Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Axelsson P, Nyström B, Lindhe J (2004) The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults: results after 30 years of maintenance. J Clin Periodontol 31:749–757. https://doi.org/10.1111/j.1600-051X.2004.00563.x

    Article  PubMed  Google Scholar 

  2. Marsh PD (2006) Dental plaque as a biofilm and a microbial community - implications for health and disease. BMC Oral Health 6:1–7. https://doi.org/10.1186/1472-6831-6-S1-S14

    Article  Google Scholar 

  3. Curtis MA, Diaz PI (2000) Van Dyke TE (2020) The role of the microbiota in periodontal disease. Periodontol 83:14–25. https://doi.org/10.1111/prd.12296

    Article  Google Scholar 

  4. Lang NP, Bartold PM (2018) Periodontal health. J Clin Periodontol 45:S9–S16. https://doi.org/10.1111/jcpe.12936

    Article  PubMed  Google Scholar 

  5. Sambunjak D, Nickerson J, Poklepovic T et al (2011) Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of SystRev 12:1–64. https://doi.org/10.1002/14651858.CD008829.pub2

  6. Sälzer S, Graetz C, Dörfer CE et al (2000) (2020) Contemporary practices for mechanical oral hygiene to prevent periodontal disease. Periodontol 84:35–44. https://doi.org/10.1111/prd.12332

    Article  Google Scholar 

  7. Worthington HV, MacDonald L, Poklepovic Pericic T et al (2019) Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev 4:1–201. https://doi.org/10.1002/14651858.CD012018.pub2

  8. Sälzer S, Slot DE, Van Der Weijden FA, Dörfer CE (2015) Efficacy of inter-dental mechanical plaque control in managing gingivitis - a meta-review. J Clin Periodontol 42:S92–S105. https://doi.org/10.1111/jcpe.12363

    Article  PubMed  Google Scholar 

  9. Saint Louis C (2016) Feeling guilty about not flossing? maybe there’s no need. Aug 2, The New York Times [Journal Article]. https://nyti.ms/2axqFyq

  10. Larimer S (2016) The shaky evidence for flossing. Aug, 2. The Washington Post [Journal Article]. https://www.washingtonpost.com/news/to-your-health/wp/2016/08/02/youve-been-told-to-floss-your-teeth-but-is-there-evidence-that-it-helps/

  11. Slawson N (2016) Everyone recommends flossing – but there ’ s hardly any proof it works. Aug 2, The Guardian [Journal Article]. https://www.theguardian.com/us-news/2016/aug/02/dental-floss-proof-works-guidelines-dropped

  12. Victor D (2016) Dental floss may not improve your health . But what else can you do with it ? Aug, 3. The New York Times [Journal Article]. https://www.nytimes.com/2016/08/04/health/dental-floss-uses.html

  13. Poklepovic T Worthington HV Johnson TM et al (2013) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev 12:55. https://doi.org/10.1002/14651858.CD009857.pub2

  14. Yaacob M, Worthington HV, Deacon SA et al (2014) Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev 6:118. https://doi.org/10.1002/14651858.CD002281.pub3

  15. Silva C, Albuquerque P, de Assis P et al (2022) Does flossing before or after brushing influence the reduction in the plaque index? A systematic review and meta-analysis. Int J Dent Hyg 20:18–25. https://doi.org/10.1111/idh.12546

    Article  PubMed  Google Scholar 

  16. Kotsakis GA, Lian Q, Ioannou AL et al (2018) A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation. J Periodontol 89:558–570. https://doi.org/10.1002/JPER.17-0368

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schüz B, Wiedemann AU, Mallach N, Scholz U (2009) Effects of a short behavioural intervention for dental flossing: randomized-controlled trial on planning when, where and how. J Clin Periodontol 36:498–505. https://doi.org/10.1111/j.1600-051X.2009.01406.x

    Article  PubMed  Google Scholar 

  18. Asadoorian J, Locker D (2006) The impact of quality assurance programming: a comparison of two Canadian dental hygienist programs. J Dent Educ 70:965–971. https://doi.org/10.1002/j.0022-0337.2006.70.9.tb04167.x

    Article  PubMed  Google Scholar 

  19. Löe H (1967) The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 38:610–616. https://doi.org/10.1902/jop.1967.38.6.610

    Article  Google Scholar 

  20. Rosema NAM, Timmerman MF, Versteeg PA et al (2008) Comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis. J Periodontol 79:1386–1394. https://doi.org/10.1902/jop.2008.070654

    Article  PubMed  Google Scholar 

  21. Sanz M, Herrera D, Kebschull M et al (2020) Treatment of stage I-III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol 47:4–60. https://doi.org/10.1111/jcpe.13290

    Article  PubMed  PubMed Central  Google Scholar 

  22. Silness J, Löe H (1964) Periodontal disease in pregnancy II. Correlation Between Oral Hygiene and Periodontal Condition. Acta Odontol Scand 22:121–135. https://doi.org/10.3109/00016356408993968

    Article  PubMed  Google Scholar 

  23. Chapple ILC, Van Der Weijden F, Doerfer C et al (2015) Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol 42:S71–S76. https://doi.org/10.1111/jcpe.12366

    Article  PubMed  Google Scholar 

  24. Graziani F, Palazzolo A, Gennai S et al (2018) Interdental plaque reduction after use of different devices in young subjects with intact papilla: a randomized clinical trial. Int J Dent Hyg 16:389–396. https://doi.org/10.1111/idh.12318

    Article  PubMed  Google Scholar 

  25. Hague AL, Carr MP (2007) Efficacy of an automated flossing device in different regions of the mouth. J Periodontol 78:1529–1537. https://doi.org/10.1902/jop.2007.060512

    Article  PubMed  Google Scholar 

  26. Zimmer S, Kolbe C, Kaiser G et al (2006) Clinical efficacy of flossing versus use of antimicrobial rinses. J Periodontol 77:1380–1385. https://doi.org/10.1902/jop.2006.050362

    Article  PubMed  Google Scholar 

  27. Santos A (2003) Evidence-based control of plaque and gingivitis. J Clin Periodontol 30:13–16. https://doi.org/10.1034/j.1600-051X.30.s5.5.x

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Gabriela Barbieri Ortigara and Karen Finger Tatsch for their contributions with data collection.

Funding

This study was funded in part by the Post-graduate Program in Oral Science and in part by the Brazilian fostering agency Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES [Coordination for the Advancement of Higher Education Personnel] – Finance code 001).

Author information

Authors and Affiliations

  1. School of Dentistry, Post-Graduate Program in Oral Science, Periodontology, Federal University of Santa Maria, Santa Maria, Brazil

    Ananda B. Londero, Ana Paula P. Reiniger, Rodrigo C. R. Tavares, Ciandra M. Ferreira, Karla Z. Kantorski & Carlos Heitor Cunha Moreira

  2. Laboratory for Applied Periodontal & Craniofacial Research, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA

    Ulf M. E. Wikesjö

  3. Universidade Federal de Santa Maria Av, Roraima nº 1000, Prédio 26F, Santa Maria /RS, CEP, 97015-900, Brazil

    Carlos Heitor Cunha Moreira

Authors
  1. Ananda B. Londero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Paula P. Reiniger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodrigo C. R. Tavares
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ciandra M. Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ulf M. E. Wikesjö
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karla Z. Kantorski
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlos Heitor Cunha Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ananda Barrachini Londero—data collection, drafting and revising manuscript.

Ana Paula Pereira Reiniger—data collection and revising manuscript.

Rodrigo da Cunha Rossignollo Tavares—data collection and revising manuscript.

Ciandra Miraglia Ferreira—data collect and revising manuscript.

Ulf M.E. Wikesjö—revising manuscript.

Karla Zanini Kantorski—study design, coordination, drafting and revising manuscript.

Carlos Heitor Cunha Moreira—study design, coordination, data analysis, drafting and revising manuscript.

Corresponding author

Correspondence to Carlos Heitor Cunha Moreira.

Ethics declarations

Ethics approval

This study was conducted following Guidelines and Norms Regulating Research Involving Human Subjects. The study protocol was reviewed and approved by the Research Ethics Committee, Federal University of Santa Maria, RS, Brazil (CAAE:53831715.5.0000.5346) and ClinicalTrials.gov (NCT04909840).

Consent for participation

Eligible individuals provided a written informed consent.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 166 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Londero, A.B., Reiniger, A.P.P., Tavares, R.C.R. et al. Efficacy of dental floss in the management of gingival health: a randomized controlled clinical trial. Clin Oral Invest 26, 5273–5280 (2022). https://doi.org/10.1007/s00784-022-04495-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04495-w

Keywords

Search

Navigation