Evaluating the hidden impact of interdental cleaning habits on maxillary anterior papilla integrity: a cross-sectional study.

OBJECTIVES: This study aimed to evaluate the association between toothpick use and loss of interdental papilla in the maxillary anterior teeth, focusing on the impact of frequency, duration, and technique of use. METHOD AND MATERIALS: A cross-sectional study was conducted among 69 participants to assess toothpick utilization on the interdental papilla of maxillary anterior teeth. Participants aged 20 to 29 were selected based on specific criteria, including manual toothbrushing and exclusive use of toothpicks as their interdental cleaning tool with no other interdental aids. Interdental papilla integrity was assessed using the Papilla Presence Index (PPI). A structured questionnaire was used to record frequency, duration, and method of toothpick use. Clinical measurements included interdental papilla loss, papilla height, proximal contact length, and alveolar bone level. Comparisons were conducted between toothpick users and nonusers to evaluate differences in interdental papilla parameters. RESULTS: A total of 69 individuals participated in the study; 87% of them reported using toothpicks. Toothpick users exhibited significantly reduced papilla presence compared to nonusers (P .05). The vertical 'up/down' technique was associated with greater papilla loss than the horizontal 'in/out' method. Increased frequency (> 3 times a day) and longer duration (> 3 years) were significantly associated with more severe papilla loss. No significant differences were observed in bone levels or proximal contact length, suggesting that hard tissue structures were not affected. CONCLUSION: Frequent and prolonged toothpick use, particularly with vertical technique, is associated with significant interdental papilla loss in maxillary anterior teeth, leading to esthetic concerns described as 'black triangles.' Given the study's cross-sectional design and modest sample size, causality cannot be established, and findings should be interpreted with caution. Clinicians should consider advising safer interdental cleaning alternatives, given the observed association between toothpick use and papilla loss, to maintain both esthetic and functional integrity of the interdental papilla.