Clinical Efficacy of Flossing vs. Use of Antimicrobial Rinses

Objectives: To evaluate the efficacy of two antimicrobial mouthrinses in reducing interdental plaque and gingivitis compared to a placebo and dental floss. Methods: 156 healthy volunteers (78 females, 78 males) took part in the parallel-design examiner-blind study. After screening and stratification by sex and papillary bleeding index (PBI), participants were randomly assigned to three test groups: (1) toothbrushing + rinsing (0.06% CHX + 0.025% NaF, Chlorhexamed® Zahnfleisch-Schutz), (2) toothbrushing + rinsing (0,1% CPC + 0.025% NaF), (3) toothbrushing + flossing (Odol med 3) and a control group (4) toothbrushing only (n=39 each). At baseline, QUIGLEY-HEIN plaque index (PI), a modified approximal plaque index (API), and PBI were recorded. This was followed by calculus removal. Thereafter, all subjects were advised to brush their teeth in the usual manner during the eight weeks study period. Additionally, test groups were instructed to rinse once daily (1 + 2, 30 sec.), or to use dental floss between all teeth (3). All participants used Dr. Best multi aktiv toothpaste and Dr. Best flex plus toothbrush. Eight weeks after baseline, indices were recorded again. Improvements between baseline and eight weeks were calculated as means. Anova with Bonferroni adjustment was used for statistical analysis. Results: After eight weeks, reductions for all indices were found in all groups at p<0.05. With respect to PI and API, the mouthrinse groups performed better than control and floss groups. PI: (1) 0.57, (2) 0.56, (3) 0.09, (4) 0.16; API: (1) 0.82, (2) 0.73, (3) 0.40, (4) 0.32 (p<0.05). For PBI, no statistically significant difference was found between groups: (1) 0.50, (2) 0.46, (3) 0.42, (4) 0.37. Conclusions: With respect to plaque reduction, toothbrushing in combination with a mouthrinse with antimicrobial activity was more effective than toothbrushing alone or in combination with flossing. This study was supported by GlaxoSmithKline.