Research shows that few individuals floss correctly and that this inability to floss properly may lead to a lack of motivation. It is important to recognise that when one is assessing the effectiveness of interdental cleaning methods, two points of reference should be considered. The first and most obvious is the theoretical efficacy of the method based on clinical evidence. A second point of reference is the practical efficacy influenced by the acceptability of the method to patients and therefore, their compliance. Historically, regular flossing compliance has been far less than ideal and the routine use of dental floss has consistently been shown to be dramatically low. Research has shown daily use among adults ranging from between 10 and 30 per cent. The reasons for this lack of compliance stem from two issues; firstly a lack of patient ability and secondly a lack of motivation.
Dental hygienist David Bridges certainly faced daily challenges with patient compliance failing to adopt his flossing advice. A typical case was Darren, a 46 year old male who had been suffering from a consistent, generalised, low grade, interdental chronic marginal gingivitis. The problem was thought to be entirely associated with Darren’s admitted non-use of an interdental cleaning regime despite being made aware of the risks he ran of more serious gingival problems, allied to his type two diabetes. He had a sporadic history using floss, PTFE tape and woodsticks at various times but would not adopt a regular habit.
David was curious to see if the Sonicare AirFloss might be a device Darren would take to and make regular use of. In November, Darren was asked if he would like to take part in an informal clinical trial of the device and was excited by the prospect.
On its arrival in November an appointment was arranged for Darren’s baseline bleeding on probing (BOP) index to be recorded and this showed he had interdental BOP at nearly every site. At his February appointment, it quickly transpired that his interdental BOP had reduced from the previous appointment. Whilst there were still a significant number of areas that bled, his oral health had improved. It transpired his wife had bought him a Philips Sonicare toothbrush for Christmas. It was decided to carry on with the AirFloss trial as he still had areas of interdental bleeding. These were charted and recorded on the practice management system.
Darren was shown how to use the Sonicare AirFloss; advised to use water in the reservoir and was told to use the device once a day between each interdental space. He was then asked to return in six weeks for the bleeding index to be repeated and the results compared. Darren was also to be asked for feedback on his experience of using the unit - how easy he found it to use, how regularly he had used it and general comments on the design of the device itself.
Darren duly returned for his reassessment appointment and a BOP index was taken. As the pre-trial and review BOP indices show, there had been a further significant reduction in interdental bleeding.
Darren reported that he liked using the Sonicare AirFloss. He found it fast and easy to use, and the gadget-like device appealed to him. He felt the reservoir was on the small side as he liked to use the device from both sides of the interdental spaces - outside in and vice versa. As a result, he found that he ran out of water during the session and had to refill the reservoir. It seems clear that the use of the Philips Sonicare toothbrush helped reduce Darren’s interdental bleeding and that this was further improved with the use of the AirFloss. As well as enjoying the experience, Darren is delighted with his oral health improvements and what this means for his long term oral and general health.
One possible confounding issue is that the continued use of the Sonicare toothbrush during the Sonicare AirFloss trial and its possible further effect on BOP reduction could not be measured. Nevertheless, this case study demonstrates the positive benefits of such a regime in a patient with a previously and consistently higher level of inflammation.