Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany.
J Clin Periodontol. 2024 Mar;51(3):252-264. doi: 10.1111/jcpe.13936. Epub 2023 Dec 20.
To estimate association between the use of interdental cleaning aids (IDAs) and type on 7-year follow-up levels of interdental plaque, interdental gingival inflammation, interdental periodontitis severity, the number of interdental sound surfaces and the number of missing teeth in a population-based cohort study.
We used 7-year follow-up data of 2224 participants from the Study of Health in Pomerania (SHIP-TREND). We applied generalized linear and ordinal logistic models, adjusting for confounding and selection bias using inverse probability treatment weighting and multiple imputation.
Flossers were 32% less likely to have higher interdental plaque (iPlaque) levels than non-users of IDAs (odds ratio [OR] = 0.68; 95% confidence interval [CI]: 0.50-0.94); flossing resulted in 5% lower means of iPlaque. Effects on interdental bleeding on probing (iBOP), mean interdental probing depths and mean interdental clinical attachment levels were direction-consistent but statistically non-significant. Interdental brushing was associated with lower follow-up levels for interdental plaque (OR = 0.73; 95% CI: 0.57-0.93) and iBOP (OR = 0.69; 95% CI: 0.53-0.89). IDAs were more effective in reducing iPlaque in participants with periodontitis, whereas iBOP reduction was more pronounced in participants with no or mild periodontitis. The analyses did not suggest that the use of IDAs affected caries. Finally, applying change score analyses, flossing reduced tooth loss incidence (incidence rate ratio [IRR] = 0.71) compared with non-users of IDAs.
Recommending flossing and interdental brushing in dental practices represents an approach to the prevention of gingivitis and consequently periodontitis.
在一项基于人群的队列研究中，估计使用牙间清洁辅助工具（IDAs）与 7 年随访时牙间菌斑、牙间牙龈炎症、牙间牙周炎严重程度、牙间健康表面数量和失牙数量之间的关联。
我们使用了来自波罗的海健康研究（SHIP-TREND）的 2224 名参与者的 7 年随访数据。我们应用了广义线性和有序逻辑模型，通过逆概率处理加权和多重插补来调整混杂因素和选择偏差。
与不使用 IDA 的人相比，牙线使用者发生较高牙间菌斑（iPlaque）水平的可能性低 32%（比值比 [OR] = 0.68；95%置信区间 [CI]：0.50-0.94）；牙线使用导致 iPlaque 的平均值降低 5%。对探诊时牙间出血（iBOP）、平均牙间探诊深度和平均牙间临床附着水平的影响方向一致，但无统计学意义。牙间刷洗与牙间菌斑（OR = 0.73；95% CI：0.57-0.93）和 iBOP（OR = 0.69；95% CI：0.53-0.89）的随访水平降低相关。IDAs 在牙周炎患者中更有效地降低 iPlaque，而在无或轻度牙周炎患者中，iBOP 的降低更为明显。分析结果表明，IDAs 的使用不会影响龋齿。最后，应用变化得分分析，与不使用 IDAs 的人相比，牙线使用降低了牙齿缺失的发生率（发病率比 [IRR] = 0.71）。
在牙科实践中推荐使用牙线和牙间刷洗，代表了一种预防牙龈炎进而预防牙周炎的方法。
