Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.
J Dent Res. 2020 Sep;99(10):1150-1156. doi: 10.1177/0022034520926139. Epub 2020 May 28.
Interdental cleaning is routinely recommended, despite limited evidence supporting efficacy to prevent advanced oral disease endpoints, such as caries and periodontal disease. We aimed to examine associations between interdental cleaning and oral health in a large, generalizable prospective cohort of adults in the United States. Data were drawn from wave 3 (2015 to 2016, = 26,086 included in analysis) and wave 4 (2016 to 2018, = 22,585) of the adult component (age ≥18 y) of the nationally representative Population Assessment of Tobacco and Health Study. Survey-weighted multivariable regression models estimated the associations between wave 3 weekly interdental cleaning frequency and 6 measures of self-reported oral health-overall rating, tooth extractions, gum bleeding, loose teeth, bone loss around teeth, and gum disease-cross-sectionally and prospectively, with adjustment for established periodontal disease risk factors. As compared with no interdental cleaning, interdental cleaning ≥7 times/wk was prospectively associated with greater odds of excellent self-rated oral health (adjusted odds ratio, 1.37; 95% CI, 1.17 to 1.62), lower odds of bleeding gums (adjusted odds ratio, 0.62; 95% CI, 0.54 to 0.70), but not statistically significantly lower odds of other oral health conditions in the following 12 mo. Older age, lower socioeconomic status, diabetes, and cigarette smoking were consistently associated with worse oral health across all outcome measures. Findings were largely robust to alternative model and variable specifications. Interdental cleaning is associated with better perceived oral health and less self-reported gingivitis. Prevention of more advanced disease states was not demonstrated. These findings should be interpreted cautiously given the self-reported nature of the measures and relatively short follow-up period.
尽管有有限的证据支持其预防龋齿和牙周病等口腔疾病终点的效果,但仍常规推荐使用牙间清洁。我们旨在检查美国一项大规模、可推广的成人前瞻性队列中,牙间清洁与口腔健康之间的关联。数据来自全国代表性的烟草与健康人群评估研究成人部分(年龄≥18 岁)的第 3 波(2015 年至 2016 年,纳入分析的 = 26086 人)和第 4 波(2016 年至 2018 年,纳入分析的 = 22585 人)。调查加权多变量回归模型估计了第 3 波每周牙间清洁频率与 6 项自我报告的口腔健康指标(总体评分、拔牙、牙龈出血、松动牙齿、牙齿周围骨质流失和牙周病)之间的横断面和前瞻性关联,同时调整了已确定的牙周病危险因素。与不进行牙间清洁相比,每周进行牙间清洁≥7 次与更好的自我报告口腔健康的可能性更高(调整后的优势比,1.37;95%置信区间,1.17 至 1.62)、牙龈出血的可能性更低(调整后的优势比,0.62;95%置信区间,0.54 至 0.70),但在接下来的 12 个月中,其他口腔健康状况的可能性没有统计学显著降低。在所有结果测量中,年龄较大、社会经济地位较低、糖尿病和吸烟与口腔健康状况较差始终相关。在替代模型和变量规范下,结果基本稳健。牙间清洁与更好的自我感知口腔健康和更少的自我报告牙龈炎相关。但未证明可以预防更严重的疾病状态。鉴于测量的自我报告性质和相对较短的随访时间,应谨慎解释这些发现。