The incidence of gingival fissures associated with toothbrushing: crossover 28-day randomized trial

Aim To compare the incidence of gingival fissures after the use of soft and medium-hard toothbrushes. Material & Methods Overall, 35 participants (1420years old), with periodontal attachment loss (PAL) 1mm, were assigned to soft or medium-hard toothbrushes in a crossover design with a wash-out of 10days between two 28-days periods. Gingival fissures were assessed using a disclosing solution. Pictures were taken from a selected quadrant every 23days in 12 sessions. Picture files were evaluated by a blind examiner. Generalized estimating equations were used to evaluate the association between gingival fissures, toothbrush type, time, gender, age, self-reported brushing frequency, plaque and PAL. Results Overall, 25% of the participants presented at least one gingival fissure. Higher incidence of fissures was observed after use of medium-hard toothbrushes. In the multivariable model, the risk of fissure development was two times higher with medium-hard compared with soft toothbrushes. The presence of buccal PAL was associated with a 5.19 times increased risk. The risk of fissure occurrence also increased with time and was higher in males than females. Conclusions Gingival fissures are a common feature associated with toothbrushing. Medium-hard toothbrushes, male gender, time and previous PAL are significant risk factors for the incidence of gingival fissures.