The effect of different methods of interdental cleaning

Three experimental studies were carried out to compare the effect of different implements recommended for interdental cleaning. In young adults, with healthy periodontal tissues, dental floss was superior to toothpicks in removing plaque from the lingual parts of the interproximal surfaces. The use of a single-tufted brush as a supplement to the toothpicks compensated for the lack of effectiveness of toothpicks alone. In wide-open interproximal areas, following periodontal destruction, the interdental brush is the most suitable implement to remove bacterial plaque.     

Plaque removal by dental floss or toothpicks

Abstract. The amount of plaque accumulation was assessed in an intraindividual study comprising 10 individuals. During different 2-week periods, the test subjects used nylon floss (unwaxed, waxed and specially treated), silk floss (unwaxed and waxed), Superfloss®, or triangular toothpicks for interdental tooth cleaning. Only teeth in contact with neighboring ones and with open interdental spaces were included in the study. The plaque removal of the interdental aids used was registered by estimating the amount of plaque present at the end of each experimental period according to a Plaque Index (Silness & Löe 1964) modified for plaque registration on 10 surface units around each tooth. In general, dental floss had a higher plaque removing potential than triangular toothpicks, especially on lingual axial surfaces.     

The effect of tensile strength on the clinical effectiveness and patient acceptance of dental floss.

This study compared the clinical effectiveness and subjective approval of 2 waxed dental flosses that differed significantly in tensile strength and wax content. At the initial appointment, subjects (20 1st-year dental students) were instructed to stop interproximal cleaning on 2 contralateral quadrants in order to allow plaque to accumulate on these surfaces for 1 week. 1 week later, subjects were instructed to begin flossing these 2 contralateral quadrants with 1 of the 2 types of floss for the next 1-week period, while withdrawing interproximal cleaning on the opposite 2 contralateral quadrants. After flossing these 2 quadrants for 1 week, the subjects began flossing the opposite 2 contralateral quadrants with the same floss. After 2 weeks of flossing contralateral quadrants, the 1st floss was withdrawn and replaced with the alternative floss for another similar 2-week trial period. At the end of each 2-week trial period, subjects completed subjective questionnaires concerning the floss they had used during the previous 2-week period. Pre- and post-flossing plaque indices were calculated for each week for both flosses, and compared statistically by a repeated measures analysis of variance. The results showed that both flosses significantly reduced interproximal plaque deposits, and had equal subjective approval. However, neither the greater-strength nor the lower-wax content of the experimental floss was associated with an increase in clinical effectiveness or with a change in subjective approval.     

Fluoride release from NaF‐ and AmF‐impregnated toothpicks and dental flosses in vitro and in vivo

The aim of this study was to determine the fluoride release from toothpicks and dental flosses in vitro and in vivo, and to evaluate various approximal administration methods. In vitro, a total of 23 commercially available toothpicks and dental flosses and 3 prototypes impregnated with sodium fluoride (NaF), amine fluoride (AmF), or a combination of these two were tested. Fluoride release was determined for up to 24 h using an ion‐specific electrode. A large variation was found between the products; most fluoride being released after 30 min. Generally speaking, toothpicks produced higher values than flosses. In vivo, the fluoride concentration in both treated and non‐treated approximal areas was evaluated after using 2 different types of toothpicks and 4 dental flosses and after different application methods—such as a fluoride gel and fluoride solution. The mean fluoride concentration in oral fluid was up to 10 times higher at the treated sites than at the non‐treated sites. Use of a fresh toothpick or a fresh piece of dental floss in each approximal space resulted in higher values compared with using one and the same toothpick/floss for the whole dentition. An interdental brush dipped in 0.2% NaF gel and a mouthrinse with 0.2% NaF resulted in elevated fluoride concentrations at the same level as when multiple toothpicks were used. To conclude, there are large variations in the fluoride release from various brands of fluoridated toothpicks and dental flosses. Treatment with a fluoridated toothpick or a dental floss can be expected to give elevated fluoride concentrations in the approximal area up to 60 min. Another interesting method for administering fluoride in the approximal area is to use an interdental brush dipped in fluoride gel.     

The plaque-removing ability of some common interdental aids. An intraindividual study

Abstract An intraindividual study was performed on 23 (15 male and 8 female) patients suffering from periodontal disease, in order to investigate the plaque-removing ability of denial floss and of round, triangular and rectangular toothpicks. Only teeth in contact with neighbouring teeth and with open interdental spaces were included in the study. The plaque-removing ability of the interdental aids used was registered by estimating the amount of plaque at the end of each experimental period (14 days) according to a modified Plaque Index (Silness & Löe 1964) in which plaque was registered on ten surfaces around each tooth. The results show that round and rectangular toothpicks remove plaque only from the buccal part of the proximal surfaces, but that triangular toothpicks and dental floss are effective on both the buccal and lingual parts of the proximal and axial surfaces.     

The toothpick method in relation to other plaque sampling techniques for evaluating mutans streptococci

The aim of the present study was to compare the use of toothpicks with other sampling methods for determination of mutans streptococci on different tooth surfaces. In nine persons with > 10⁵ CPU per ml saliva of mutans streptococci, plaque samples were taken from 90 buccal and lingual surfaces. 108 occlusal surfaces and 90 approximal surfaces with toothpicks. The prevalence of mutans streptococci on these tooth surfaces was compared with samples taken at four 1-week intervals on the same tooth surfaces with a carver (buccal/lingual surfaces), a needle (occlusal surfaces) or a dental floss (approximal surfaces). Each sample was plated on MSB agar and the presence of mutans streptococci was expressed on a scale varying from 0 to 4. On two of the sampling occasions the amount of plaque, mirrored by total viable counts on blood agar, was also determined. Only for buccal/lingual plaque samples was a difference in total counts between methods noted and then with higher total recoveries obtained after sampling with toothpicks. More surfaces were found to be positive for mutans streptococci when samples were taken with a toothpick than with a carver, needle or floss. On surfaces positive for mutans streptococci the colonization score was higher in samples taken with a toothpick than with a carver or a needle while samples taken with a floss showed a tendency to higher levels of mutans streptococci than samples collected with a toothpick. The data indicate that the results obtained by using toothpicks for evaluating the prevalence of mutans streptococci an individual tooth surfaces compare favorably with the other methods tested     

Effect of fluoridated toothpicks and dental flosses on enamel and dentine and on plaque composition in situ

The aim was to evaluate the effect of two toothpicks and two dental flosses on demineralized enamel and dentine and on plaque composition, using an in situ model with simulated approximal spaces within dentures. Fifteen subjects with full dentures were recruited and 14 completed the study. It consisted of two crossover periods, the first comparing a birch toothpick with AmF and a birch toothpick with NaF, and the second comparing a dental floss with AmF + NaF and a dental floss without F. Between these four periods, there was a control period without any approximal cleaning. In small, rectangular sample holders, one enamel and one dentine specimen were embedded, forming a triangular, approximal-like space. Two sample holders were mounted in the premolar-molar region of the upper or lower dentures. The subjects used the toothpicks or dental flosses 3 times/day for 4 weeks. The results showed that all toothpicks and dental flosses inhibited further demineralization compared to the control period (p < 0.001). The dental flosses were somewhat more effective in this respect than the toothpicks, especially in dentine. There were relatively small numerical differences between AmF and NaF toothpicks, but in favour of NaF regarding mineral gain (p < 0.05). The fluoridated floss gave somewhat less lesion depth in dentine than the non-fluoridated floss (p < 0.01). Toothpicks and flosses resulted in lower counts of microorganisms in plaque compared to the control period (p < 0.001); the AmF toothpick gave a more pronounced reduction than the NaF toothpick (p < 0.001).     

Fluoride uptake into demineralized primary enamel from fluoride-impregnated dental floss in vitro

Fluoridated mouthrinses are not advised for preschool children who may swallow much of the agent. An alternate method of delivering topical fluoride to the interproximal tooth surfaces in these young patients may be fluoridated dental floss. The purpose of this study was to determine the fluoride levels of demineralized primary enamel both before and after the use of a commercially available dental floss impregnated with commercially available fluoride-containing products. The results showed that demineralized primary tooth surfaces treated with fluoride-impregnated dental floss exhibited significantly higher fluoride levels than those surfaces treated by immersion in a fluoridated mouthrinse or deionized water.     

Effect of multiple dental floss-SnF2 treatment on Streptococcus mutans in interproximal plaque.

Samples of dental plaque obtained from the interproximal tooth surfaces of seven young men showed considerable variation in the prevalence and anatomic site distribution of the potentially cariogenic microorganism S mutans. Multiple application of 10% SnF2 topical solution and saline solution delivered to interproximal test sites with dental floss were evaluated as short-term measures for eliminating S mutans from these surfaces. A greater overall reduction in the number of positive S mutans sites was observed for the SNF2-treated sites than the saline solution-treated sites. Long term studies are required to evaluate the effect of the treatments on the incidence of dental caries.     

The effect of 1% chlorhexidine gel delivered with toothpicks on proximal dental plaque. A pilot study.

The aim of this study was to determine the effect of 1% chlorhexidine gel delivered with toothpicks on interproximal dental plaque. Seven follow-up patients participated in two treatment periods of 1 week each, separated by a normal oral hygiene period of one week. The study had double-blind design. The plaque index by Silness and L?e (Acta Odontol Scand 22: 121-135, 1964) was scored on mesial, distal, buccal and lingual surfaces of each tooth after plaque disclosure, with an aqueous solution of erythrosine and the measurements were performed by the same examiner, at the initial visit and at the end of every experimental week. The ability to use toothpicks was checked and upgraded to the individual need. The participants were instructed to carry out their normal oral hygiene procedures, with placebo gel or 1% chlorhexidine gel delivered interproximally with toothpicks once daily. No significant differences in the measurement of plaque were noted between placebo gel and 1% chlorhexidine gel at interproximal areas. After treatment with 1% chlorhexidine gel, the mean distribution of plaque score 0 was increased significantly (P < 0.05), from 30.7 sites (52%) to 42 sites (71.1%) when all sites are taken into account and compared to the placebo period. 1% Chlorhexidine gel delivered by toothpick on interproximal areas had a limited effect on reduction of dental plaque.     

Use of dental floss by Finnish students

In order to elucidate dental care behavior related to interdental cleaning, a group of first-year students were invited to a free dental examination. 186 of the students invited (76%) were examined clinically and roentgenologically. The mean DMFS-index of the students was 22.6 (+/- 12.6). They were also asked about their use of dental floss. 35% of the students reported using dental floss, but only 2% reported daily usage. 45% of the students had been taught how to use dental floss, and 83% of these had been taught by dental personnel. Teaching had no effect on the reported frequency of use. There were no statistically significant differences in the occurrence of dental plaque and gingivitis between those who used dental floss and those who did not. The subjects were unable to use dental floss on 1 out of every 3 filled proximal surfaces of the first molars. No correlation could be found between dental caries experience and the reported use of dental floss.     

The effectiveness of 3 types of dental floss for interdental plaque removal

Abstract. The relative effectiveness of waxed dental floss, dental tape and Superfloss as proximal plaque removal aids were compared in 20 subjects. Each subject used each of the three interdental aids for I week. The order of use was randomly selected. Interdental plaque scores were recorded at baseline, weeks 1, 2 and 3. At the end of week 3, subjects answered a questionnaire to ascertain their subjective responses to the 3 types of dental floss they had used. The use of all 3 types of dental floss resulted in significant improvement in mterproximal plaque scores compared to baseline scores. Improvement in plaque scores, in decreasing order were: dental tape, dental floss and Superfloss. Dental tape was significantly more efficient than Superfloss ( p = 0.003). There were no significant differences observed between the effectiveness of dental tape and waxed floss ( p = 0.059). and waxed dental Hoss and Superfloss ( p = 0.143). Regardless of the type of dental floss used, patients removed plaque more efficiently from buccal inter-proximal areas compared to lingual/palatal interproximal areas ( p < 0.001) and from anterior teeth than posterior teeth ( p < 0.001). Subjective responses indi-cated that 50% of subjects preferred dental tape. 40% waxed dental floss and only 10% preferred Superfloss.     

Fluoride release from NaF- and AmF-impregnated toothpicks and dental flosses in vitro and in vivo

The aim of this study was to determine the fluoride release from toothpicks and dental flosses in vitro and in vivo, and to evaluate various approximal administration methods. In vitro, a total of 23 commercially available toothpicks and dental flosses and 3 prototypes impregnated with sodium fluoride (NaF), amine fluoride (AmF) or a combination of these two were tested. Fluoride release was determined for up to 24 h using an ion-specific electrode. A large variation was found between the products; most fluoride being released after 30 min. Generally speaking, toothpicks produced higher values than flosses. In vivo, the fluoride concentration in both treated and non-treated approximal areas was evaluated after using 2 different types of toothpicks and 4 dental flosses and after different application methods--such as a fluoride gel and fluoride solution. The mean fluoride concentration in oral fluid was up to 10 times higher at the treated sites than at the non-treated sites. Use of a fresh toothpick or a fresh piece of dental floss in each approximal space resulted in higher values compared with using one and the same toothpick/floss for the whole dentition. An interdental brush dipped in 0.2% NaF gel and a mouthrinse with 0.2% NaF resulted in elevated fluoride concentrations at the same level as when multiple toothpicks were used. To conclude, there are large variations in the fluoride release from various brands of fluoridated toothpicks and dental flosses. Treatment with a fluoridated toothpick or a dental floss can be expected to give elevated fluoride concentrations in the approximal area up to 60 min. Another interesting method for administering fluoride in the approximal area is to use an interdental brush dipped in fluoride gel.     

Fluoride uptake in vitro by interproximal enamel from dental floss impregnated with amine fluoride gel

In a study in vitro it was observed that dental floss impregnated with amine fluoride gel may serve as a source of fluoride for interproximal surfaces of human teeth.     

Gingival sequela from a retained piece of dental floss

A case was reported where a piece of dental floss broke and was retained in an interproximal area. The patient came to the clinic a few days later with a periodontal abscess. After the retained fragment of dental floss was removed, the abscess resolved. Therefore, a retained portion of dental floss should be immediately removed to prevent gingival irritation and tissue injury.     

Recent changes in health related dental behaviors in Norway

There has been a substantial decrease in the prevalence of caries in younger age groups in the western world during the last 15 years. A corresponding increase has been reported regarding use of preventive remedies. Since prevention and control of dental disease is highly dependent upon personal behavior, investigations of dental health behaviors within subgroups of the population are important for future preventive strategies. Occurrence and changes in individual dental health behaviors in Norway were studied through four sets of cross-sectional data collected in 1981, 1983, 1985, and 1987. Personal interviews performed by trained interviewers were held with probability samples, each of about 1400 persons, covering the Norwegian population aged 15 and above. During the 6-yr period the proportion of individuals who brushed their teeth and used fluoride dentifrice every day increased. The number of people who used toothpicks or dental floss every day also increased from 1981 to 1985. A marked decrease was, however, observed in use of interdental remedies from 1985 to 1987. Daily use of dental floss was reduced by 10 percent points. Logistic regression showed that the reduction in the probability of using interdental aids was most pronounced among those with few teeth. Lower importance attached to dental health education, at all levels, combined with difficult economic times since 1987, might account for the decrease in daily use of interdental aids in Norway.     

Communication about dental health in Norwegian adults

The present study describes the amount and distribution of communication on dental health issues in Norwegian adults. The empirical data stem from a representative sample of Norwegians aged 15 and above, and were collected by means of personal interviews by the poll organization Norges Markedsdata in 1983. Edentulous subjects were excluded, and the study group finally comprised 1225 subjects. The dependent variable - dental communication - was a dichotomy based upon whether or not the respondents had communicated with friends about dental health during the last 6 months. The following independent variables were used: age, sex, marital status, education, use of dental services, number of teeth, knowledge of prevention, information about dental health from dentists and media, use of dental floss and toothpicks. The empirical analysis was performed using contingency table analysis and Multiple Classification Analysis (MCA). Separate analyses were performed for men and women. Significantly more women (27.6%) than men (14.5%) reported dental communication. In addition, the model provided a better fit to the data on women compared to men in terms of R2 (12.5% and 8.9%). These observations can to some extent be accounted for by the existing sex-role pattern. The only predictor which showed a consistent direct effect across sex was whether the respondents had received information about dental health from media. This means that reference to the interpersonal context of mass communication perhaps best describes the complex transactional interplay of media and interpersonal sources in dental health matters.     

A comparison of proximal plaque removal using floss and interdental brushes

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.     

Plaque-removing effect of a toothbrush, dental floss, and a toothpick

The ability of three different oral hygiene devices to remove 2-day-old bacterial deposits was evaluated on 21 young adults with healthy periodontia. On buccal tooth surfaces, the cleaning effect of a multitufted nylon brush was superior to that of a wooden toothpick or unwaxed dental floss. On lingual surfaces, the toothpick was as effective as the brush. On the visible portions of proximal surfaces, all three devices were equally efficient. A combined cleaning exercise with all three instruments together yielded significantly better results than did the use of each single device. Eight subjects were able to remove all disclosable deposits.     

A survey of floss frequency, habit and technique in a hospital dental clinic & private periodontal practice

The purpose of the study was to determine floss frequency, habits and techniques of patients entering a private periodontal office (office site) vs. a hospital dental clinic (hospital site). It was found that the flossing frequency in a hospital dental clinic is far less than in a private practice, and patients who do floss may not be using the proper flossing technique. Patients need more instruction and care with regard to their interproximal oral hygiene.