Abstract
This study evaluated the clinical diagnosis of proximal gingivitis by comparing two methods: dental flossing and the gingival bleeding index (GBI). One hundred subjects (aged at least 18 years, with 15% of positive proximal sites for GBI, without proximal attachment loss) were randomized into five evaluation protocols. Each protocol consisted of two assessments with a 10-minute interval between them: first GBI/second floss, first floss/second GBI, first GBI/second GBI, first tooth floss/second floss, and first gum floss-second floss. The dental floss was slid against the tooth surface (TF) and the gingival tissue (GF). The evaluated proximal sites should present teeth with established point of contact and probing depth ≤ 3mm. One trained and calibrated examiner performed all the assessments. The mean percentages of agreement and disagreement were calculated for the sites with gingival bleeding in both evaluation methods (GBI and flossing). The primary outcome was the percentage of disagreement between the assessments in the different protocols. The data were analyzed by one-way ANOVA, McNemar, chi-square and Tukey's post hoc tests, with a 5% significance level. When gingivitis was absent in the first assessment (negative GBI), bleeding was detected in the second assessment by TF and GF in 41.7% (p < 0.001) and 50.7% (p < 0.001) of the sites, respectively. In the absence of gingivitis in the second assessment (negative GBI), TF and GF detected bleeding in the first assessment in 38.9% (p = 0.004) and 58.3% (p < 0.001) of the sites, respectively. TF and GF appears to be a better diagnostic indicator of proximal gingivitis than GBI.
Highlights
Plaque-induced gingivitis is an inflammation caused by the accumulation of microorganisms around the gingival margins.[1]
The findings of this study indicate that flossing against both the teeth and gums can diagnose proximal gingivitis at a higher frequency in adults compared with the gingival bleeding index (GBI)
Our study indicates a high degree of intra-examiner reliability in the assessment of interdental inflammation using bleeding after stimulation; the reliability obtained with the dental flossing protocol was higher than that with periodontal probing
Summary
Plaque-induced gingivitis is an inflammation caused by the accumulation of microorganisms around the gingival margins.[1]. Both prevention and treatment of gingivitis are important as it affects almost 100% of the general population.[3,4] There is a large abundance of supragingival biofilms in the general population, indicating poor oral hygiene, in proximal areas.[5,6]
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