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. 2017 Oct;67(5):299-307.
doi: 10.1111/idj.12300. Epub 2017 May 15.

The Bleeding on Brushing Index: a novel index in preventive dentistry

Tobias Rosenauer  1 , Constanze Wagenschwanz  1 , Matthias Kuhn  2 , Anna Kensche  1 , Sandra Stiehl  1 , Christian Hannig  1
Affiliations

The Bleeding on Brushing Index: a novel index in preventive dentistry

Tobias Rosenauer et al. Int Dent J. 2017 Oct.

Abstract

Background: The aim of this study was to evaluate the suitability of a dichotomous index, based on a special interdental brushing tool, to detect initial pathological processes in interproximal areas. Furthermore, different techniques of interdental hygiene were compared.

Methods: Participants (n = 108) were instructed to clean their teeth using the Bass technique and were randomly assigned to three groups according to the type of interdental cleaning used: group A, use of interdental brushes; group B, no interdental hygiene (the control group); and group C, use of dental floss. Approximal Plaque Index (API), Plaque Index (PI), modified Sulcus Bleeding Index (mSBI) and the Bleeding on Brushing Index (BOB) were measured at baseline, and after 2 (t1) and 4 (t2) weeks. Statistical analysis was performed using the Wilcoxon test and the Mann-Whitney U-test.

Results: One-hundred and six participants completed the study. The BOB decreased significantly in all groups (P < 0.001) with the most pronounced reduction being recorded for group A (baseline: 49.3 ± 23.0%; 4 weeks: 5.1 ± 6.9%). Also, the mSBI (P < 0.001) decreased significantly in all groups during the study. The API appeared to be less affected by the oral hygiene than other indices. The highest correlation was observed between BOB and mSBI (r = 0.785, P < 0.001).

Conclusion: The BOB is a valuable complement for the existing array of indices in preventive dentistry, and is able to detect potential pathological processes in interproximal spaces. Additionally, this study suggests that interdental hygiene with individually selected brushes is superior to flossing.

Clinical relevance: With the BOB, gingival inflammation can be demonstrated to patients, which could increase compliance.

Keywords: Dental hygiene; bleeding on brushing; floss; index; interdental brushes; interproximal cleaning; preventive dentistry.

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Figures

Figure 1.
Figure 1.
The BOB-probe®. A diagnostic tool, with synthetic bristles and a central core of stainless steel, for measuring the Bleeding on Brushing Index (BOB).
Figure 2.
Figure 2.
Study design. API, Approximal Plaque Index; BOB, Bleeding on Brushing Index; IDB, interdental brush; mSBI, modified Sulcus Bleeding Index; PI, Plaque Index; PD, probing depths.
Figure 3.
Figure 3.
SOLO-STIX®, Fa. SOLO-MED GmbH: 12 sizes of cylindrical interdental brushes used in the study (synthetic bristles, central core stainless steel).
Figure 4.
Figure 4.
Approximal Plaque Index (API; in %) at baseline, and after 2 and 4 weeks, for group A [interdental brushes (IDB)], group B (control) and group C (floss). Bars represent mean; standard deviation is shown.
Figure 5.
Figure 5.
Plaque Index (PI) at baseline, and after 2 and 4 weeks, for group A [interdental brushes (IDB)], group B (control) and group C (floss). Bars represent mean; standard deviation is shown.
Figure 6.
Figure 6.
Modified Sulcus Bleeding Index (mSBI; in %) at baseline, and after 2 and 4 weeks, for group A [interdental brushes (IDB)], group B (control) and group C (floss). Bars represent mean; standard deviation is shown.
Figure 7.
Figure 7.
Bleeding on Brushing Index (BOB; in %) at baseline, and after 2 and 4 weeks, for group A [interdental brushes (IDB)], group B (control) and group C (floss). Bars represent mean; standard deviation is shown.
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