Effectiveness of Floss versus Toothpick in Removing Supragingival Interproximal Plaque

Objective: To determine whether the toothpick was equally effective as floss in removing supragingival, interproximal plaque when patient utilization as an experimental variable was eliminated.

Methods: About 10-15% of adults floss. Previous research has shown that patient compliance is the most important factor in interproximal oral hygiene and that floss and toothpick are equally effective in plaque removal when operated by patients. However, it is unclear whether the equal effectiveness was because the devices were equally effective in plaque removal, or because subjects had more difficulty using floss than the toothpick? Thirty-eight healthy male and female student healthcare volunteers 20 to 35 years of age in general good oral health participated in the study. All subjects were given a standardized full mouth prophylaxis and instructed to abstain from interproximal hygiene and use of mouthrinse for two weeks. After two weeks of plaque accumulation, two trained and calibrated clinical operators removed interproximal plaque, one using floss and the other using the toothpick in randomized quadrants. Using Turesky's modification of Quigley and Hein, plaque scores were recorded before and after interproximal plaque removal. The difference between the two plaque scores was analyzed using the Wilcoxon Signed Rank test at the significance level of alpha = 0.05.

Results: Floss was significantly more effective (p<0.0001) in removing plaque than the toothpick on maxillary teeth. Floss was also significantly more effective (p<0.0001) in removing plaque than the toothpick on mandibular teeth. On average the floss removed 1.9 times more plaque then the toothpick.

Conclusion: Under conditions of the present study, floss is significantly more effective than the toothpick when operated by dental professionals. Combined with previous research this study demostrates the impact patient complaince has on interproximal oral hygiene effectiveness.