Effect of endoscopic full-thickness resection assisted by distal serosal turnover with floss traction for gastric submucosal masses.

BACKGROUND: Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection (EFTR). Successful perforation repair under endoscopy, thereby avoiding surgical intervention and postoperative complications such as peritonitis, are pivotal for effective EFTR. AIM: To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors. METHODS: A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted. The total operation time, tumor dissection time, wound closure time, intraoperative bleeding volume, length of hospital stay and incidence of complications were analyzed. RESULTS: There were 93 patients, aged 55.1 ± 12.1 years. Complete tumor resection was achieved in all cases, resulting in a 100% success rate. The average total operation time was 67.4 ± 27.0 min, with tumor dissection taking 43.6 ± 20.4 min. Wound closure times varied, with gastric body closure time of 24.5 ± 14.1 min and gastric fundus closure time of 16.6 ± 8.7 min, showing a significant difference (P < 0.05). Intraoperative blood loss was 2.3 ± 4.0 mL, and average length of hospital stay was 5.7 ± 1.9 d. There was no secondary perforation after suturing in all cases. The incidence of delayed bleeding was 2.2%, and the incidence of abdominal infection was 3.2%. No patient required other surgical intervention during and after the operation. CONCLUSION: Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss, making it a viable approach for gastric submucosal tumors.

Effectiveness of dental floss in the management of gingival health: A 6-month follow-up of a randomized controlled clinical trial.

OBJECTIVES: To evaluate, (i) if subjects submitted to a structured oral hygiene training program (OHt) maintain adopted habits over 180 days without professional guidance; and (ii) in perspective whether flossing provides additional benefits to toothbrushing on gingival health. MATERIALS AND METHODS: Seventy-five adult subjects showing approximately 40% proximal gingival bleeding were randomized to receive OHt (1 session weekly over 8 weeks) using toothbrush and dental floss or toothbrush alone. The subjects were then followed over 180 days without professional guidance. Primary outcomes were mean interproximal Gingival Index (GI) and GI = 2 (gingival bleeding). Mixed linear models were used for the comparison between groups (p < 0.05). RESULTS: 68 subjects received OHt, 48 subjects completed the 180-day follow-up. Subjects maintained adequate oral hygiene routines. Besides a reduction in gingival inflammation, no alterations in gingival status were observed among groups, subjects additionally instructed to use dental floss showing a mean interproximal GI = 2 of 12.8 ± 2.5 compared with 19.8 ± 2.2 for subjects limited to tooth brushing alone. CONCLUSIONS: OHt intensive training promotes gingival health and maintenance lasting at least 6 months without professional supervision reinforcing important principles: (i) dental health professionals should dedicate time training and motivating their patients to reach adequate self-performed plaque control; and (ii) the adjunctive use of dental floss appears essential to reduce interproximal gingival inflammation in subjects with intact interdental papillae. CLINICAL RELEVANCE: Dentists need to invest time in training/motivating/engage their patients to achieve adequate OH; adjunct flossing in subjects with papilla filling the interdental space appears essential to reach and maintain gingival health. CLINICALTRIALS: GOV : (53831716.5.0000.5346). TRIAL REGISTRATION: The protocol registration was filed May 9, 2018 (# 538,311,716.5.0000.5346) on ClinicalTrials.gov. An NCT number (NCT04909840) was generated upon completed registration.

The effectiveness of water jet flossing and interdental flossing for oral hygiene in orthodontic patients with fixed appliances: a randomized clinical trial.

BACKGROUND: Orthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment. METHODS: A single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software. RESULTS: The water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group. CONCLUSION: Both water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients.

Evaluation of the efficacy of inter-dental brush and dental floss for peri-implant mucositis: A crossover randomized clinical trial.

OBJECTIVES: To evaluate the most effective method for mechanical inter-dental plaque removal between inter-dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri-implant mucositis (PIM); to identify possible factors related to the patient or to the single implant-supported element that could influence plaque accumulation and inflammation of peri-implant tissues. METHODS: Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter-dental device used (IDB or DF). At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter-dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2. RESULTS: Both inter-dental cleaning devices were effective in reducing PI and GI in the inter-dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°. CONCLUSION: IDB was the most effective method for inter-dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity.

Effects of interdental aids on clinical periodontal indices.

BACKGROUND: Removal of plaque and food particle between teeth represent interdental cleaning. Every patient's self-care program includes plaque removal efficiently and systematically. Periodontal disease, tooth decay and tooth loss may result from the absence of interdental cleaning or even an irregular and unsuccessful interdental cleaning. AIM: The aim of the current study was to assess the effect of inter-dental aids, including dental floss and toothpicks, on gingival and plaque indices. METHODS: A questionnaire including age, gender, education level and other information was obtained from 150 male subjects who were systemically and periodontally healthy. Clinical periodontal parameters (including plaque index and gingival index) were taken from each subject. The participants were categorized into different groups according to the use of inter-dental aids (dental floss, dental picks and without any interdental aids). The participants were divided into the toothbrush-alone group, including participants who did not use either dental floss or toothpicks; the dental floss group, including participants who used dental floss; and the toothpick group including participants who used toothpicks. Plaque and gingival indices compared among groups. RESULTS: Statistical analysis showed that the maximum mean of Plaque index was found in the toothbrush-alone group (1.09 ± 0.43), while the lowest mean of Plaque index was found in the dental floss group (0.87 ± 0.39). Plaque index of the toothpick group was (0.99 ± 0.41) with statistically significant difference among groups (p-value = 0.04*). CONCLUSION: In conclusion, dental floss is the most effective mean of removing interdental plaque.

Efficacy of water flossing on clinical parameters of inflammation and plaque: A four-week randomized controlled trial.

Purpose The primary prevention of periodontitis is controlling gingivitis daily. The study objective was to compare the efficacy of a pulsating water flosser to a pulsating water flosser infused with air microbubbles on clinical signs of inflammation and plaque.Methods One hundred and five participants were enrolled in this single-blind, single-center, parallel, four-week, IRB/IEC-approved clinical trial. Participants were randomly assigned to one of three groups: water flosser (WF) plus manual toothbrush, water flosser infused with microbubbles of air (MBWF) plus manual toothbrush, or dental floss (DF) plus manual toothbrush. Bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification Navy Plaque Index (RMNPI) scores were recorded at baseline, 2-weeks, and 4-weeks.Results All participants completed the study (n=105). All groups showed a statistically significant reduction for BOP, MGI, and RMNPI at 4-weeks (p<0.05, except DF marginal RMNPI). The WF group showed a statistically significant greater reduction in whole mouth BOP (0.41) compared to MBWF (0.32) and DF (0.19). This was also true for MGI (0.37, 0.30, and 0.20, respectively) and RMNPI (0.13, 0.11, and 0.06, respectively) (p<0.05 for all comparisons). No adverse events were reported.Conclusion This study demonstrates that a manual toothbrush and water flosser, with or without microbubbles, is an effective oral care regimen for controlling gingivitis over four weeks.

Developing a bioactive glass coated dental floss: antibacterial and mechanical evaluations.

In the present study, we investigated commercial dental floss coated with chitosan or chitosan + mesoporous bioactive glass nanoparticles (MBGNs) in order to determine the antimicrobial and mechanical properties of the newly fabricated flosses. Whereas these coatings showed notable ability to inhibit growth of both Gram (+) and Gram (-) bacteria after 24 h, the impact was negligible at 3 h. Furthermore, the tensile strength of the floss was improved by the addition of these layers, making it more durable and effective for cleaning between teeth. We therefore propose enhanced investigations of these composites since they demonstrate enormous potential in promoting oral health.

Efficacy of water flossing on clinical parameters of inflammation and plaque: A 4-week randomized controlled trial.

BACKGROUND: The primary prevention of periodontitis is controlling gingivitis daily. The study objective was to compare the efficacy of a pulsating water flosser to a pulsating water flosser infused with air microbubbles on clinical signs of inflammation and plaque. METHODS: One hundred and five participants were enrolled in this single-blind, single-centre, parallel, 4-week, IRB/IEC-approved clinical trial. Participants were randomly assigned to one of three groups: water flosser (WF) plus manual toothbrush, water flosser infused with microbubbles of air (MBWF) plus manual toothbrush, or dental floss (DF) plus manual toothbrush. Bleeding on probing (BOP), Modified Gingival Index (MGI) and Rustogi Modification Navy Plaque Index (RMNPI) scores were recorded at baseline, 2 and 4 weeks. RESULTS: All participants completed the study (n = 105). All groups showed a statistically significant reduction for BOP, MGI and RMNPI at 4 weeks (p < 0.05, except DF marginal RMNPI). The WF group showed a statistically significant greater reduction in whole mouth BOP (0.41) compared to MBWF (0.32) and DF (0.19). This was also true for MGI (0.37, 0.30 and 0.20, respectively) and RMNPI (0.13, 0.11 and 0.06, respectively; p < 0.05 for all comparisons). No adverse events were reported. CONCLUSION: This study demonstrates that a manual toothbrush and water flosser, with or without microbubbles, is an effective oral care regimen for controlling gingivitis over 4 weeks.

A Cross-Sectional Study on Self-Perceived Halitosis among Undergraduate University Students in Riyadh, Saudi Arabia.

Aim: The present cross-sectional observational study was conducted to evaluate the prevalence of halitosis among undergraduate university students at Riyadh Elm University, Riyadh, Saudi Arabia. Materials and Methods: A survey of 301 participants who answered a questionnaire on their self-perceived halitosis was undertaken. Results: The response rate was 35% (301/863). Of the total, 54.5% of participants reported that they had experienced halitosis. A majority of participants (61.4%) responded to having experienced an unpleasant bad taste in the morning when they woke up, with most participants (42.4%) stating that their breath was the worst early in the morning. A majority of respondents (59.6%) reported that they were aware of their condition. Only 27% of the respondents stated that they had admitted to having undergone an examination for bad breath from their dentist, and 22.9% of the respondents reported that they had undergone an examination for conditions associated with bad breath. The measures used to reduce the condition were evenly distributed, with approximately one-third using mouthwash (34.6%), gum/mentos (38.3%), and toothpaste (27.2%). Conclusion: The incidence of self-perceived halitosis that was revealed in the current study is normal compare to others studies. It is unrelated to age and sex. Non-usage of dental floss, no use of mouthwash, and smoking, on the other hand, were shown to be associated with self-perceived halitosis. Furthermore, tongue cleaning was not linked to introspection halitosis. Halitosis may be also due to underlying systemic conditions. Hence it is necessary to evaluate the condition's prevalence and examine the relationship with other etiological variables with halitosis in our country.

Comparison of dental flosses - an investigation of subjective preference and mechanical properties.

Objective: To investigate the properties (tensile strength, roughness, abrasiveness) of different dental flosses and how these properties relate to subjective preference for floss by users. Materials and method: Four flosses of differing compositions were selected (polytetrafluoroethylene (PTFE), nylon, silk, and ultra-high-molecular-weight polyethylene (UHMWPE)). Tensile strength (TS) was measured utilising a universal testing machine (total n = 40). Surface roughness (Ra) was measured on 3D reconstructed models of scanning electron microscope and abrasiveness was measured through block-on-ring tests against human enamel. Subjective preference for floss was measured by asking a sample of 16 individuals to use each floss for an 8-day period using a split-mouth design. Results: The highest TS was found in UHMWPE floss (194.18±24.61 MPa) while the lowest TS was found in PTFE floss (11.78±0.77 MPa). Silk floss had the highest Ra (0.304±0.025 µm) while PTFE floss had the lowest (0.048±0.003 µm). In-vitro abrasion testing of the flosses identified no significant differences between the flosses in causing wear on tooth enamel. Subjective ratings of flosses indicated PTFE floss to be most preferred and nylon floss to be least preferred. Conclusion: There was a difference in subjective preference between dental flosses composed of different materials. The PTFE floss was the overall most preferred while the nylon floss was the least preferred. There was also an association between the mechanical properties and preference for their usage, with PTFE floss being the most preferred but having the lowest surface roughness and tensile strength. Clinical Relevance: This study compared a wide range of mechanical properties and subject preferences of commercially available dental floss. The results of this study can provide guidance for the recommendation of dental floss for oral hygiene routines.

Effectiveness of a sonic-flosser toothbrush with different size brush heads and manual toothbrush plus dental floss on plaque, gingival bleeding and inflammation in adults with naturally occurring gingivitis: A 4-week randomized controlled trial.

OBJECTIVE: To compare the effectiveness of three oral hygiene groups: a novel sonic-flosser toothbrush with a compact brush head, a novel sonic-flosser toothbrush with a full size brush head and manual toothbrush plus dental floss on the reduction of gingival bleeding after 4 weeks. Secondarily, the groups were compared on the reduction of gingival inflammation and dental plaque. MATERIALS AND METHODS: One hundred and five (n = 105) healthy adults were enrolled in this randomized, examiner-blind, three-group, parallel clinical trial. Subjects were assigned to one of three groups: sonic-flosser toothbrush with full size brush head (SFF), sonic-flosser toothbrush with compact brush head (SFC), or manual toothbrush and string floss (MTF). Bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification of the Navy Plaque Index (RMNPI) scores were recorded at baseline, 2-weeks, and 4-weeks. RESULTS: All subjects completed the study. All three groups demonstrated a significant reduction in BOP, MGI and RMNPI from baseline to 4-weeks for all areas recorded (p < 0.001), except gingival margin plaque scores for SFF, SFC and MTF (p = 0.203, p = 0.082, p = 0.324 respectively). Both the SFF and SFC groups were statistically more effective than MTF for whole mouth BOP, MGI and RMNPI (p < 0.001) and proximal areas (p = 0.022 or less). There were no adverse events reported by the subjects or identified by the examiner during the study. CONCLUSION: The sonic-flosser toothbrush with a full size or compact brush head was statistically and clinically more effective at improving gingival health and reducing plaque than manual toothbrush and dental floss for adults with naturally occurring gingivitis over 4-weeks.

Engineering of bioactive nanocomplexes on dental floss for targeted gingival therapy.

Periodontitis induced by chronic subgingival infection is a ubiquitous disease that causes systemic inflammatory consequences and poses a negative impact on quality of life. The disease is treated and potentially prevented by patient's self-care aimed at eliminating the oral pathogens from the region. Currently available products for interdental self-care, including dental floss and interdental brush, have limited ability to prevent the disease. Here, we report a coated dental floss thread, termed "nanofloss," which uses polyphenol-based nanocoating to functionalize the floss thread with therapeutic agents. Multiple therapeutics can be integrated into the nanofloss including antibacterial small molecules and proteins. Flossing with nanofloss-delivered therapeutic agents to the challenging subgingival region with long-term retention even against the flushing action of the oral fluid in vivo. Our in vitro and in vivo studies demonstrate that chlorhexidine gluconate-loaded nanofloss effectively treats the subgingival infection by Porphyromonas gingivalis. Collectively, the nanofloss offers a promising and easily usable tool for targeted self-care of subgingival infection against periodontitis.

Knowledge and awareness assessment of cross-contamination of dental floss containers in King Saud University dental hospital clinics.

Introduction: Infection control procedures are implemented in dental clinics to reduce the risk of cross-contamination; saliva, blood, or airborne droplets containing infective agents are example of direct contamination, while indirect exposure via contact with contaminated surfaces and dental equipments such as dental chair, tray, faucet, air syringe, suction tip, gutta percha, paper points, retraction cords, and dental floss containers. Dental floss is known to be an integral part of most dental procedures. Objectives: The objective of this study was to assess the knowledge and awareness regarding cross-contamination of dental floss containers among a selected population of dental assistants in dental clinics at King Saud University (KSU). Material and Methods: A swab was taken from 60 dental floss containers selected by simple random sampling among 60 different dental clinics at KSU and culture test was done using a charcoal transport swab to identify the type of bacteria that might be present on the dental floss containers. Also a Google forms questionnaire which consisted of 20 multiple choice questions, including demographic questions on gender, nationality, and professional experience, followed by questions to evaluate different infection control concepts and practices. Results: This study included 70 dental assistants, most of whom were female (94.3 %). A significant number (41.4 %) of the dental assistants have never heard of OSHA course, and most of them (77.1 %) have never taken an OSHA course. Some participants who attended > 2 infection control courses (37.8 %) did not disagree that it is a waste of material to use new gloves to clean each clinic. Regarding the laboratory results for the collected samples, the highest frequency was noted for Staphylococcus hominis (27.8 %). Conclusion: The present study concluded that there is still further need for implementation of infection control programs and raising more awareness regarding this subject.

Individual, familial and country-level factors associated with oral hygiene practices in children: an international survey.

BACKGROUND: Maintaining good oral hygiene is key to preventing dental caries and periodontal disease. Children and adolescents with good oral hygiene behaviours are likely to grow into adults with the same behaviours. This study assessed the frequency of using various oral hygiene methods among children and adolescents from different countries and individual, familial and country-level factors associated with the use of these methods. METHODS: A multi-country online survey collected data from caregivers of children in 2020-21 about children's use of oral hygiene methods including toothbrush, fluoridated toothpaste, mouthwash, dental floss and miswak using self-administered, close-ended questions. Adjusted multilevel logistic regression models were used to assess the relationship between each of the five oral hygiene methods (dependent variables) and the independent factors: sex, age, and history of dental visits (individual factors), mother's education and area of residence (familial factors) as well as country income and region (country-level factors). RESULTS: A total of 4766 parents/caregivers were included from 20 countries (77.4% Eastern Mediterranean-region and 41.6% lower middle income countries). The most frequent oral hygiene methods were using toothbrush and toothpaste (90% and 60.3%). The use of oral hygiene methods differed by age, sex and history of dental visits as well as mother's education and area of residence (P < 0.05). In addition, children from low income countries had significantly lower odds of using mouthwashes and dental floss than those from high income countries (AOR = 0.55, 95% CI 0.31, 0.98 and AOR = 0.34, 95% CI 0.12, 0.97) whereas children from the European region had higher odds of using mouthwash (AOR = 2.82, 95% CI 1.27, 6.26) and those from the region of the Americas had higher odds of using dental floss (AOR = 3.84, 95% CI 1.28, 11.52) than those from the Eastern Mediterranean region. CONCLUSIONS: The use of various oral hygiene methods is associated with individual, familial and country-level factors. Oral health promotion programs should be developed taking into account these influences.

Prevalence of dental floss use in deciduous dentition: A systematic review and meta-analysis.

OBJECTIVES: Adherence to the daily use of dental floss in childhood is recommended by various international health institutions/organizations. This systematic review (PROSPERO number CRD42020205232) aims to evaluate the prevalence of dental floss use in deciduous dentition. MATERIALS AND METHODS: A systematic review was conducted in six databases (B-on, Cochrane Library, PubMed, Scielo, Science Direct and Web of Science) up to December 2020. The CoCoPop mnemonic allowed for obtaining 2333 articles and resulted in the inclusion of 7 observational studies that evaluated the prevalence of dental floss use (primary outcome) in children up to 6 years old. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias, showing that most articles presented good quality. Meta-analyses were performed using the proportion of dental floss use (yes or once/day) and the random effects model. RESULTS: The meta-analysis showed a prevalence of dental floss use of only 12.60% (95% CI: 7.69%-18.52%) based on studies with high heterogeneity of results (I2  = 94.75%; 95% CI: 91.44%-96.78%). Six of the seven studies showed that more than 70% of children never used dental floss. CONCLUSIONS: A low prevalence of dental floss use was observed in children up to 6 years old. Given the diversity of evaluating the use of dental floss, different options should be the target of standardization in future studies.

Dental floss ties for rubber dam isolation: A proposed classification and a new technique.

Rubber dam application has become an essential part of restorative dentistry. In late 2019, dentistry faced a new challenge with the COVID-19 pandemic and therefore, the implementation of extra isolation methods became crucial. This article introduces a classification of dental floss ties used with a rubber dam, including the "simple" ties that are subdivided into traditional ties, single-loop self-ligating ties and double-loop self-ligating ties, and a new state-of-the-art design. The "compound tie" design incorporates a combination of one or more subdivisions of the simple ties. This new design may provide better isolation and more consistent gingival tissue retraction. Furthermore, due to the advanced technique applied, the tie will offer improved stability and prevent the sheet from sliding over the dental floss tie from all surfaces.

The Use of Interdental Care Products in Korean Adults Aged 30 Years and Older and Factors Affecting Their Use: 4th to 7th Korean National Health and Nutrition Examination Survey.

This study aimed to review the use of interdental care products (ICPs) among adults in Korea, reconfirm their relevance to periodontal health, and identify factors affecting the use of ICPs. Data from 2007 to 2018 from the National Health Nutrition Survey (KNHANES) were used, and 43,069 adults (18,412 men, 24,657 women) aged 30 years or older were included. The frequency and percentage of ICP use according to the characteristics of the subjects are presented. In addition, multivariate logistic regression analysis identified the factors affecting ICP use. The ICP usage rate of participants in the KNHANES phase gradually increased to 22.8% in the 4th, 26.4% in the 5th, and 38.0% in the 6th phase and then decreased to 36.3% in the 7th phase. The adjusted OR values for periodontal health in ICP users were 0.721 for gingivitis and 0.642 for periodontitis, confirming that ICP was associated with a lower prevalence of these conditions. Sex, age, educational level, household income, toothbrushing, and dental check-ups were related to ICP use in all phases. ICP was associated with improved periodontal health, but its use rate was very low. Therefore, oral health professionals should educate adults on the use of ICP, particularly interdental brushing.

Efficacy of Flossing and Mouthrinsing Regimens on Plaque and Gingivitis: A randomized clinical trial.

Purpose:Flossing is a well-known component of daily recommended oral care regimens, but patients often find it challenging to perform effectively on a regular basis. The purpose of this 12-week supervised clinical trial was to investigate the effects of twice daily rinsing with a mouthrinse containing a fixed combination of four essential oils (4EO) and supervised daily dental flossing regimens as compared to a negative control 5% hydroalcohol rinse (NC) on the prevention and reduction of plaque, gingivitis, and gingival bleeding.Methods:Volunteer participants who met the inclusion criteria were randomized into the following groups for the 12- week trial: 1) NC; 2) mouthrinse containing 4EO; 3) professional flossing performed by a dental hygienist (FBH); 4) supervised self-flossing (FUS). All participants received a professional dental prophylaxis prior to beginning the trial. On weekday mornings, all participants brushed on site. After brushing, the rinse groups used their products under supervision, and the floss groups had their teeth flossed by a dental hygienist or self-flossed under supervision. Participants performed their assigned regimen in the evenings and the twice-daily weekend use at home. Each individual assessment of oral hard and soft tissue, plaque, gingivitis, and gingival bleeding at weeks 4 and 12, probing depth and bleeding on probing at week 12 was made by the same calibrated examiner.Results:Of 156 randomized participants, 149 completed the trial. Use of the 4EO mouthrinse statistically significantly reduced plaque, gingivitis, and gingival bleeding on probing after 12 weeks as compared to the NC rinse. Both flossing interventions statistically significantly reduced interproximal gingivitis and gingival bleeding at 12 weeks compared to the NC rinse; neither flossing intervention significantly reduced interproximal plaque after 12 weeks compared to the NC rinse.Conclusions:Rinsing with a 4EO mouthrinse statistically significantly improved all oral health outcome measures at all time points compared to a NC rinse in this 12-week clinical trial. While professional and supervised flossing improved gingival health compared to use of the NC rinse, statistically significant plaque reduction with dental flossing was not attained at the end of the 12-week trial.

Habits, Practices and Beliefs Regarding Floss and Mouthrinse among Habitual and Non-Habitual Users.

Purpose:The purpose of this survey was to investigate how flossing and rinsing behaviors impact individual beliefs about oral disease risk, the efficacy of floss and mouthrinse, and the perceived benefits and barriers of floss and mouthrinse.Methods:Participants in this required component of a 12-week plaque and gingivitis randomized clinical trial on flossing and rinsing regimens completed a paper questionnaire prior to randomization and baseline/screening measurements.Results:All of the clinical trial participants (n=213) completed the questionnaire. Respondents were grouped as habitual or non-habitual users of floss or mouthrinse if the product was used at least once daily; 16% (n=34) were habitual users of floss and 17% (n=36) were habitual users of mouthrinse. Perceived barriers included fear of gingival bleeding and pain, forgetting, and not including flossing or rinsing as part of the daily oral care routine. Non-habitual users were less likely to believe in the intangible benefits of flossing or rinsing and much more likely to perceive barriers to using floss or mouthrinse. Risk perception of developing oral disease was not shown to predict product usage. Respondents viewed their risk of developing gingivitis as relatively low despite this diagnosis being confirmed clinically among the participants.Conclusions:While respondents strongly believed that brushing, flossing, and mouthrinse use carry unique benefits and that combining all three methods would be optimal, these respondents still had high perceived barriers to using floss and mouthrinse regularly and consequently these habits were not included in their daily oral hygiene regimen. Understanding the perceptions regarding oral health behaviors may help drive more effective interventions and assist practitioners in improving their patients' oral health outcomes.

Efficacy of dental floss in the management of gingival health: a randomized controlled clinical trial.

OBJECTIVES: This randomized controlled clinical trial evaluated the efficacy of dental floss as a supplement to toothbrushing in support of gingival health in adults. MATERIALS AND METHODS: Seventy-five systemically healthy subjects, non-smokers, without loss of interproximal periodontal attachment and with more than 15% of the interproximal sites presenting with gingival bleeding were randomized into two groups either performing toothbrushing supplemented by dental floss (TB + DF) or toothbrushing (TB) alone. Over a 60-day period, participating subjects weekly received oral hygiene instruction and supervised personal and professional plaque removal by applying the devices assigned for the group. Study subjects were instructed to perform toothbrushing twice daily (group TB + DF and TB) and use dental floss once daily (group TB + DF). Gingival Index (GI) and Plaque Index (PlI) were evaluated at baseline, and at 30 and 60 days. Linear mixed models were used to compare PlI and GI intra- and intergroup means. RESULTS: Interproximal gingival inflammation (GI = 2 and mean GI) was significantly reduced in both groups by day 30, reduction in inflammation being significantly greater in the TB + DF compared with the TB alone group. No further significant alterations were observed by day 60. Moreover, reduction in gingival inflammation (GI = 2) was greater in the anterior compared with the posterior dentition. CONCLUSIONS: Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss. TRIAL REGISTRATION: The protocol registration was filed on May 9, 2018 (# 538,311,716.5.0000.5346) on ClinicalTrials.gov and after complete registration, a NCT number was generated (NCT04909840). Since the date in May 2018 when the protocol preregistration was filed, no change in methodology, primary outcome, and data analysis has occurred. CLINICAL RELEVANCE: Optimized personal oral hygiene routines in individuals without loss clinical attachment interproximal should include dental floss as a supplement to toothbrushing in support of gingival health.