Use of toothpicks for chlorhexidine staining.

The purpose of this study was to determine if the extrinsic dental staining associated with the use of chlorhexidine gluconate (CHX) mouthrinse could be prevented or controlled by the patient with the use of toothpicks. 25 subjects received a prophylaxis to establish a stain-free baseline and were then randomly assigned a control and experimental side of the mouth. The rinsing regimen was 1/2 oz of 0.12% CHX mouthrinse 2x a day for 3 months. Subjects self-examined daily for the appearance of stain. Where stain was visible, a toothpick was used to 'rub it away' on the distolabial, labial and mesiolabial surfaces of the experimental side only. The rubbing action was similar to the use of an eraser to remove a pencil mark from paper. The amount and intensity of stain was photographed and graded by a blinded examiner after 2 weeks, 1, 2 and 3 months. Subjects kept calendars to encourage and document compliance. When analyzed across time, teeth and surfaces, there was a statistically significant difference in stain between the control and experimental sides for stain amount, intensity, and for a composite of amount/intensity. Clinical differences were slight. The study indicates that the use of a simple toothpicking technique can affect chlorhexidine stain.