Clinical efficacy of flossing versus use of antimicrobial rinses

J Periodontol. 2006 Aug;77(8):1380-5. doi: 10.1902/jop.2006.050362.


Background: Dental floss is only used by a small part of the population on a daily basis. Therefore, an easy, applicable alternative is needed. This alternative could be a mouthrinse with antimicrobial activity for daily use. The aim of the present study was to evaluate the efficacy of two mouthrinses in reducing interdental plaque and gingivitis compared to dental floss.

Methods: A total of 156 healthy volunteers were randomly assigned to the following groups: 1) toothbrushing and rinsing (0.06% chlorhexidine and 0.025% fluoride); 2) toothbrushing and rinsing (0.1% cetylpyridiniumchloride and 0.025% fluoride); 3) toothbrushing and flossing; and 4) toothbrushing only (N = 39 subjects in each group). At baseline, the modified proximal plaque index (MPPI) and papillary bleeding index (PBI) were recorded. Thereafter, subjects had to brush in the usual manner during 8 weeks. Additionally, test groups had to rinse once a day (groups 1 and 2: 30 seconds) or to floss (group 3). Eight weeks after baseline, indices were recorded again and improvements were calculated. Analysis of variance (ANOVA) and the Bonferroni test served for statistical analysis.

Results: After 8 weeks, reductions for all indices were found in all groups (P <0.05). With respect to the MPPI, mouthrinse groups performed better than the control and floss groups: 1) 0.73; 2) 0.82; 3) 0.40; and 4) 0.32 (P <0.05). The PBI showed no statistically significant difference between groups: 1) 0.46; 2); 0.50; 3); 0.42; and 4) 0.37.

Conclusion: The results suggest that, in combination with toothbrushing, daily use of the tested mouthrinses may result in a higher interproximal plaque reduction than daily flossing.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Anti-Infective Agents, Local / therapeutic use*
  • Cetylpyridinium / therapeutic use*
  • Chlorhexidine / therapeutic use*
  • Dental Devices, Home Care*
  • Dental Plaque / therapy*
  • Dental Plaque Index
  • Female
  • Gingivitis / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Mouthwashes / therapeutic use*
  • Single-Blind Method
  • Sodium Fluoride / therapeutic use
  • Toothbrushing
  • Treatment Outcome


  • Anti-Infective Agents, Local
  • Mouthwashes
  • Sodium Fluoride
  • Cetylpyridinium
  • Chlorhexidine