Frequent and prolonged toothpick use, particularly with vertical technique, is associated with significant interdental papilla loss in 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 may consider advising safer interdental cleaning alternatives, given the observed association between toothpick use and papilla loss to maintain both aesthetic and functional integrity of the interdental papilla.
ElHaddad et al. (Fri,) studied this question.