Efficacy of Two Interdental Cleaning Devices on Clinical Signs of Inflammation: A Four-Week Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare the reduction of the clinical signs of inflammation by two power interdental cleaning devices combined with a manual toothbrush. METHODS: Sixty-nine subjects completed this randomized, four-week, single-blind, two-group, parallel clinical study. Subjects were randomly assigned to one of two treatment groups: Waterpik Water Flosser (WF) plus a manual toothbrush; or Sonicare Air Floss Pro (AFP) plus a manual toothbrush. All subjects received both written and verbal instructions and demonstrated proficiency prior to starting the study. Instructions were reviewed at the two-week visit (W2). Data were evaluated for whole mouth, lingual, and facial areas for bleeding on probing (BOP) and Modified Gingival Index (MGI). Plaque data were recorded for whole mouth, lingual, facial, approximal, and marginal areas of the tooth using the Rustogi Modification of the Navy Plaque Index (RMNPI). BOP, MGI, and RMNPI were scored at baseline (BSL), two weeks, and four weeks (W4). RESULTS: Both groups showed significant reductions in BOP and MGI from baseline for all regions and time points measured (p < 0.001). Both groups showed significant reductions from baseline for all areas at W4 for RMNPI (p < 0.001). The WF group was significantly more effective than the AFP group at reducing bleeding and gingivitis for all areas measured at all time points. At W4, the WF group was 54% more effective for bleeding and 32% for gingivitis (p < 0.001). Plaque accumulation was significantly less at W4 for the WF group compared to the AFP group (28%, p 0.017). CONCLUSIONS: The Waterpik Water Flosser is significantly more effective than the Sonicare Air Floss Pro for reducing clinical signs of inflammation.

Dental floss selection and its impact on evaluation of interproximal contacts in licensure exams.

Ideal interproximal contacts between adjacent natural teeth or dental restorations are a critical factor for the health of the dental-alveolar complex. Interproximal contact tightness is a physiological entity affected by many patient-related and restorative parameters. This variation poses a challenge in defining the "clinically acceptable" contact area tightness (CAT) and therefore how students and clinicians should be trained to evaluate this parameter. The most widely used method to evaluate interproximal contacts is to pass dental floss between contact areas. Candidates for licensure exams are instructed to check contact areas with dental floss and are advised that this will be one of the crucial parameters to be evaluated in the overall restoration quality. The purpose of this study was to evaluate a standardized interproximal contact with six brands of dental floss. Thirty faculty members and thirty dental students at one U.S. dental school evaluated the tightness of a single interproximal contact on a typodont. The results showed that no difference was found between CAT evaluations by faculty and students, whereas significant differences were found between different floss brands. In light of the results, it is suggested that licensure boards should standardize the recommendation for which floss brand should be used in order to avoid inconsistencies in students' preparation.

Relevance of the water flosser: 50 years of data.

A review of the literature answers many questions related to the use of water flossers, the first of which was introduced in 1962. Numerous studies suggest that water flossers remove biofilm from tooth surfaces and bacteria from periodontal pockets better than string flossing and manual toothbrushing-together or alone. Clinicians should review these findings and consider recommending water flossers for appropriate patients to improve their oral health. As different irrigation or water-flossing devices now on the market offer different features, designs, and combinations of pulsation and pressure, clinicians must consider the needs of individual patients and supporting research in selecting a model that the patient will like and use, and that will provide improved oral health.

Is self interdental cleaning associated with dental plaque levels, dental calculus, gingivitis and periodontal disease?

BACKGROUND AND OBJECTIVE: To ascertain whether interdental cleaning behaviours of Australian adults were associated with lower levels of plaque, gingivitis and periodontal disease. MATERIAL AND METHODS: Data were obtained from the National Survey of Adult Oral Health 2004-06. Outcome variables were three indicators of oral hygiene outcomes (the presence or not of dental plaque, dental calculus and gingivitis) and two of periodontal disease (the presence or not of at least one tooth with a periodontal pocket or clinical attachment loss of ≥ 4 mm). The independent variable was classified into the following three groups: regularly clean interproximally 'at least daily' (daily+); 'less than daily' (< daily); and 'do not regularly clean interproximally' (reference group). Poisson regression with robust variance estimation was used to calculate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) relative to the reference group, adjusted for covariates. RESULTS: Regular self interdental cleaning was associated with less dental plaque (< daily, PR = 0.89, 95% CI = 0.84, 0.95; and daily+, PR = 0.89, 95% CI = 0.82, 0.96), less dental calculus (< daily, PR = 0.88, 95% CI = 0.80, 0.97; and daily+, PR = 0.79, 95% CI = 0.70, 0.89) and lower levels of moderate/severe gingivitis (daily+, PR = 0.85, 95% CI = 0.77, 0.94). Periodontal pocketing was less likely for the < daily group (PR = 0.61, 95% CI = 0.46, 0.82), but was not associated with daily+ cleaning (PR = 0.99, 95% CI = 0.663, 1.49). There was not a significant association between interdental cleaning and clinical attachment loss (< daily, PR = 0.90, 95% CI = 0.77, 1.05; and daily+, PR = 1.17, 95% CI = 0.95, 1.44). CONCLUSION: Regular interdental cleaning was associated with better oral hygiene outcomes, such as dental plaque and gingivitis, although there was no significant association between regular interdental cleaning and clinical attachment loss.

Efectividad y preferencia de la rafia como material de limpieza dental interproximal / Effectiveness and Patient Preference of a raffia-type material for interproximal dental hygiene / Efetividade e preferência da ráfia como material alternativo para a limpeza dentária interprossimal

Antecedentes: el uso de la seda dental en programas de salud pública oral se constituye en un problema económico, debido a su alto costo. La rafia se ha propuesto como un materialalternativo de limpieza interdental. Objetivo: determinar la efectividad y preferencia de la rafia usada durante dos meses como material alternativo de limpieza interproximal. Métodos:se realizó un estudio experimental doble ciego, con 96 jóvenes en el grupo control y 105 en el experimental. Antes de la prueba y después de esta se determinaron los índices de placa bacteriana de Quigley y Hein modificado, inflamación gingival de Lõe y Silness y presencia de hendiduras en la papila interproximal y en los labios en la zona de las comisuras en un mapa de tejidos blandos. Se aplicó, además, el cuestionario de preferencia deHanes y colaboradores. Resultados: se halló una diferencia significativa entre el promedio del índice de placa inicial y final y el promedio del índice gingival, tanto en los jóvenes que utilizaron la rafia (p<0,05) como en los que utilizaron el material del grupo control (seda) (p<0,05). Hubo una mayor proporción de jóvenes que consideró que la rafia se reventaba fácilmente, lastimaba la encía y era muy gruesa, difícil de introducir entre los dientes e incómoda. Conclusión: la rafia fue efectiva para disminuir, en promedio, el índice de placa bacteriana y el índice gingival. En cuanto a la preferencia, los jóvenes refirieron problemasrelacionados con la comodidad en su uso...

Background: The use of dental floss in public health programs is an economic problem due to its high cost. The raffia has been proposed an alternative material for interdental hygiene. Objective: Determine the effectiveness and patient preference of raffia used during two months as an alternative material for cleaning interproximal surfaces. Methods: This experimental double-blind study included 96 young individuals in the control group and 105in the experimental group. The study examined the pre- and post-test Quigley-Hein modified dental plaque index, Lõe & Silness gingival index, and the presence of grooves in the interproximal papilla and lip commissures. Data were written down in a soft tissue map-chart. Moreover, the Hannes et al. preference survey was applied. Results: A significant difference was observed between the average initial and final dental plaque indexes and gingival index in individuals who used raffia (p<0.05) and those in the control group who used dental floss (p<0.05). A greater proportion of subjects found raffia prone to tear, harmful for gums,thick, difficult to use in between the teeth, and uncomfortable to use. Conclusion: Raffia was effective in lowering the dental plaque index and gingival index scores. Regarding the users’ preference of using raffia problems related to comfort use were reported...

Introdução: o uso do fio dental em programas de saúde pública oral torna-se um problema econômico devido a seu alto custo. A ráfia tem sido proposta como um material alternativo para a limpeza dentária. Objetivo: determinar a efetividade e a preferência da ráfia usada durante dois meses como material alternativo de limpeza dentária interprossimal. Método: o estudo experimental duplo-cego, 96 jovens no grupo controle e 105 no grupo experimental.Tomaram-se os pré- e pós-índices de placa bacteriana de Quigley e Hein modificados, inflamação gengival de Loe e Silness e a presencia de fendas na papila interprossimal e nos lábios ao nível da comissura num mapa de tecidos moles. Aplicou-se também o questionário de preferência de Hanes et al. Resultados: observa-se uma diferencia significativa entre o meio do índice de placa inicial e final e o meio do índice gengival tanto em jovens queutilizaram a ráfia (p<0,05) como em aqueles que utilizaram o material do grupo controle (fio) (p<0,05). Houve uma maior proporção de jovens que consideraram que a ráfia podia-serebentar facilmente, lastimava a gengiva, era muito grossa, era difícil de introduzir entre os dentes e era também muito incômoda. Conclusão: a ráfia foi efetiva para reduzir no pontomeio o índice de placa bacteriana e o índice gengival. Em quanto à preferência, os jovens referem os problemas relacionados com a comodidade no seu uso...

Effects of ultrasonic, electric, and manual toothbrushes on subgingival plaque composition in orthodontically banded molars.

INTRODUCTION: Orthodontic appliances hinder mechanical plaque control. In this study, we evaluated the effect of self-performed supragingival plaque removal with ultrasonic, electric, and manual toothbrushes on subgingival plaque composition in orthodontically banded molars. METHODS: Twenty-one patients wearing fixed orthodontic appliances were assigned to this single-blind crossover study. Samples of subgingival plaque were collected from banded molars, before and after each toothbrush usage period, for quantification of 22 bacterial species by the checkerboard DNA-DNA hybridization method. For each crossover, patients used a toothbrush for 30 days, followed by a washout period of 14 days. RESULTS: The prevalence of Tannerella forsythia decreased significantly after a month of electric brush usage. In the manual brush group, the prevalences of Selenomonas noxia, Streptococcus sanguinis, and Prevotella melaninogenica also decreased significantly. However, there were no significant differences in the prevalences and levels of bacteria after usage of the ultrasonic brush. Intergroup comparisons showed no statistical differences among the 3 brushes for the microbiologic parameters. CONCLUSIONS: All 3 brushes generally reduced bacterial prevalences, and, although electric and manual toothbrushes showed some isolated significant variations, we found no superiority with any toothbrush type when used three times daily for 2 minutes on microbiologic parameters in orthodontically banded molars.

Clinical effects of interdental cleansing on supragingival biofilm formation and development of experimental gingivitis.

PURPOSE: The aim of the present study was to test the effects of interdental cleansing with dental floss on supragingival biofilm removal in natural dentition during a 3-week period of experimental biofilm accumulation. MATERIALS AND METHODS: The present study was performed as a single-blind, parallel, randomised, controlled clinical trial using the experimental gingivitis model (Löe et al, 1965). Thirty-two students were recruited and assigned to one of the following experimental or control groups: Group A used a fluoride-containing dentifrice (NaF dentifrice) on a toothbrush for 60 s twice a day, Group B used an unwaxed dental floss twice a day, Group C used a waxed dental floss twice a day in every interproximal space and Group D rinsed twice a day for 60 s with drinking water (control). RESULTS: During 21 days of abolished oral hygiene, the groups developed various amounts of plaque and gingivitis. Neither of the cleansing protocols alone allowed the prevention of gingivitis development. Toothbrushing alone yielded better outcomes than did any of the flossing protocols. Interdental cleansing with a waxed floss had better biofilm removal effects than with unwaxed floss. CONCLUSIONS: Toothbrushing without interdental cleansing using dental floss and interdental cleansing alone cannot prevent the development of gingivitis.

Evaluation of toothbrush bristles' deterioration used by preschool children.

The toothbrush is an effective instrument for oral diseases prevention. The flexibility and status of bristles, as well as the size of the handle are fundamental for an effective toothbrushing. Thus, the assessment of physical characteristics of toothbrushes is important. This study evaluated the deterioration and wear of bristles of toothbrushes used by preschool children. For the sample selection, five elementary schools were assorted from a city of the São Paulo State northwest region, one from each city area. All toothbrushes used by preschool children who aged between 5 and 6 years old and who attended the assorted schools were visually analysed by two calibrated examiners, according to the criteria proposed by Rawls HR, Mkwayi-Tulloch NJ, Casella R, Cosgrove R (J Dent Res 1989; 12:1781): 0 - it is impossible to state if the toothbrush was used or not; 1 - the bristles seem to be separated within some tufts; 2 - most tufts are separated, many cover other tufts and present a large number of curved and inclined bristles; 3 - most tufts are covered by others and bristles are folded and tipped. In total, 333 toothbrushes were evaluated. The data obtained revealed that 57.96% of the toothbrushes presented adequate condition for utilization (scores 0 and 1), whereas 42.04% presented inadequate bristles for their function (scores 2 and 3). It was concluded that a great number of toothbrushes presented deterioration of the bristles. Thus, there is the need to guide and promote awareness among teachers, parents and children as well as the need to replace toothbrushes.

The efficacy of woodsticks on plaque and gingival inflammation: a systematic review.

OBJECTIVE: To review the literature on whether a hand-held triangular woodstick, as compared with no adjunct or other interdental cleaning device in addition to daily toothbrushing, can improve clinical parameters of gingival inflammation. MATERIAL AND METHODS: MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2008 to identify appropriate studies. Plaque and gingivitis were selected as outcome variables. RESULTS: Independent screening of the titles and abstracts of 181 MEDLINE and 65 CENTRAL papers yielded seven publications with eight clinical experiments that met the eligibility criteria. The improvement in gingival health, as observed in seven studies, represents a significant incremental benefit realized by the use of triangular woodsticks. None of the studies that scored plaque demonstrated any significant advantage to the use of woodsticks, as opposed to alternative methods, in gingivitis patients. CONCLUSION: Evidence from controlled trials, most of which were also randomized, shows that woodsticks do not have an additional effect on visible interdental plaque or gingival index, but do, however, provide an improvement in interdental gingival inflammation by reducing the bleeding tendency.

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.

Medical devices; dental devices; classification of oral rinse to reduce the adhesion of dental plaque. Final rule.

The Food and Drug Administration (FDA) is classifying the oral rinse to reduce the adhesion of dental plaque device into class II (special controls). The special control that will apply to the device is the guidance document entitled "Class II Special Controls Guidance Document: Oral Rinse to Reduce the Adhesion of Dental Plaque." The agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of a guidance document that is the special control for this device.

Dental devices; classification for intraoral devices for snoring and/or obstructive sleep apnea. Final rule.

The Food and Drug Administration (FDA) is classifying the intraoral devices for snoring and/or obstructive sleep apnea into class II (special controls). These devices are used to control or treat simple snoring and/or obstructive sleep apnea. This classification is based on the recommendations of the Dental Devices Panel (the Panel), and is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA). Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of the guidance document that will serve as the special control for this final rule.

Unconventional dentistry: Part IV. Unconventional dental practices and products.

This is the fourth in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). Several common UD and UM practices are described to familiarize practitioners with a variety of theories, practices, products and treatments that specifically apply to dentistry. This brief review is not intended as an in-depth resource.

Evaluation of floss types for interproximal plaque removal.

PURPOSE: To evaluate the efficacy of four different floss types for interproximal plaque removal on the normal dentition. MATERIALS AND METHODS: 24 dental hygiene students tested each of four different floss types: waxed, unwaxed, woven and shred-resistant. At baseline, all subjects received a prophylaxis to become plaque-free and identical flossing instructions were given. Subjects were then instructed not to brush, floss, or rinse for 3 days to allow for plaque development. On the fourth day, each subject's teeth were disclosed and scored using O'Leary's Plaque Index. Subjects were then randomly assigned one of the four floss types to use throughout the dentition, following which a second plaque record was assessed. Subjects were timed while flossing, and then completed a 10 cm Visual Analogue Scale (VAS) scoring their degree of discomfort/comfort and ease of use for each specific type of floss. This protocol was followed until all four floss types were tested by each subject. Results analyzed reductions in total interproximal plaque score (TIPS), anterior (teeth) interproximal plaque score (AIPS), and posterior (teeth) interproximal plaque score (PIPS). RESULTS: The greatest reduction in TIPS and PIPS was with waxed floss (68.87%, 66.54% respectively) and in AIPS with woven floss (75.15%). Post-hoc testing using Tukey's method revealed no significant differences among the four floss types. VAS scores revealed shred-resistant most comfortable (6.99) while unwaxed was least (4.29). These results indicated minimal differences in the efficacy of different types of floss, their degree of comfort and ease of use.

Avaliações clínicas para ajuizar o descarte das escovas / Clinical evaluation to decide upon toothbrush disposal

Os autores analizaram 303 escovas dentárias, em uso, de diferentes marcas e modelos, com o escopo de catalogar as mais usadas e propor alguns parâmetros para ajuizar o descarte das mesmas pela perda das suas características físicas e higiênicas. Para tanto, avaliaram a quantidade de resíduos na base de inserção de encerdagem e as alterações de peculiaridade das cerdas. Classificaram também, as escovas dentárias com base no índice de avaliação de uso e enquadraram as mesmas numa graduação de uso propostos por RAWS e col. (19). Os resultados permitiram inferir que o público usuário diversifica bastante as suas preferências por marcas e modelos de escovas dentárias e que as usam além do tempo de vida útil por desconhecerem os parâmetros que determinam o seu descarte. Concluíram ainda, pela validade das avaliações propostas quanto à quantidade de resíduos e tendências de perpendicularidade das cerdas no descarte das escovas dentárias, como parâmetros que podem ser utilizados

[Microscopic studies of the structures of different dental floss types]. / Mikroskopische Untersuchungen zur Struktur verschiedener Zahnseidetypen.

26 different dental flosses, made from silk, polyamide (Nylon) or Teflon, were analyzed with respect to their surface structure and their cross-section. Principally, two different types of manufacturing could be distinguished. The dental flosses either consisted of a large number of individual fibers, or a single, falted membrane. Even flosses that were manufactured in the same manner revealed considerable differences. Apart from the chemical composition, the structure of dental flosses is decisive for their use and this is why an exact classification would be desirable. In this study the requirements for classifying dental flosses are provided.