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.     

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).     

Approximal fluoride concentration using different fluoridated products alone or in combination

The aim of the present investigation was to measure the approximal fluoride (F) concentration after using different F-containing products, either alone or in combination. Ten subjects participated on a total of 17 occasions, which were randomized, distributed and divided into two trials (called trial I and trial II). The F concentration was studied after treatment with toothpicks, dental flosses, an interdental brush dipped in 0.2 or 0.32% F gels, brushing with toothpaste containing 0.32% F and a mouthrinse with 0.2% NaF solution. The results of trial I revealed that the rinsing solution resulted in the highest approximal F values, followed by toothpicks and brushing. When brushing was combined with either flossing or toothpick, the sequence order of the two methods had less influence. However, when combined with rinsing it appeared to be better to use the floss or the toothpicks first, prior to the mouthrinse. In trial II, treatment with the gels alone, and in combination with brushing, resulted in higher approximal F concentrations compared with brushing alone. The data indicate that the order of usage when combining products may be of importance when it comes to obtaining high F levels at the approximal sites and that an interdental brush with F gel after toothbrushing may be a suitable method, called 'Inter Dental Brush Gel Method', to produce elevated F concentrations at approximal sites.     

Uptake and release of fluoride from birch and lime toothpicks

Birch and lime toothpicks were impregnated in a 4% sodium fluoride (NaF) solution for different periods of time, viz. 30 s, 30 min and 3 d. After impregnation for 30 min, an average of 4.1 mg NaF per birch toothpick was taken up. The corresponding value for lime toothpicks was 5.1 mg. About 60% of the fluoride (F) was released within 1 h in vitro when the toothpicks were kept in water. In vivo , the concentration of F was determined in whole saliva from five adults during 30 min after using birch toothpicks immersed in a 4% NaF solution. After 2 min, the mean salivary F concentration was 2.7 mM. Impregnation of birch toothpicks in 1, 2 or 3% NaF resulted in lower F concentrations both in vitro and in vivo , with a clear dose-response effect. When comparing the use of a 4% NaF impregnated birch toothpick, a mouthrinse with 10 ml of 0.025% NaF, sucking on a F tablet containing 0.55 mg NaF, and toothbrushing with 1 g of an 0.068% F (as NaF) dentifrice – all procedures carried out in the mouth during 2 min – the highest concentration of F in saliva was obtained after using the fluoridated toothpick. Thus. NaF impregnated birch and lime toothpicks show a quick release of F in vitro as well as in vivo and may be suitable as home care products for prevention of dental caries.     

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.     

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     

Laboratory study of fluoride impregnated toothpicks

Abstract – The uptake of NaF in wooden toothpicks as well as the release of F from toothpicks impregnated with either sodium fluoride or amine fluoride was studied. The initial rate of fluoride uptake was found to be high, and an amount of NaF suitable for clinical use was obtained after immersing toothpicks in a 4% NaF solution for about 5 min. When immersed water or saliva, fluoride was rapidly released from the impregnated toothpick. The F⁻ Concentration registered is saliva collected during use of fluoride impregnated toothpicks varied from about 0.1 part/10⁶ F (amine fluoride impregnated toothpicks) to more than 50 parts/10⁶ F (extended impregnation with NaF). The results indicate that teh clinical potential of fluoride impregnated toothpicks should be explored.     

A 30-day clinical comparison of a novel interdental cleaning device and dental floss in the reduction of plaque and gingivitis

OBJECTIVE: To compare the safety and efficacy of a novel battery-operated interdental cleaning device (Oral-B Hummingbird) [ID], fitted with either a flossette or pick attachment, versus hand-held dental floss in the reduction of plaque and gingivitis when combined with manual tooth brushing over a 30-day period. METHODOLOGY: This randomized, examiner blind, parallel group study assessed three treatment groups: ID/flossette (ID/F), ID/pick (ID/P), and unwaxed manual dental floss. All groups used the same soft manual toothbrush and toothpaste. The 84 subjects were stratified to treatment groups based on initial whole mouth mean plaque scores, gingivitis scores, and gender. Subjects were instructed to brush twice daily and use their assigned interdental method once daily in the evening before brushing. Gingivitis, gingival bleeding, and plaque were evaluated at baseline and Day 30. RESULTS: A total of 78 subjects completed all aspects of the study and were included in the analyses. There was no significant difference between treatment groups in baseline plaque, gingivitis, and bleeding scores. After 30 days, statistically significant reductions from baseline gingivitis and bleeding scores were found for all groups (p < 0.0001), but there were no significant statistical differences among groups. Whole mouth and approximal plaque scores were significantly reduced from baseline in the manual floss and ID/F groups after 30 days of product use, with no significant difference between groups. Plaque reduction for both the manual floss and ID/F groups was significantly greater than the ID/P group. All interdental cleaning methods were safe as used in the study, with no evidence of oral hard or soft tissue trauma. CONCLUSION: The Oral-B Hummingbird was safe and effective in reducing approximal plaque and gingival inflammation, and provides a useful alternative device for interdental cleaning.     

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.     

Gliding capacity of different dental flosses

BACKGROUND: One of the major concerns with the use of dental floss is the passage of the proximal contact, which might be influenced by the material characteristics of the floss. The aim of this study was to compare the gliding capacities of different flosses with major differences in structure and experimental behavior in vivo. METHODS: In a clinical, single-blind, crossover study of 27 subjects, the forces necessary for passing all 14 proximal contacts between the first premolars were measured using 2 polytetrafluoroethylene (PTFE)-based flosses, 2 nylon-based flosses, and 1 nylon-based tape. The flosses were fixed in a special holder with strain gauges, which allowed registration of the maximum forces at insertion into and removal from the interdental area. RESULTS: In most contacts, the PTFE flosses needed less force compared to the nylon flosses. The range between the flosses was higher in the mandible compared to the maxilla and increased from the mesially located contacts to the more distally located contacts. The nylon tape required higher forces at insertion for all maxillary contacts. All other flosses proved to be equivalent at these contacts. CONCLUSIONS: PTFE flosses are superior to nylon flosses in terms of passing stronger proximal contacts in both directions. Due to gliding differences between different types of floss, the selection of a floss has the potential of compensating intra- and interindividual variation in contact strengths.     

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.     

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.     

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.     

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.     

Comparative effectiveness of flossing and brushing in reducing interproximal bleeding

This study assesses the comparative effectiveness of three types of dental floss and toothbrushing in reducing interproximal bleeding sites, measured by stimulation with wooden interdental cleaners using the interdental bleeding index assessment method. The 119 adult subjects with gingival inflammation were randomly assigned to one of four groups at the beginning of a supervised 2 week clinical trial. The toothbrushing only group achieved a 35% reduction in bleeding sites and the three flossing groups all demonstrated dramatic reductions of about 67%. The three varieties of dental flosses were about equally effective in reducing interproximal bleeding and doubly effective as toothbrushing alone. Compared to probing, the interdental bleeding index method is considered a simplified method of assessing interproximal gingival inflammation.     

泉州市居民口腔保健用品使用情况调查

目的调查泉州市城乡居民的口腔保健用品使用情况,为口腔保健用品的普及提供依据。方法采用多阶段、分层、整群、等容量、随机抽样的方法,抽取泉州市20岁以上城乡常住人口600人,分为20～29岁组、30～39岁组、40～49岁组、50～59岁组、60岁及以上5个组,进行口腔保健用品使用情况调查。结果被调查的600名居民中,65.5%(393/600)的居民每天至少刷2次牙,年龄与刷牙频率等级之间有线性关系(P<0.05),即随着年龄的增加,刷牙频率有降低的趋势;年龄与每次刷牙时间等级之间有线性关系(P<0.05),即随着年龄的增加,每次刷牙时间有增加的趋势;53.7%(322/600)的受调查者每天都用牙签,年龄与牙签使用频率等级之间有线性关系(P<0.05),即随着年龄的增加,牙签使用频率有增加的趋势。70.8%的居民没听说过牙线;91.8%的居民没听说过牙间隙刷;只有10.8%的居民使用过漱口水。结论泉州市的城乡居民刷牙比较普遍,牙线、牙间隙刷、漱口水等口腔保健用品的使用率较低。有必要推广全民性自我口腔保健行动,更新群众观念,促进其正确认识及使用口腔保健用品。     

Comparison of the use of a toothpick holder to dental floss in improvement of gingival health in humans

BACKGROUND: Although advances have been made in modulation of host inflammatory response in periodontal therapy, it is important to control the bacterial challenge to the host immune system through conventional therapy and improvement of personal oral hygiene. Although toothbrushing is generally performed, interdental cleaning is not as common. This study compared the use of dental floss to a toothpick holder in the improvement of gingival health. METHODS: Participants were examined and those with clinical gingivitis or slight chronic periodontitis were included in the study. O'Leary plaque, interproximal plaque index (IPI), and Eastman interdental bleeding index scores (EIBI) were recorded at baseline and following appointments. Forty-two females and 13 males ranging from 18 to 50 years in age were randomly divided into either a dental flossing group or toothpick holder using group. Each was given instructions in the use of the oral hygiene device and examined 2, 6, and 12 weeks following baseline. At 12 weeks, 27 floss users and 20 toothpick-holder users completed the study. RESULTS: Plaque scores were reduced in both groups as the study progressed. Mean O'Leary plaque scores decreased significantly for both methods from baseline to week 12 (P < 0.05). The EIBI and IPI scores decreased in mean scores over time for each method (P < 0.05). A correlation was found between the O'Leary plaque index and the IPI scores (P < 0.05). CONCLUSION: The results of this study found that the use of dental floss or toothpick holder resulted in no significantly different effect in the improvement of gingival health.     

Comparison of interdental cleaning methods: a randomized controlled trial

BACKGROUND: Although interdental cleaning is an integral component of home plaque control for periodontally involved patients, limited data exist on the periodontal benefits of commonly used interdental cleaning methods before definitive root surface debridement is undertaken. Therefore, the aim of this study was to compare the effects of a customized interdental brushing technique and a customized flossing technique on clinical periodontal outcomes prior to root surface debridement in chronic periodontitis cases. METHODS: This was a single-blind, randomized controlled clinical trial. Seventy-seven patients with chronic periodontitis were measured for plaque, relative interdental papillae level, Eastman interdental bleeding index, probing depths, and bleeding on probing at interdental sites and underwent a 10-minute hand scaling to remove easily accessible calculus deposits. Before group allocation, patients were advised on toothbrushing and instructed in two customized methods of interdental cleaning involving dental floss and precurved interdental brushes. Materials were supplied after random allocation. Participants were recalled at 6 and 12 weeks for clinical measurements, reinforcement of instructions, and fresh materials. RESULTS: There were significant reductions from baseline for all indices in both groups (P <0.01). At 6 weeks, the interdental brush group improved more than the floss group in every parameter (P <0.05). By 12 weeks, the changes in plaque, papillae level, and probing depths were significantly greater in the interdental brush group than the floss group (P <0.01). CONCLUSION: This trial demonstrated that patients were able to improve clinical periodontal outcomes by interdental cleaning, particularly with interdental brushes, even before thorough root surface debridement was undertaken.     

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.     

Plaque removing effect of a convex-shaped brush compared with a conventional flat brush

The plaque-removing effect of a convex-shaped multitufted brush was compared with that of a conventional flat multitufted brush. Two group (five and seven dental students, respectively), well instructed in the modified Bass technique, participated in a blind, splitmouth, crossover study during two consecutive experimental periods of 96 hours of undisturbed plaque growth. After each of these periods, a supervised brushing session was performed, followed by toothpick utilization. Plaque removal was evaluated using the modified Navy Plaque Index (MNPI) and planimetry. A 4% erythrosin solution was used as a disclosing agent. Planimetrically, the flat Oral B brush appeared significantly more effective than the convex shaped Ph brush (P less than 0.001). This superiority was even enhanced after the use of toothpicks (P less than 0.0005). The differences between the brushes, however, were too small to be detected by the less discriminating MNPI. Although it has been claimed that the convex brush could assure approximal plaque control, the results indicate that for the convex-shaped, as well as for the flat brush, an approximal aid is essential for good plaque control. The hypothesis that the design of the convex-shaped brush could facilitate the modified Bass technique for the average patient could not be proven in this study.