On Caries Prevention Using Fluoridated Toothpicks and Dental Flosses

Sammanfattning: The prevalence of approximal dental caries is still high worldwide in all age groups. The aim was to evaluate different aspects of fluoridated toothpicks and dental flosses in relation to caries prevention with the emphasis on the approximal area. Fluoride (F) release was studied in vitro and in vivo, together with the effect on demineralised enamel and dentine and on plaque composition in situ. In all, 23 commercially available toothpicks and dental flosses, together with three prototypes, were analysed in vitro. The F release was followed for up to 24 h using an ion-specific electrode. In an in vivo study, the F concentration in both treated and non-treated approximal areas was evaluated after using two toothpicks and four dental flosses compared with an interdental brush dipped in 0.2% NaF gel and solution. In an in situ study, 15 subjects with enamel and dentine specimens, mounted in full dentures, participated. They were asked to use toothpicks and dental flosses three times/day for four weeks. The effect on demineralised samples, analysed by transversal microradiography, and on the oral microflora was studied. A comparison was made with an F-free dental floss and a control period without any approximal cleaning. In these studies, products impregnated with sodium fluoride (NaF), amine fluoride (AmF) or a combination of these two were used. A large variation in the F release in vitro was found; the toothpicks generally resulted in higher values than the flosses. In the in vivo study, the F concentration was up to 10 times higher at the treated sites than at the non-treated ones. Using a fresh toothpick or a piece of dental floss for each interproximal area resulted in higher values compared with using one and the same toothpick/floss for the whole dentition. An interdental brush dipped in NaF gel or solution produced F levels of the same magnitude as using multiple toothpicks. In the in situ experimental caries study, all cleaning aids inhibited further demineralisation. In this respect, the dental flosses were somewhat more effective than the toothpicks, especially in case of dentine. Relatively small differences were found between toothpicks impregnated with AmF and NaF. The most pronounced reduction in plaque microflora was found for the AmF toothpick. The conclusion from this thesis is that both fluoridated toothpicks and dental flosses may be useful tools for delivering fluoride to the caries prone approximal area.