Interproximal Gingivitis and Plaque Reduction

Objective: The study was conducted to compare the performance of three interdental products to dental floss in the control and removal of plaque, and in the reduction of gingivitis. • Methodology: One-hundred and twenty subjects were screened for the presence of interproximal sites of a size suitable for a GUM® Go-Betweens® cleaner, and for being in compliance with inclusion and exclusion criteria. They were then assessed with the Plaque, Gingivitis, and Eastman Interdental Bleeding Indices (EIBI) at baseline, given a prophylaxis, randomly assigned to one of four products (Glide® dental floss, Butler® flossers, GUM® Go-Betweens® cleaners, and GUM® Soft-Picks® cleaners), and given product use instructions. Subjects returned at three weeks for a compliance review and at six weeks for a final visit. Plaque was assessed at the final visit before and after using the assigned products. Plaque, gingivitis, and bleeding scores were evaluated by analysis of covariance using the baseline measurements as the covariate. • Results: All four interdental products significantly reduced interdental plaque from baseline to before-use at the final visit (after six weeks) employing baseline plaque as a covariate. Reductions were 16% to 24%. Similarly, use of the products at the final visit resulted in 26% to 31% reductions in plaque with the before-use plaque as a covariate. Interdental gingivitis scores showed a reduction both lingually and buccally, with reductions ranging from 27% to 36% for the former and 34% to 53% for the latter (baseline was the covariate). No statistical differences were found between the products on the lingual interdental sites. The Go-Betweens cleaners showed a statistically greater reduction in the Gingival Index score buccally than the other three products. No differences were noted among the products for the EIBI. • Conclusion: In this study, dental floss, the recognized “gold standard” for gingivitis reduction, was matched in performance by flossers and an interdental cleaner with small elastomeric fingers, and surpassed by an interdental brush. All products performed comparably for plaque reduction and removal. (J Clin Dent 17:79–83, 2006) 79 Introduction Toothbrushes are the primary and most frequently used tool for maintaining good oral hygiene. About 98% of Americans use a toothbrush to clean their teeth. However, tooth brushing is not enough. With a good design and careful technique a toothbrush can clean into the embrasure, the open and easily accessible area between teeth. Toothbrush bristles cannot properly penetrate under the contact and thoroughly clean interproximal spaces.1 It has long been known the most severe gingivitis occurs interproximally.2 Mechanical cleaning has even been found to perform better than chemical treatment in reducing gingivitis.1 The American Dental Association recommends the use of dental floss for complete between-teeth cleaning. By disturbing and removing plaque, flossing has become the standard of care since it reaches the area where gingivitis starts and is often missed when brushing. Traditional dental floss is not easy to use, however, presenting a barrier to achieving good oral care to those with reduced dexterity or an inability or unwillingness to devote time to the flossing procedure. Alternatives to traditional floss include single-use flossers and interdental brushes. Previous studies have examined the plaque removal capabilities of interdental brushes to floss with varying results.3-7 In particular, Yamamoto, et al.4 found the addition of flossing to brushing resulted in an increase in plaque removal, and the use of an interdental brush with regular brushing removed even more plaque. This study compared the plaque removal and gingivitis reduction capabilities of a flosser, a fine, small-diameter, interdental brush, and an interdental cleaner with small synthetic rubber fingers, to those of traditional dental floss. Materials and Methods Study Population Study participants were chosen from an urban and suburban population in Florida. A total of 154 subjects were screened and signed the consent form, with 128 meeting all the study criteria to be enrolled and randomized. An additional eight subjects were dropped after randomization with the remaining 120 subjects completing the study. A summary of the demographics appears in Table I. Interproximal Gingivitis and Plaque Reduction by Four Interdental Products