BackgroundThe aim of this study is to investigate the amount and the distribution of biofilm in patients wearing fixed appliances and its relation with age, gender, frequency of tooth brushing, and patient motivation.MethodsThe sample comprised 52 patients (15.5 ± 3.6 years old, 30 females and 22 males) wearing fixed orthodontic appliances. Dental biofilm was assessed using a modified plaque index (PI). A questionnaire was used to collect patient’s information, including gender, age, treatment motivation, and frequency of tooth brushing.ResultsGingival (PI score = 0.9 ± 0.7), mesial (0.8 ± 0.6), and distal (0.8 ± 0.5) areas accumulated more biofilm than occlusal areas (0.3 ± 0.3) (P < 0.038). The maxillary lateral incisors (1.1 ± 0.8) and maxillary canines (1.0 ± 0.8) had more biofilm than other teeth (P < 0.05). The maxillary arch (0.8 ± 0.7) had significantly more biofilm than mandibular arch (0.6 ± 0.6) (P = 0.042). No significant difference was found between the right side (0.7 ± 0.7) and left side (0.7 ± 0.6) (P = 0.627). Less biofilm was found in females (0.6 ± 0.5), adults (0.3 ± 0.3), and “self-motivated” patients (0.3 ± 0.3), compared with males (0.9 ± 0.5), children (0.8 ± 0.6), and “family-motivated” patients (1.1 ± 0.5) (P < 0.001). The amount of biofilm was associated with self-report of the frequency of daily tooth brushing (P < 0.001).ConclusionsPatients wearing fixed orthodontic appliances have the highest biofilm accumulation on the maxillary lateral incisors and maxillary canines, particularly in the gingival area and areas behind arch wires. Less biofilm was observed in female and adult patients and in those who were self-motivated and brushed their teeth more often.

The effectiveness of Super Floss and waxed dental floss as proximal surface cleansing agents was compared in 34 subjects. Each subject used 1 agent twice daily for 2 weeks followed by the other agent used with the same frequency and for the same period. The order in which the agents were used was selected at random. Plaque was stained by erythrosin, and a plaque index of Wolffe used. Super Floss was found to be superior to waxed dental floss in removing proximal plaque, but neither was 100% effective. Some plaque was present in 49.9% of the proximal surfaces when Super Floss had been used and on 54.7% when the waxed dental floss had been used. Both agents cleaned distal surfaces better than mesial surfaces, proximal surfaces of anterior teeth more effectively than those of posterior teeth, the coronal half of the proximal surfaces better than the apical half and the facial half more efficiently than the lingual half. No differences were found between maxillary teeth and mandibular teeth. Subjects used more lengths of Super Floss than of waxed dental floss, indicating its relative 'brittleness'. However, the majority of subjects preferred Super Floss, mainly because it was thicker and felt more abrasive.