title: The incidence of gingival fissures associated with toothbrushing: crossover 28-day randomized trial.
abstract: OBJECTIVE
  To compare the incidence of gingival fissures after the use of soft and medium-hard toothbrushes.
  
  
  METHODS
  Overall, 35 participants (14-20 years old), with periodontal attachment loss (PAL) ≤1 mm, were assigned to soft or medium-hard toothbrushes in a crossover design with a wash-out of 10 days between two 28-days periods. Gingival fissures were assessed using a disclosing solution. Pictures were taken from a selected quadrant every 2-3 days 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.
authors: Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors: Bruna Frizon
authors: BF
authors: Greggianin
authors: Sara Cioccari
authors: SC
authors: Oliveira
authors: Alex Nogueira
authors: AN
authors: Haas
authors: Rui Vicente
authors: RV
authors: Oppermann
mesh_terms: D000293:Adolescent; D018592:Cross-Over Studies; D003773:Dental Plaque / Q000150:complications; D005260:Female; D005882:Gingival Diseases / Q000209:etiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D017622:Periodontal Attachment Loss / Q000150:complications; D012737:Sex Factors; D016037:Single-Blind Method; D013997:Time Factors; D014099:Toothbrushing / Q000009:adverse effects*; D055815:Young Adult