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


  • Conflict of interest and source of funding statement

    There are no conflicts of interest associated with this study. The study was supported in part from grants received from FAPERGS, CAPES and CNPq. Registration number NCT01636830,


Rui Vicente Oppermann

Rua Ramiro Barcelos 2492 - Rio Branco

Porto Alegre-Rio Grande do Sul





To compare the incidence of gingival fissures after the use of soft and medium-hard toothbrushes.

Material & 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.


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.


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.