Jung Katja, Böttge Björn, Kullmann Mathis, Ganss Carolina
Department of Restorative Dentistry and Endodontology, Dental Clinic, Justus-Liebig-University of Giessen, Giessen, Germany.
Department of Operative Dentistry, Endodontics, and Paediatric Dentistry, Section of Cariology, Medical Centre of Dentistry, Philipps-University Marburg, Marburg, Germany.
Clin Oral Investig. 2025 Sep 4;29(9):438. doi: 10.1007/s00784-025-06505-z.
Interdental hygiene plays a crucial role in maintaining oral health, yet the effectiveness of dental floss remains a subject of debate. Thus, this study aimed to assess whether improved flossing technique relates to improved cleaning efficacy.
A total of 37 adults (23.1 ± 3.2 years) participated. After habitual toothbrushing, plaque was disclosed and an intraoral scan was performed; afterwards, habitual flossing was videotaped, followed by a second intraoral scan of disclosed plaque. Participants then watched an instruction video. After one week of practice, flossing was again videotaped and intraoral scans were taken before and after flossing. On defined regions on images obtained from the four scans, plaque coverage was assessed with a three-level score (0: none, 1: <50%, 3: ≥50%). Proximal Surface Plaque Index (PSPI) was calculated as mean from all scores. A flossing performance score (FPS) was generated from the percentage of interdental spaces that were correctly flossed (interdental space reached, floss correctly applied and vertical movements; 0: totally imperfect, 3: perfect flossing). Ramfjord teeth (16, 21, 24, 36, 41, 44) were analysed, values are given as median [95% CI].
FPS improved distinctly after instruction (2.0 [1.48;2.54] vs. 2.83 [2.45;2.95]; (p < .001), but not plaque removal (difference PSPI before/after: 0.17 [0.04;0.25] vs. 0.21 [0.13;0.25]; p = .112). Plaque removal was not correlated with PSPI.
These findings suggest that even with correct technique, flossing may not substantially reduce plaque levels.
The results align with previous studies questioning the efficacy of flossing and highlight the need for further investigation into interdental cleaning approaches.
牙间隙卫生在维持口腔健康中起着关键作用，但牙线的有效性仍是一个有争议的话题。因此，本研究旨在评估改进的牙线使用技巧是否与提高清洁效果相关。
共有37名成年人（23.1±3.2岁）参与。在习惯性刷牙后，使用菌斑显示剂并进行口腔内扫描；之后，对习惯性使用牙线的过程进行录像，随后再次对显示菌斑的口腔进行扫描。参与者随后观看指导视频。经过一周的练习后，再次对使用牙线的过程进行录像，并在使用牙线前后进行口腔内扫描。在从四次扫描获得的图像上的特定区域，用三级评分（0：无，1：<50%，3：≥50%）评估菌斑覆盖情况。近端表面菌斑指数（PSPI）以所有评分的平均值计算。从正确使用牙线的牙间隙百分比（到达牙间隙、正确使用牙线并进行垂直移动；0：完全不完善，3：完美使用牙线）得出牙线使用性能评分（FPS）。对Ramfjord牙（16、21、24、36、41、44）进行分析，数值以中位数[95%置信区间]表示。
指导后FPS有明显改善（2.0[1.48；2.54]对2.83[2.45；2.95]；（p<0.001），但菌斑清除情况未改善（PSPI前后差值：0.17[0.04；0.25]对0.21[0.13；0.25]；p=0.112）。菌斑清除与PSPI无关。
这些发现表明，即使使用正确的技巧，使用牙线可能也不会大幅降低菌斑水平。
结果与之前质疑牙线功效的研究一致，并强调需要进一步研究牙间隙清洁方法。
