Ch. 25 - Interdental and Supplemental Oral Self-Care Devices

Why is interdental cleaning necessary?

To remove plaque from areas that toothbrushing cannot adequately reach.

Which tooth surfaces do manual and power toothbrushes clean?

Facial, lingual, and occlusal surfaces.

Which areas does toothbrushing not adequately reach?

Proximal surfaces and the area immediately beneath the contact point of adjacent teeth.

When can initial disease present after plaque accumulates in interdental areas?

Within 2–4 days, according to the slides.

Why remove interdental plaque?

To help prevent periodontal disease and halitosis.

Where does periodontal disease most commonly begin according to the slides?

In the col area.

What is the col?

Nonkeratinized tissue beneath the contact of two adjacent teeth that connects the lingual and buccal papillae.

Is flossing the only option for interdental cleaning?

No. Several alternative devices are available.

Should floss always be the first or only device recommended?

No. The hygienist should consider other effective options.

Which alternatives to string floss are listed in the slides?

Interdental brushes, floss holders, and power flossers.

What outcomes can alternative interdental devices improve?

Plaque, bleeding, gingivitis, and pocket depths.

Is there evidence supporting interdental cleaning for caries reduction in adults?

The slides state that no evidence supports interdental cleaning for caries reduction in adults.

How much brushing is insufficient for patients with periodontal disease according to the slides?

Two minutes of brushing is insufficient.

How often is interdental cleaning recommended for patients with gingivitis?

Once daily.

When is floss ineffective?

When interdental gingiva is reduced or missing and embrasures are open.

When should a hygienist select interdental cleaning devices?

During the assessment phase.

What factors should be considered when selecting self-care devices?

Embrasure size, restorations, gingival contour and consistency, probing depths, clinical attachment level (CAL), tooth position and alignment, preference, cost, motivation, dexterity, ability, and disease susceptibility.

What type of self-care procedures should be recommended?

The simplest, least time-consuming procedures that are effective.

What should be done if a patient's current self-care regimen is effective?

Reinforce it without adding unnecessary devices.

How does limiting the number of self-care devices affect acceptance and effectiveness?

Patient acceptance and effectiveness are better when fewer devices are used.

What should a hygienist do if a patient's current self-care regimen is ineffective?

Ask the patient what they think and involve them in decision-making.

What factors may affect a patient's use of self-care devices?

Time required and difficulty using the device.

What is one benefit of flossing?

It reduces or prevents inflammatory toxins.

What is a limitation of flossing?

It is a difficult skill.

For which patients is floss recommended according to the slides?

Patients with healthy gingiva and normal gingival contour.

When may other interdental devices be more effective than floss?

With larger embrasure spaces and periodontal disease.

Which therapy has more impact on interproximal caries according to the slides?

Fluoride therapy.

For which embrasure classification is dental floss or tape recommended?

Class I embrasures.

What else should be considered when recommending floss?

Dexterity and patient preference.

What materials are used to make dental floss?

Synthetic monofilaments or multifilaments.

What is a monofilament floss?

Floss made from a single filament.

What is a benefit of coated monofilament floss?

It slides easily between teeth and does not fray.

What is a characteristic of multifilament floss?

It allows separation of the filaments.

Is waxed floss more effective than unwaxed floss?

No difference in effectiveness is stated in the slides.

What is dental tape?

A wider, flatter ribbon-style form of dental floss.

What are the three segments of tufted floss?

Waxed or unwaxed floss, nylon meshwork, and a nylon threading needle.

Which type of floss removes more plaque according to the slides?

Braided floss.

How much floss should adults use with the spool method?

12–18 inches.

Where should floss be wrapped when using the adult spool method?

Around the middle fingers, leaving approximately ½ inch between them.

Which fingers direct floss during the adult spool method?

The index fingers.

How should floss pass through the contact area?

With a gentle seesaw motion.

How should floss adapt around each tooth during cleaning?

Wrap it tightly in a C shape.

How many up-and-down strokes should be used with floss?

Three to four strokes.

What should be done as floss becomes soiled during use?

Advance to a clean section.

How much floss is used in the children's loop method?

8–10 inches.

How is the children's loop flossing method prepared?

Tie the two ends of the floss together in a knot.

How is floss advanced in the children's loop method?

Slide it away from the knot to a clean section.

How should floss be held in the children's loop method?

With the thumbs and index fingers.

What is the correct sequence for adapting floss past a contact point?

Use a gentle seesaw motion through the contact, then move the floss up and down.

What can happen if floss is forced through a contact area?

Gingival trauma.

Who may benefit from floss holders?

Patients who have difficulty using string floss.

How effective are floss holders at reducing gingivitis?

They are as effective as string floss at reducing gingivitis according to the slides.

Why might patients choose floss holders over string floss?

They may find them easier or prefer them.

What are floss threaders used for?

Cleaning under fixed prosthetics and around abutments.

What is an abutment in the context of these slides?

A supporting tooth or structure around which floss may need to pass.

What is a dental water flosser?

An interdental cleaning device that uses a stream of water.

What type of water stream was studied for dental water flossers?

A pulsating stream.

In which situations have pulsating dental water flossers been studied?

Fixed orthodontics, implants, crowns, bridges, gingivitis, and periodontal maintenance programs.

What outcomes can pulsating water flossers improve according to the slides?

Plaque, bleeding, gingivitis, pocket depth, bacteria, and calculus.

Have steady-stream devices attached to showers or faucets been clinically tested for efficacy according to the slides?

No.

What is hydrokinetic activity in water flossers?

Activity that produces compression and decompression.

What pressure range is listed for dental water flossers?

50–90 psi.

At what setting should a water flosser be started?

Low.

How deeply can a dental water flosser reach compared with other cleaning methods?

Deeper into a pocket than a toothbrush, interdental aid, or rinsing.

How much solution can a standard water flosser tip reach into pockets 0–3 mm deep?

Approximately 71%.

How much solution can specialty water flosser tips deliver into pockets 6 mm or less?

Up to 90%.

What is the most effective method of interdental plaque removal and inflammation reduction according to the slides?

Interdental brushes.

What are the two most common interdental brush shapes?

Cylindrical and tapered.

How do interdental brushes compare with floss in type II and III embrasures and furcations?

They are equally or more effective for plaque removal and inflammation reduction.

How should the size of an interdental brush compare with the embrasure?

It should be slightly larger than the embrasure space.

At what angle should an interdental brush be inserted?

At a 90-degree angle.

From which surfaces can an interdental brush be inserted?

Facial and/or lingual.

What should be done to an interdental brush after use?

Rinse the bristles and handle to remove debris.

When are end-tufted or single-tufted brushes used?

For type II and III embrasures, furcations, specific sites, and fixed dental appliances.

What are examples of site-specific areas for end-tufted brushes?

The distal of molars and the lingual of sextant 5.

What motion is used with end-tufted or single-tufted brushes?

A rotating motion.

What oral benefit do ordinary household toothpicks provide according to the slides?

Removing food between teeth, with no additional oral benefit.

Which toothpick devices are recommended in the slides?

A toothpick holder or triangular toothpick (wedge).

At what angle should a triangular toothpick be placed?

At the proximal surface, angled occlusally at 45 degrees.

From which direction should a triangular toothpick be used?

From the facial only.

What motion should be used with a triangular toothpick?

An in-and-out motion.

How many strokes should be used with a triangular toothpick?

Approximately four strokes per surface.

When should pressure with a triangular toothpick stop?

When slight resistance is felt.

What is the primary purpose of rubber tip stimulators?

Gingival stimulation rather than plaque control.

What are potential benefits of massaging the gingiva with a rubber tip stimulator?

Improved circulation and increased keratinization.

Why should tongue cleaning be included in an oral self-care routine?

It helps address tongue bacteria and halitosis.

Which compounds from food putrefaction on the tongue are associated with halitosis?

Hydrogen sulfide and methyl mercaptan.

What is the primary cause of halitosis according to the tongue-cleaner slides?

Putrefaction of food on the tongue.

How can tongue cleaners compare with toothbrushes regarding the gag reflex?

A tongue cleaner may stimulate the gag reflex less than a toothbrush.

In which direction should a tongue cleaner move?

From the posterior toward the tip.

What should a patient do if tongue cleaning causes gagging?

Move the cleaner from lateral border to lateral border.

What other tongue-cleaning option is listed?

Powered attachments.

When might tooth towelettes be useful?

When toothbrushing is not possible.

In which direction should a tooth towelette move?

From the cervical margin toward the incisal or occlusal surface.

What devices are listed for cleaning clasps and dentures?

A clasp brush and a denture brush.

Where can oral piercings be located?

Perioral areas such as the cheeks, nose, and eyebrows.

What sterilization concern is associated with piercing professionals?

There may be inadequate enforcement of sterilization procedures.

What long-term oral complications can oral piercings cause?

Tooth fractures, gingival recession, and alveolar bone loss.

What should patients with oral piercings be instructed to do?

Brush the piercing daily and avoid clicking jewelry against the teeth.

What flossing behaviors can cause gingival trauma?

Using too long a piece of floss, snapping floss through contacts, failing to wrap floss before moving subgingivally, and failing to use a finger rest.