In human evolution, this habit has often been documented in different Homo species, from Homo habilis 1.84 m.a. The use of toothpicks is widespread in every culture, and spans from the beginning of the genus Homo to modern times. Although these are modern uses, they very likely have a very long history. Although not recommended by dentists, toothpicks are widely used to remove trapped food particles that irritate or hurt the gums. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist.Ī toothpick is a small stick normally made of wood, but also of bamboo, metal, bone or other material with one or two sharp ends to insert between the teeth. Field work at the Cova Foradà site is supported by Diputación de Valencia. ![]() This research has been supported by AGAUR 2009 SGR-324 and SGR-566 projects of the Generalitat of Catalunya. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This work is funded by the Dirección General de Investigación of M.E.C., projects number CGL2012-38434-C03-01 and CGL2012-38434-C03-03. Received: JAccepted: AugPublished: October 16, 2013Ĭopyright: © 2013 Lozano et al. PLoS ONE 8(10):Įditor: Alejandro Lucia, Universidad Europea de Madrid, Spain There were no significant differences between woodsticks, brushing only and dental floss when assessed by visual signs of inflammation (one study).Citation: Lozano M, Subirà ME, Aparicio J, Lorenzo C, Gómez-Merino G (2013) Toothpicking and Periodontal Disease in a Neanderthal Specimen from Cova Foradà Site (Valencia, Spain). It was unclear whether there were differences between floss and woodsticks (one study). Gingival inflammation: Three studies reported bleeding scores as an assessment of gingival inflammation and all showed significantly greater effectiveness compared to brushing alone. Two studies reported comparisons with interdental brushes the only one with usable data showed significantly greater effectiveness for interdental brushes. Five studies used dental floss as a comparator only one showed a statistically significant between-group difference and favoured dental floss. Three compared the additional use of woodsticks to toothbrushing alone and found no statistically significant differences between the groups. Plaque scores: Six studies reported plaque scores as an outcome. Only three studies adequately reported loss to follow-up. Five studies used blinded outcome assessment. Sample sizes appeared to range from 10 to 161, but there were some discrepancies between the text and tables. Four studies were cross-over trials and the others had a parallel design. Disagreements were resolved through discussion.Įight studies reported in seven publications were included in the review (n=438): six RCTs (n=265) and two controlled clinical trials (n=173). ![]() Two reviewers independently assessed the studies for inclusion in the review. Gingival inflammation was assessed using the Eastman Interdental Bleeding Index and the Visual Gingival Index. Plaque outcomes were scored using Plaque Index of Silness and Loe, Global Plaque Index and Wolffe Index. Several studies gave prophylactic oral treatment before the study began, including supra- and subgingival scaling. Participant ages ranged from 18 to 81 years. Included studies enrolled subjects who never or only occasionally used adjunctive interdental cleaning devices, dental students, patients treated for periodontitis or partially edentulous subjects. Control interventions were dental floss or interdental brushes. Three different brands of woodsticks were assessed (Stim-U-Dent, Jordan and Inter-Dens). Trials were required to report on plaque, bleeding or gingivitis.Īll included studies assessed interventions in conjunction with unsupervised manual toothbrushing. Randomised controlled trials (RCTs) or controlled clinical trials that compared handheld triangular woodsticks with another or no interdental cleaning device in healthy adults aged over 18 years were eligible for inclusion in the review.
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