain its greater effectiveness.
Article
The removal of interproximal plaque was compared using a standard toothbrush alone, a toothbrush with unwaxed dental floss and a toothbrush with an interdental brush. 30 previously treated periodontal patients were given the cleaning aids in a three-way crossover study design. After each 1 month trial period, scores for gingivitis, buccal/lingual plaque and proximal plaque were recorded. Mean GI scores for subjects were 0.37 using the toothbrush only, 0.36 using the toothbrush with floss and 0.32 using the toothbrush with the interdental brush. Mean buccal/lingual plaque scores were 0.64 using the toothbrush only, 0.62 using the toothbrush with floss and 0.51 using the toothbrush with the interdental brush. Mean plaque scores were 2.32 with the toothbrush only, 1.71 using the toothbrush with floss and 1.22 using the toothbrush with the interdental brush. Statistically significant differences were seen in proximal plaque scores between the 3 treatment groups. The results indicate that the interdental brush used in combination with a toothbrush is more effective in the removal of plaque from proximal tooth surfaces than a toothbrush used alone or in combination with dental floss.
Article
Twenty-four adults participated in an intraindividual crossover experimental study to compare the plaque removing ability of straight multitufted and V-shaped brushes. Twelve of the participants had loss of periodontal tissue resulting in open but healthy interdental areas while the other 12 displayed no periodontal breakdown. In part 1 the participants were asked to brush their teeth using their own brushing technique and length over two 12-day periods during which time they, at random, used one brush for the first and the other brush for the second period. In part 2 the participants were professionally brushed by two dental assistants using four brushing techniques (The Bass, The Roll, The Circular Scrub and The Horizontal Scrub) randomly assigned to the four quadrants of the mouth. Cleaning was performed once a day for two 5-day periods, during which time the participants refrained from brushing and interdental cleaning. Initial toothbrush assignment was randomized. At the beginning of the study and each test period no plaque or gingival inflammation was visible. At the end of each period the accumulated plaque was registered. The results showed that there was no difference between the two brushes tested in the unsupervised part. The plaque removing ability when using either of the brushes varied between participants. When professionally used the straight multitufted and V-shaped toothbrushes did not show any difference in plaque removal on buccal and lingual surfaces. Interproximally the V-shaped toothbrush was better at plaque removal than the straight one.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The purpose of the present study was to find out to what extent subgingival plaque formation may be prevented by toothbrushing. The experiment was carried out on a total of 28 molars in four monkeys. On day 0 all supra- and subgingival deposits were removed, and during the following year, the teeth on the left side were carefully brushed three times a week, employing the Bass' method. The right side was kept as unbrushed control. The histologic sections, which were cut in a bucco-lingual direction, showed that subgingival plaque almost invariably had developed on the unbrushed teeth. Although all of the brushed teeth were free of subgingival plaque, a mild to moderate cellular infiltration prevailed for some distance below the gingival margin. These inflammatory reactions were assumed to have been induced by the bristles of the toothbrush, which were shown to penetrate as far as 0.9 mm below the gingival margin, when employing the Bass method. It was concluded that subgingival plaque formation can be prevented in areas accessible to the toothbrush.