Professional flossing as a diagnostic method for gingivitis in the primary dentition

Abstract

The aim of this study was to evaluate flossing as a diagnostic method for interproximal gingival bleeding in children. For this crossover study, 23 pre-schoolchildren presenting neither restorations nor approximal carious cavities and with at least 15% of gingival bleeding sites were selected. Examinations were performed at three different moments (3-4 days interval). Examinations comprised repeated measurements of two gingival indices with a 10-minute interval in the following sequences: the Ainamo & Bay Gingival Bleeding Index (GBI) followed by the Carter & Barnes flossing index (CBI); CBI followed by GBI; and GBI followed by GBI. Data analysis was performed only for the interproximal sites, considering the GBI as the gold-standard. Agreement between indices, sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) were estimated. Percentage agreements in sequences GBI-CBI, CBI-GBI and GBI-GBI were 70.3%, 76.4% and 84.5%, respectively.

Dental flossing as a diagnostic method for proximal gingivitis: a validation study

“…By reversing the order of the assessments, in the first flossing-second GBI group, lower S values and higher SP values were observed; however, there was a larger number of false positives than false negatives. These findings are not in agreement with those of Mariath et al, 16 who found low S values and high SP values for the first GBI-second flossing and first floss-second GBI groups. These differences may be explained, in part, by the fact that children were evaluated in the study of Mariath et al 16 Gingivitis is less severe in children compared to adults, when similar amounts of dental plaque are found.…”

“…9,15,16 In the present study, flossing against the teeth was compared with that against the gums. In the absence of bleeding with TF in the first assessment, 19% of the sites bled following the second assessment with GF.…”

“…Eligible subjects were ≥18 years old, with at least 20 present teeth and 15% of positive proximal sites for GBI, 16 in addition to having 12 papillae (teeth without giroversion and/or diastema). Subjects were not included if they presented proximal attachment loss, had a probing depth >3 mm at proximal sites, had diabetes mellitus, or used cyclosporine, phenytoin, or nifedipine.…”

“…16 The parameters used were: 10% difference in the mean percentages for sites with gingival bleeding between the assessments, standard deviation of 15%, an 80% statistical power, α = 0.05, and a paired design. Twenty subjects were necessary for each evaluation protocol.…”

“…Previous studies 15, 16 have compared the use of dental floss with the gingival bleeding index (GBI) 7 and found that dental floss is a suitable tool for the diagnosis of proximal gingivitis in children and that it is particularly useful as an indicator of gingival health. However, there is no evidence comparing flossing with GBI in adults with no history of periodontitis.…”