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The aim of this study was to investigate whether the sequence of brushing and flossing would have an impact on the efficacy of plaque removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 56 college students were randomly assigned to the floss-brush group and the brush-floss group. A baseline plaque index (PI) assessment was performed on the participants, followed by oral hygiene instruction on the modified Bass brushing technique and flossing methods. The participants in the floss-brush group were directed to floss before brushing their teeth, while the brush-floss group executed the same tasks, differing only in the order of operations. The Turesky Modified Quigley-Hein Plaque Index (TMQHPI) was utilized to assess total, buccal, lingual, and interproximal plaque, with results deemed statistically significant at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Values are presented as mean\u2009\u00b1\u2009standard deviation (mean\u2009\u00b1\u2009SD). The floss-brush group exhibited significantly greater mean\u2009\u00b1\u2009SD reductions in PI compared to the brush-floss group in the maxillary anterior region for both total surfaces (1.13\u2009\u00b1\u20090.87 vs. 0.71\u2009\u00b1\u20090.89;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) and interproximal surfaces (1.15\u2009\u00b1\u20090.92 vs. 0.65\u2009\u00b1\u20090.86;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), as well as in the mandibular anterior region for total surfaces (0.91\u2009\u00b1\u20090.76 vs. 0.64\u2009\u00b1\u20090.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026) and interproximal surfaces (0.93\u2009\u00b1\u20090.80 vs. 0.62\u2009\u00b1\u20090.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031). No statistically significant difference was identified between the two groups in other regions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results suggest a potential advantage of flossing followed by brushing in anterior regions, evidenced by greater PI reduction compared to brushing then flossing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      (23-07-2024) on\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.chictr.org.cn\/\" ext-link-type=\"uri\">https:\/\/www.chictr.org.cn\/<\/jats:ext-link>\n                      with the ID (ChiCTR2400087214).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-07984-6","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T10:35:37Z","timestamp":1772015737000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of brushing-flossing sequence on plaque removal: a single-blind, randomized controlled trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Yi-Fei","family":"Ma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hui","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-Zhen","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"7984_CR1","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1111\/jcpe.12366","volume":"42","author":"ILC Chapple","year":"2015","unstructured":"Chapple ILC, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, Madianos P, Louropoulou A, Machtei E, Donos N, et al. 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