Effect of a 3-Year Professional Flossing Program with Chlorhexidine Gel on Approximal Caries and Cost of Treatment in Preschool Children

Abstract

The aim was to evaluate the effect of chlorhexidine gel treatment on the incidence of approximal caries in preschool children. One hundred and seventeen 4-year-olds, divided into two groups, participated: (1) chlorhexidine gel group (n = 59), and (2) placebo gel group (n = 58). Group 1 was treated 4 times a year with a 1% chlorhexdine gel and group 2 with a placebo gel. Approximately 0.7 ml of gel was applied interdentally by means of a flat dental floss. A control group (group 3), which did not receive any flossing or gel treatment, was also included in the study (n = 116). After 3 years, i.e. when the children were 7 years old, the mean incidence of caries on approximal surfaces (defs), including both enamel and dentin lesions, was 2.59 in the chlorhexidine gel, 4.53 in the placebo gel and 4.20 in the control group (group 1 vs. 2 and group 1 vs. 3: p < 0.01). Mean number of approximal fillings at the end of the study, i.e. when the children were 7 years old, was 0.33 in the chlorhexidine gel, 1.04 in the placebo gel and 0.80 in the control group (group 1 vs. 2: p < 0.01; group 1 vs. 3: p < 0.05). The progression of approximal caries lesions, diagnosed on bitewing radiographs from the age of 5 to 7, was slower in the chlorhexidine than in the placebo gel group (the control group was not evaluated in this respect). A cost analysis, based on the total treatment time in minutes, showed a small gain for the flossing program. Thus, the results indicate that professional application 4 times a year of chlorhexidine gel in combination with dental flossing has a caries-reducing effect on approximal caries in primary teeth.

Efficacy of dental floss impregnated with chlorhexidine on reduction of supragingival biofilm: a randomized controlled trial

“…In addition, a study by Gisselsson et al . showed that after 3 years, the number of caries lesions was lower in children that used dental floss combined with chlorhexidine 1% gel than in children that used dental floss and a placebo gel.…”

Detection of Approximal Caries in 5-Year-Old Swedish Children

“…Thus, in Scandinavian populations, between 30 and over 50% of these surfaces show radiographic evidence of caries not detected from clinical examination alone [Boman et al, 1999;Raadal et al, 2000]. Progression of approximal lesions in primary molars can be prevented or retarded [Gisselsson et al, 1994], so, early detection of approximal enamel lesions is important. …”

Approximal Caries Increment in Two Cohorts of Schoolchildren after Discontinuation of a Professional Flossing Program with Chlorhexidine Gel

“…Details of the 3-year fl ossing program and its effect on the development of approximal caries have been reported elsewhere [Gisselsson et al, 1988[Gisselsson et al, , 1994. Briefl y, during the experimental years (the preschool children 1987-1990 and the teenagers 1980-1983), the caries preventive treatment included regular professional fl ossing with a 1% CHX gel (Hibitane Dental, ICI, Macclesfi eld, UK) or a placebo gel, carried out 4 times per year.…”

“…The method is both simple and cheap compared to the tray method and can therefore be applied to a large group of individuals considered to be at risk for developing dental caries. The method has been evaluated both and in 4-to 7-year-old preschool children [Gisselsson et al, 1994] and in 12-to 15-year-old teenagers [Gisselsson et al, 1988]. After 3 years, the approximal caries reduction was around 40% compared to a placebo gel or a no gel treatment.…”