Interdental oral hygiene interventions elicit varying compositional microbiome changes in naturally occurring gingivitis: Secondary data analysis from a clinical trial.

AIM: To evaluate the effect of different oral irrigators on the sub-gingival microbiome composition in patients with naturally occurring plaque-induced gingivitis. MATERIALS AND METHODS: Sub-gingival plaque was collected from adults participating in a clinical trial assessing the efficacy of oral hygiene with two different oral irrigators (Waterpik Water Flosser [Group 1] and Oral-B Water Flosser [Group 2]) versus dental flossing (Group 3) for microbiome analysis. Plaque samples were reflective of naturally occurring plaque-induced gingivitis at baseline and of gingival health at the endpoint (4 weeks). Clinical measures of gingival inflammation were collected, and the sub-gingival microbiome was analysed by 16S rRNA sequencing to identify amplicon sequence variants. RESULTS: Oral hygiene instruction with self-performed manual toothbrushing and water-jet irrigation led to significant reductions in inflammation for all groups; both oral irrigators outperformed flossing in bleeding-on-probing reduction (p < .001). Microbiome diversity of sub-gingival plaque remained relatively stable over time, but significant changes were noted in certain taxa, consistent with increases in the relative abundance of commensals and reductions in late colonizers and periodontal pathogens in the water-jet groups. CONCLUSIONS: Reduction in gingival inflammation at 4 weeks within the water-jet groups is accompanied by slight but critical changes in microbiome composition. Although biodiversity does not substantially change within 4 weeks during the resolution of naturally induced gingivitis, significant relative increases in commensal early colonizers such as Streptococcus, Veillonella and Fusobacterium were accompanied by a shift towards a less anaerobic microbiota associated with return to health. These changes were contingent upon the type of interdental hygiene, with Group 1 exhibiting more significant alterations in microbiome composition towards a periodontal-health-compatible community.

Interdental cleaning aids are beneficial for oral health at 7-year follow-up: Results from the Study of Health in Pomerania (SHIP-TREND).

AIM: To estimate association between the use of interdental cleaning aids (IDAs) and type on 7-year follow-up levels of interdental plaque, interdental gingival inflammation, interdental periodontitis severity, the number of interdental sound surfaces and the number of missing teeth in a population-based cohort study. MATERIALS AND METHODS: We used 7-year follow-up data of 2224 participants from the Study of Health in Pomerania (SHIP-TREND). We applied generalized linear and ordinal logistic models, adjusting for confounding and selection bias using inverse probability treatment weighting and multiple imputation. RESULTS: Flossers were 32% less likely to have higher interdental plaque (iPlaque) levels than non-users of IDAs (odds ratio [OR] = 0.68; 95% confidence interval [CI]: 0.50-0.94); flossing resulted in 5% lower means of iPlaque. Effects on interdental bleeding on probing (iBOP), mean interdental probing depths and mean interdental clinical attachment levels were direction-consistent but statistically non-significant. Interdental brushing was associated with lower follow-up levels for interdental plaque (OR = 0.73; 95% CI: 0.57-0.93) and iBOP (OR = 0.69; 95% CI: 0.53-0.89). IDAs were more effective in reducing iPlaque in participants with periodontitis, whereas iBOP reduction was more pronounced in participants with no or mild periodontitis. The analyses did not suggest that the use of IDAs affected caries. Finally, applying change score analyses, flossing reduced tooth loss incidence (incidence rate ratio [IRR] = 0.71) compared with non-users of IDAs. CONCLUSIONS: Recommending flossing and interdental brushing in dental practices represents an approach to the prevention of gingivitis and consequently periodontitis.

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.

Cleansing efficacy of an oral irrigator with microburst technology in adolescent orthodontic patients. A randomized-controlled crossover study.

OBJECTIVES: Simplifying interdental space cleaning is a constantly discussed topic. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in adolescent patients with fixed braces after four weeks of home-use. MATERIALS AND METHODS: The study design is a randomized, single-blinded cross-over study. Following a twenty-eight-day period of product utilization in a home setting, a comparative analysis was conducted on hygiene indices, the Rustogi Modified Navy Plaque Index (RMNPI) and the Gingival Bleeding Index (GBI), between the test group (oral irrigator) and the control group (dental floss). RESULTS: Seventeen adolescent individuals completed the study. After 28 days of cleaning with the oral irrigator, RMNPI was 58.81% (55.31-66.47) compared to 59.46% (52.68-68.67) with dental floss (p = 0.070). Subgroup analyses did not indicate the superiority of either method. GBI after the test phase with the oral irrigator was 28.93% (23.21-33.97) and insignificantly higher compared to 26.40% (21.01-31.41) achieved with dental floss (p = 0.1585). CONCLUSIONS: Neither of the two products demonstrated statistically significant superiority in terms of cleaning efficacy. Therefore, no recommendation can be made in favor of one over the other. It was found that the high initial hygiene indices for fixed orthodontic appliances could be improved through increased awareness and precise instruction. CLINICAL RELEVANCE: For adolescent patients who struggle to use interdental brushes an oral irrigator may be suggested as a simple alternative in hard-to-reach areas, such as those around a fixed dental appliance.

Does YouTube Provide High-Quality Information for Patients Regarding Night Guards, Especially for Over-the-Counter Ones?

The aim of this study was to evaluate the quality of the information on YouTube regarding night guards (NGs). YouTube was systematically searched using the keyword "night guards." Two independent reviewers examined the first 100 videos and exclusion criteria were applied. Descriptive characteristics of the remaining 60 videos were recorded. In addition, the purpose, target audience, and source of the included videos were collected. A 12-point content scale (CS) was used to evaluate video content, and the Global Quality Scale (GQS) was used to determine video quality. Statistical analyses were performed using the Kruskal-Wallis and Mann-Whitney tests, and the correlation between scores was evaluated using Spearman rho. Of the included videos, 50% were uploaded by dentists/health institutions, 26% by commercial sources and 24% by laypersons. The aim of 80% of the videos was to inform laypeople and 14% to inform professionals only. The content discussed the most (59.3%) was the production stages of NGs. The mean CS and GQS score of the videos were 2.06 ± 1.35 (poor) and 1.71 ± 0.88 (generally poor), respectively. A positive correlation was found between the CS and GQS scores ( r = 0.447). YouTube videos were found to be poor in terms of both content and quality. Since NGs for treating bruxism will always be a trending topic for patients on social media, the content of YouTube videos should be checked and enriched by professionals so that patients can access accurate information, especially about NGs obtained over the counter.

New design of interdental rubber picks - does the archimedean screw design bring an improvement for experimental cleaning efficacy and force?

BACKGROUND: Up to date, interdental brushes (IDB) are the first choice for interdental cleaning because of their cleaning efficacy. Cylindrical ones must be selected individually according to the size/morphology of the interdental area (IDR), whereas conical ones cover a larger variability of IDR. However, there is a trend on the part of patients towards interdental rubber picks (IRP) which are in general conically shaped, and which seem to be linked with lower cleaning efficacy. A new IRP with an Archimedes´ screw design was developed to overcome this limitation. Therefore, the in vitro study aimed to measure the experimental cleaning efficacy (ECE) and force (ECF) during interdental use of IDBs versus the new IRP type. METHODS: Three IRPs with different tapers (PHB angled: 0.039, PHB straight S: 0.027, Vitis straight M: 0.045; all Flexipicks, Dentaid, Cerdanyola del Vallès, Spain) were compared to one IDB (Interprox micro PHD 0.9, Dentaid, Cerdanyola del Vallès, Spain). IDR were reproduced by a 3D-printer (Form2, Formlabs Sommerville, MA, USA) according to human teeth and matched to equivalent pairs (isosceles triangle, concave, convex) in three different diameters (1.0 mm,1.1 mm,1.3 mm). Covered with simulated biofilm, pre-/ post-brushing situations of IDR (standardized, computer-aided ten cycles) were photographed and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N]. Statistically significant differences were detected using the Mann-Whitney-U-test and the Kruskal-Wallis-test with Bonferroni correction for multiple testing. RESULTS: Overall, the ECE (mean ± SD) was higher for IDB micro 0.9 (45.95 ± 11.34%, p < 0.001) compared to all IRPs (PHB angled: 25.37 ± 15.29%; PHB straight: 22.28 ± 16.75%; Vitis straight: 25.24 ± 12.21%; p ≤ 0.001), whereat best ECE was achieved in isosceles triangle IDR of 1.0-1.1 mm (IDB micro 0.9: 70.7 ± 7.7%; PHB angled S: 57.30 ± 4.43%; p < 0.001). The highest ECF occurred for Vitis straight M with 2.11 ± 0.46 N, while IDB micro 0.9 showed lowest ECF values (0.64 ± 0.14 N; p < 0.001). CONCLUSIONS: IRP with an Archimedes´ screw design and a higher taper were associated with advanced ECE but also higher ECF, nevertheless, ECE didn't reach the cleaning efficacy of conventional IDBs.

A novel toothbrush with a thin-head, slender-neck and super-tapered bristles enhancing accessibility in hard-to-reach areas: a crossover randomized trial.

BACKGROUND: Toothbrushing is the most commonly used method to physically remove dental plaque. However, there are many areas of the mouth that are difficult to reach with a toothbrush. The type of toothbrush is a critical factor influencing the effectiveness of oral care. The purpose of the study was to evaluate a toothbrush with a thin head, slender-neck and super-tapered bristles to target hard-to-reach areas in the oral cavity for reducing dental plaque and gingivitis. METHODS: This crossover study included 58 adults aged 20 years and older. All participants were randomly assigned to use test and control toothbrushes (the latter had a normal head and round bristles) for two 4-week phases. Participants brushed their teeth twice daily in their habitual manner. At the start and end of each phase the Silness-LÓ§e plaque index (PI), LÓ§e -Silness gingival index (GI) and bleeding-on-probing index (BOP) were assessed and performed plaque fluorescence tests using quantitative light-induced fluorescence technology. RESULTS: After using the test toothbrush, PI, GI and BOP decreased by 25%, 30% and 48%, respectively (P < 0.05). For the rearmost molars, PI, GI and BOP decreased by 18%, 26% and 47%, respectively (P < 0.05). For the implants, GI and BOP decreased by 31% and 57%, respectively (P < 0.05). The plaque fluorescence tests indicated that after using the test toothbrush, the dental plaque area for the anterior teeth and the simple plaque score for the rearmost molars decreased by 25% (P < 0.05) and 14% (P = 0.527), respectively. CONCLUSIONS: The test toothbrush was markedly better than the control toothbrush at reducing dental plaque and gingivitis. In particular, the test toothbrush produced an excellent reduction in dental plaque and gingivitis for the rearmost molars and the implants. TRIAL REGISTRATION: KCT0009669, retrospectively registered 02/08/2024.

It is the habit not the handle that affects tooth brushing - a randomised counterbalanced cross over study with young and healthy adults.

OBJECTIVE: To assess the effect of the toothbrush handle on video-observed toothbrushing behaviour and toothbrushing effectiveness. METHODS: This is a randomized counterbalanced cross-over study. N = 50 university students and employees brushed their teeth at two occasions, one week apart, using either a commercial ergonomically designed manual toothbrush (MT) or Brushalyze V1 (BV1), a manual toothbrush with a thick cylindrical handle without any specific ergonomic features. Brushing behaviour was video-analysed. Plaque was assessed at the second occasion immediately after brushing. Participants also rated their self-perceived oral cleanliness and directly compared the two brushes regarding their handling and compared them to the brushed they used at home. RESULTS: The study participants found the BV1 significantly more cumbersome than the M1 or their brush at home. (p < 0.05). However, correlation analyses revealed a strong consistency of brushing behavior with the two brushes (0.71 < r < 0.91). Means differed only slightly (all d < 0.36). These differences became statistically significant only for the brushing time at inner surfaces (d = 0.31 p = 0.03) and horizontal movements at inner surfaces (d = 0.35, p = 0.02). Plaque levels at the gingival margins did not differ while slightly more plaque persisted at the more coronal aspects of the crown after brushing with BV1 (d = 0.592; p 0.042). DISCUSSION: The results of the study indicate that the brushing handle does not play a major role in brushing behavior or brushing effectiveness.

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.

Efficacy of flossing and mouth rinsing regimens on plaque and gingivitis: a randomized clinical trial.

BACKGROUND: To investigate the effects of combinations of mechanical (brushing and flossing) and chemotherapeutic regimens which included essential oils (EO) non-alcohol and alcohol-containing mouthrinses compared to brushing only in the prevention and reduction of plaque, gingivitis, and gingival bleeding. METHODS: This was a randomized, virtually supervised, examiner blind, controlled clinical trial. Following informed consent and screening, subjects (N = 270) with gingivitis were randomly assigned to one of the following regimens: (1) Brush Only (B, n = 54); (2) Brush/Rinse (EO alcohol-containing mouthrinse) (BA, n = 54); (3) Brush/Rinse (EO non-alcohol containing mouthrinse) (BZ, n = 54); (4) Brush/Floss (BF, n = 54); (5) Brush/Floss/Rinse (EO non-alcohol containing mouthrinse) (BFZ, n = 54). Unflavored waxed dental floss (REACH unflavored waxed dental floss), and fluoridated toothpaste (Colgate Cavity Protection) were used. Examinations included oral hard and soft tissue, plaque, gingivitis, gingival bleeding, probing depth and bleeding on probing. RESULTS: After 12 weeks, both BA and BZ and the BFZ group were superior in reducing interproximal plaque (30.8%, 18.2%, 16.0%, respectively), gingivitis (39.0%, 36.9%, 36.1%, respectively), and bleeding (67.8%, 73.6%, 79.8%, respectively) compared to B. The BF group did not provide significant reductions in interproximal plaque but did reduce interproximal gingivitis (5.1%, p = 0.041) at Week 4 and bleeding at Weeks 4 and 12 (34.6%, 31.4%, p < 0.001 respectively) compared to B. The BFZ group did not significantly reduce interproximal plaque, gingivitis or bleeding compared to BZ. CONCLUSIONS: This study demonstrated that the addition of EO non-alcohol containing mouthrinse to the manual toothbrushing and flossing regimen further reduces plaque, gingivitis and bleeding showing that addition of EO mouthrinses (alcohol or non-alcohol containing) to the oral hygiene regimen provides sustained reductions in plaque to help maintain gingival health after a dental prophylaxis. Dental professional recommendation of the addition of an EO non-alcohol containing mouthrinse to daily oral hygiene routines of brushing or brushing and flossing should be considered to aid supragingival plaque control and improve gingivitis prevention. STUDY REGISTRY NUMBER: NCT05600231.

Self-determined use of provided powered oral hygiene devices leads to improved gingival health after 1 year: a longitudinal clinical trial.

PURPOSE: Our study aimed to evaluate the long-term concordance and acceptance when using powered devices for everyday oral hygiene routine and gingival health in patients showing papillary bleeding. PATIENTS AND METHODS: Thirty-one participants were recruited at the dental clinic of the University Hospital of Cologne, Germany, over a 6-week duration. At baseline, a standard dental check-up was performed, including oral hygiene indices and documentation of oral hygiene devices used. The study consisted of two consecutive phases: the first (motivational trial) was designed to prove the effectiveness and safety of a microdroplet device and a powered toothbrush compared to dental floss and a manual toothbrush over a period of 4 weeks. The second (observational) phase began with all participants receiving the powered oral homecare devices. Participants were able to use their oral hygiene measures of choice over an unsupervised period of 1 year. All participants were then rescheduled for a routine dental check-up, where oral hygiene indices and oral hygiene devices used were reevaluated. RESULTS: After 1 year, 93.3% of participants stated they performed interdental cleaning on a regular basis (baseline 60.0%). The percentage using a powered toothbrush increased from 41.9% (baseline) to 90.0% after 1 year. Oral hygiene parameters had improved after both the motivational trial and observational phases compared to baseline (papillary bleeding index p = .000; Rustogi Modified Navy Plaque Index p < .05; Quigley-Hein Index p = .000). CONCLUSION: In the long term, participants preferred using powered oral hygiene devices over the gold standard dental floss and manual toothbrush. Improved oral hygiene parameters after 1 year may indicate implementation of newly acquired oral-hygiene skills during the 4-week instruction phase.

Quantitative analysis of the effects of brushing, flossing, and mouthrinsing on supragingival and subgingival plaque microbiota: 12-week clinical trial.

BACKGROUND: Translational microbiome research using next-generation DNA sequencing is challenging due to the semi-qualitative nature of relative abundance data. A novel method for quantitative analysis was applied in this 12-week clinical trial to understand the mechanical vs. chemotherapeutic actions of brushing, flossing, and mouthrinsing against the supragingival dental plaque microbiome. Enumeration of viable bacteria using vPCR was also applied on supragingival plaque for validation and on subgingival plaque to evaluate interventional effects below the gingival margin. METHODS: Subjects with gingivitis were enrolled in a single center, examiner-blind, virtually supervised, parallel group controlled clinical trial. Subjects with gingivitis were randomized into brushing only (B); brushing and flossing (BF); brushing and rinsing with Listerine® Cool Mint® Antiseptic (BA); brushing and rinsing with Listerine® Cool Mint® Zero (BZ); or brushing, flossing, and rinsing with Listerine® Cool Mint® Zero (BFZ). All subjects brushed twice daily for 1 min with a sodium monofluorophosphate toothpaste and a soft-bristled toothbrush. Subjects who flossed used unflavored waxed dental floss once daily. Subjects assigned to mouthrinses rinsed twice daily. Plaque specimens were collected at the baseline visit and after 4 and 12 weeks of intervention. Bacterial cell number quantification was achieved by adding reference amounts of DNA controls to plaque samples prior to DNA extraction, followed by shallow shotgun metagenome sequencing. RESULTS: 286 subjects completed the trial. The metagenomic data for supragingival plaque showed significant reductions in Shannon-Weaver diversity, species richness, and total and categorical bacterial abundances (commensal, gingivitis, and malodor) after 4 and 12 weeks for the BA, BZ, and BFZ groups compared to the B group, while no significant differences were observed between the B and BF groups. Supragingival plaque vPCR further validated these results, and subgingival plaque vPCR demonstrated significant efficacy for the BFZ intervention only. CONCLUSIONS: This publication reports on a successful application of a quantitative method of microbiome analysis in a clinical trial demonstrating the sustained and superior efficacy of essential oil mouthrinses at controlling dental plaque compared to mechanical methods. The quantitative microbiological data in this trial also reinforce the safety and mechanism of action of EO mouthrinses against plaque microbial ecology and highlights the importance of elevating EO mouthrinsing as an integral part of an oral hygiene regimen. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov on 31/10/2022. The registration number is NCT05600231.

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.

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.

An environmental impact study of inter-dental cleaning aids.

AIM: The aim of this study was to compare the environmental footprint of eight inter-dental cleaning aids. MATERIALS AND METHODS: A comparative life cycle analysis was conducted based on an individual person using inter-dental cleaning aids every day for 5 years. The primary outcome was a life cycle impact assessment. This comprised of 16 discrete measures of environmental sustainability (known as impact categories), for example, greenhouse gas emissions (measured in kilograms of carbon dioxide equivalent, or kg CO2 e), ozone layer depletion (measured in kilograms of chloroflurocarbon equivalent, or kg CFCe), and water use (measured in cubic metres). Secondary outcomes included normalized data, disability-adjusted life years, and contribution analysis. RESULTS: Inter-dental cleaning using floss picks had the largest environmental footprint in 13 of 16 impact categories. Depending on the environmental impact category measured, the smallest environmental footprint came from daily inter-dental cleaning with either bamboo inter-dental brushes (five impact categories, including carbon footprint), replaceable head inter-dental brushes (four impact categories), regular floss (three impact categories), sponge floss (three impact categories), and bamboo floss (one impact category). CONCLUSIONS: Daily cleaning with inter-dental cleaning aids has an environmental footprint that varies depending on the product used. Clinicians should consider environmental impact alongside clinical need and cost when recommending inter-dental cleaning aids to patients.

Effects of crown contour on artificial biofilm removal efficacy with interdental cleaning aids: An in vitro study.

OBJECTIVES: To evaluate the efficacy of various interdental cleaning aids for artificial biofilm removal on different implant-supported crown designs. METHODS: Mandibular models with missing first molar were fabricated and installed with single implant analogs and loaded with crowns of different designs (concave, straight, and convex). Artificial biofilm was made with occlusion spray. Thirty volunteers (periodontists, dental hygienists, and laypersons) were asked to clean the interproximal areas. The crowns were unscrewed and photographed in a standardized setting. The outcome was measured by the cleaning ratio which represents the cleaned surfaces in relation to the area of the tested surface. RESULTS: A significant difference in favor of concave crown (p < .001) on the basal surface was cleaned by all tools, except the water flosser. There was evidence of an overall effect of "cleaning tool," "surface," and "crown design" (p < .0001) except for the "participant" factor. The mean cleaning ratio for each cleaning tool and overall combined surfaces were (in%): dental floss: 43.02 ± 23.93, superfloss: 42.51 ± 25.92, electric interspace brush: 36.21 ± 18.78, interdental brush: 29.10 ± 15.95, and electric water flosser: 9.72 ± 8.14. Dental floss and superfloss were significantly better (p < .05) than other tools in removing plaque. CONCLUSIONS: Concave crown contour had the greatest artificial biofilm removal, followed by straight and convex crowns at the basal surface. Dental floss and superfloss were the most effective interdental cleaning devices for artificial biofilm removal. None of the tested cleaning devices were able to completely remove the artificial biofilm from the interproximal/basal surfaces.

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.

Cleansing efficacy of an auto-cleaning toothbrushing device with nylon bristles: a randomized-controlled pilot study.

OBJECTIVES: To compare the cleansing efficacy of an auto-cleaning device with nylon bristles (Y-brush®) to that of manual toothbrushing. MATERIALS AND METHODS: Twenty probands refrained from oral hygiene for 3 days. Rustogi Modified Navy Plaque Index was assessed before and after (randomized) toothbrushing either with the auto-cleaning device for 5 s per jaw or with a manual toothbrush for a freely chosen time up to 4 min. The clinical investigation was repeated in a cross-over design. In a third trial period, the brushing time for auto-cleaning was increased to 15 s per jaw. The study was supplemented by plaster cast analyses. RESULTS: Full-mouth plaque reduction was higher with manual toothbrushing than with auto-cleaning for 5 s per jaw (p < 0.001). There was no statistically significant difference on smooth tooth surfaces but on marginal and interdental sites. Increasing the brushing time of auto-cleaning to 15 s per jaw resulted in a comparable full-mouth plaque reduction as with manual toothbrushing (p = 0.177). In 95% of individuals, the device was too short not completely covering second molars. In 30.67% of teeth, the gingival margin was not covered by bristles. CONCLUSIONS: Auto-cleaning devices with nylon bristles have a future potential to reach plaque reduction levels comparable to manual toothbrushing, although manufacturers must focus on improving an accurate fit. CLINICAL RELEVANCE: Under the premise of an ameliorated fit, the auto-cleaning device might be recommendable for people with low brushing efficacy. Interdental sites remain a failure point if adjunct interdental cleaning is not viable.

Effects of water flossing on gingival inflammation and supragingival plaque microbiota: a 12-week randomized controlled trial.

OBJECTIVES: The effects of water flossing on dental plaque removal have been suggested, but its ecological impact on dental plaque microbiota needs further investigation. In addition, whether this plaque control measure by water flossing promotes the control of halitosis still needs clinical validation. The aim of this study was to evaluate the effects of water flossing on gingival inflammation and supragingival plaque microbiota. MATERIALS AND METHODS: Seventy participants with gingivitis were randomly assigned to control (toothbrushing) and experimental (toothbrushing + water flossing) groups (n = 35). Participants were recalled at 4, 8, and 12 weeks, and their gingival index, sulcus bleeding index, bleeding on probing, dental plaque index, and oral malodor values were measured. The microbiota of supragingival plaque was further investigated using 16S rRNA sequencing and qPCR. RESULTS: Sixty-three participants completed all revisits (control: n = 33; experimental: n = 30). The experimental and control groups exhibited similar clinical characteristics and dental plaque microbiota at baseline. Adjunctive water flossing effectively reduced the gingival index and sulcus bleeding index as compared to the toothbrushing control group. The water-flossing group showed reduced oral malodor at week 12 as compared to the baseline. Consistently, the water-flossing group exhibited altered dental plaque microbiota at week 12, characterized by a depletion of Prevotella at genus level and Prevotella intermedia at species level as compared to the toothbrushing control. In addition, the plaque microbiota of water-flossing group exhibited a more aerobic phenotype, while the control group was more anaerobic. CONCLUSIONS: Daily water flossing can effectively alleviate gingival inflammation and reduce oral malodor, possibly by depleting oral anaerobes and altering the oral microbiota to a more aerobic phenotype. CLINICAL RELEVANCE: Water flossing adjunctive to toothbrushing effectively alleviated gingival inflammation, representing a promising oral hygiene practice to promote oral health. CLINICAL TRIAL REGISTRATION: The trial was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showprojen.aspx?proj=61797 , #ChiCTR2000038508) on September 23, 2020.

Cleansing efficacy of an oral irrigator with microburst technology in orthodontic patients-a randomized-controlled crossover study.

OBJECTIVES: Orthodontic patients struggle with interdental cleaning calling for simpler mechanical devices to reduce the high plaque levels. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in patients with fixed braces after 4 weeks of home-use. MATERIALS AND METHODS: The study design is a randomized and single-blinded cross-over study. After 28 days using the products at home, hygiene indices (Rustogi Modified Navy Plaque Index (RMNPI); gingival bleeding index (GBI)) were compared between test (oral irrigator) and control product (dental floss). RESULTS: Seventeen adult individuals finalized the study. After 28 days of cleaning with the oral irrigator, RMNPI was 54.96% (46.91-66.05) compared to 52.98% (42.75-65.60) with dental floss (p = 0.029). Subgroup analysis revealed that the higher cleansing efficacy of the dental floss is attributable to buccal and marginal areas. GBI after the test phase with the oral irrigator was 12.96% (7.14-24.31) and statistically significantly higher compared to 8.33% (5.84-15.33) with dental floss (p = 0.030) which could be seen in all subgroups. CONCLUSIONS: Oral irrigators do not remove plaque and reduce gingival bleeding as efficiently as dental floss in easily accessible regions. However, in posterior regions, where the patients struggled with the application of dental floss, the oral irrigator showed similar results. CLINICAL RELEVANCE: Oral irrigators should only be recommended to orthodontic patients who cannot use interdental brushes and are not compliant with dental flossing.