Effectiveness of the Use of Dental Floss for Gengivite Treatment in Adults: a Randomized Clinical Trial

Plaque-induced gingivitis is an inflammation caused by the accumulation of microorganisms around the gingival margins (MARIOTTI, 1999). The bacterial etiology of gingivitis was established by Löe et al. (1965). In this study, the accumulation of plaque on healthy gingiva produced gingivitis between 10 and 21 days and the restitution of oral hygiene procedures for 7 to 10 days reestablished gingival health. Epidemiological data show a high prevalence of gingivitis in the adult population of developed and developing countries (LI et al., 2010; MINISTÉRIO DA SAÚDE, 2011), besides being the most frequent type of periodontal disease (PAGE; BAAB, 1985).

The main clinical outcomes of gingivitis are edema, color change, probing bleeding, increased gingival exudate and sensitivity (PAGE, SCHROEDER, 1976; MARIOTTI, 1999). The clinical signs are restricted to the gingiva and are reversible with the removal of the etiological factor without any damage to the support periodontium (MARIOTTI, 1999). In adition to the local repercussions, the gingival condition has an impact on the quality of life. Self-perception of swollen gums and gingival pain were associated with reduced quality of life (NEEDLEMAN et al., 2004).

Gingivitis is a risk factor in the clinical course of chronic periodontitis. Lang et al. (2009) found that teeth associated with inflamed gingiva had a significantly greater risk of tooth loss than teeth with healthy or slightly inflamed gingiva. Hugoson et al. (2008) showed that improvements in plaque control reduced the prevalence of gingivitis and moderate periodontitis in four cross-sectional studies conducted over 30 years in Sweden. Thus, prevention and treatment of gingivitis can indirectly reduce tooth loss.

The mechanical control of the supragingival plaque is the main mechanism of prevention and treatment of gingivitis (PINTO et al., 2013; SAMBUNJAK et al., 2011). The benefits of adequate plaque control include maintaining a functional dentition, optimizing aesthetic values such as appearance and good breath, reducing the risk of loss of periodontal attachment, and the need for complex, uncomfortable, and costly periodontal treatment (CLAYDON, 2008). In addition, the improvement in periodontal clinical indicators is correlated with an increase in quality of life related to oral health in adults (SHANBHAG; DAHIYA; CROUCHER, 2013).

Manual brushing is the most commonly used method for plaque control. (VAN DER WEIJDEIN; SLOT, 2015). The effectiveness of this procedure depends on the individual ability to remove plaque and the frequency at which this removal is performed (JEPSEN, 1998). The XI European Workshop of Periodontology recommended the daily brushing twice daily with the use of fluoride dentifrice (CHAPPLE et al., 2015). However, Pinto et al. (2013) demonstrated that mechanical self-control with 24-hour frequency is able to prevent gingivitis in subjects with no history of periodontitis. A systematic review showed that a single brushing exercise reduces plaque levels by approximately 42% (SLOT et al., 2012). Randomized clinical trials (ROSEMA et al., 2008; SCHIFF et al., 2006; SHARMA et al., 2002) have shown that manual brushing without the aid of interdental plaque removal devices reduces plaque and gingivitis levels and maintains gingival health.