interdental cleaning

what are the main ways of interdental cleaning?

• Interdental brushes - nylon 

• Interdental silicone sticks

• Floss

• Fossettes

is flossing/interdental cleaning really necessary?

• yes! - though there was some contrasting literature 

• Evidence supports the use of interdental brushes for cleaning between the teeth where there is space to do so – particularly in areas of periodontal tissue loss caused by periodontitis

• Therefore, floss is not a waste of time – it is a viable alternative to interdental brushing where appropriate → eg tight contacts

• difficult to investigate - needs very long term studies → perio is a chronic long term disease

recommendation

Scientific meeting in 2015 evaluating evidence to produce guidelines for the prevention of periodontal diseases

Recommendation “Daily cleaning between your teeth using special interdental brushes is essential for treating and preventing gum disease. Floss is of little value UNLESS the spaces between your teeth are too tight for the interdental brushes to fit without hurting or causing harm”

Interdental brushes

• First choice for interdental cleaning where appropriate

• Remove plaque supra and subgingival surfaces approximately 2-2.5 mm below gum margin

• Can be cylindrical or tapered

• Better engagement of interproximal spaces after disease or recession

• Good for engaging root concavities → exposed roots due to recession

• Easy to use

• good for orthodontic appliances 

• chlorohexidine gel can be added onto the brushes to reduce inflammation → short term basis

• don’t put toothpaste on the interdental brushes as the toothpaste contains abrasive agents → they may access subgingival areas - cementum/root dentine → wearing as they are less mineralised

• should be done BEFORE brushing → fluoride have access to these areas

interdental brushes are inserted just above the papilla - back and fourth

how often do you change the brushes - depends on how often the brushes are used and how many teeth they are used on → most patients need a variety of brushes

general rule - lasts a week

use of these brushes should be reviewed regularly → spaces between the teeth will become larger due to reducing inflammation as treatment progresses → needs to move a size up 

Silicone (rubber) sticks

diameter is narrow - best to replace the smaller TePe brushes 

Flossing

• Advise where spaces too tight for interdental brushes

• Difficult → long term compliance is poorer compared to interdental brushing

• Requires skill and manual dexterity

• Time consuming compared to interdental brushes

• Waxed/unwaxed → waxed is smoother and can pass through the contact point more easily 

• Flossettes (holders)/floss holders

• Superfloss for bridgework

flossing techniques

20-30 cm 

small length is passed through 

Other floss types

1. Flossettes

2. SuperFloss

3. tape - wider version of floss

Single-tufted brushes

• Crowding, rotated or tipped teeth

• Localised gingival recession

• Lone standing teeth

• Partially erupted wisdom teeth

• operculum - skin flap over tooth → plaque trap underneath

• Implants, furcation areas, fixed orthodontic retainers

• Place bristles into gingival margin area.

• Apply medium pressure while moving brush in small circular motions

Oral irrigators – water, liquid or air-based

• Limited evidence for effectiveness

• Dislodge food particles

• Minimal impact on plaque removal and inflammation unless medicaments (chlorohexidine) added