Ch 25 - Interdental and Supplemental Oral Self-Care Devices

Why is toothbrushing alone insufficient?

It does not reach proximal tooth surfaces or the area immediately under adjacent tooth contact points.

What does toothbrushing clean?

Facial, lingual, and occlusal tooth surfaces.

Is flossing the only interdental cleaning option?

No.

When can initial disease present if interdental areas are not cleaned?

Within 2–4 days.

Why remove interdental plaque?

To prevent periodontal disease and halitosis.

Where does periodontal disease most commonly begin?

In the col area.

Col

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

What should dental hygienists know about floss?

Floss should not be the first or only tool used to prevent and reverse inflammation.

Interdental alternatives

ID brushes, floss holders, and power flossers.

Effectiveness of interdental alternatives

As effective or more effective than floss for reducing plaque, bleeding, gingivitis, and pocket depths.

Interdental cleaning and caries

No evidence supports interdental cleaning for caries reduction in adults; potential exists in primary teeth.

Brushing duration for patients with periodontal disease

Two minutes of brushing is insufficient.

Interdental cleaning recommendation for gingivitis

Once-daily interdental cleaning is recommended.

When is floss ineffective?

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

How should interdental devices be selected?

Evaluate during assessment and select the most appropriate aid.

Factors for selecting self-care devices

Embrasure size, gingival tissue contour and consistency, restorations, tooth position and alignment, probing depths, CAL, cost, preference, motivation, susceptibility to disease, dexterity, and ability.

Recommended self-care procedures

Simplest, least time-consuming procedures that are effective.

If a current self-care regimen is effective

Reinforce it and do not add anything new.

How does limiting self-care devices affect patients?

Patient acceptance and effectiveness are better when the number of devices is limited.

What should you do if a self-care regimen is ineffective?

Ask the patient what they think.

Patient involvement in device selection

Patients must participate in decision-making.

What should be considered when a device is difficult to use?

Time and difficulty using it.

Benefits of flossing

Flossing reduces or prevents inflammatory toxins.

Flossing difficulty

Flossing is a difficult skill.

Who is floss recommended for according to the slides?

Patients with healthy gingiva and normal gingival contour.

Other devices and larger embrasures

Other devices are more effective with larger embrasure spaces and periodontal disease.

Fluoride and interproximal caries

Fluoride therapy has more impact on interproximal caries.

Dental floss and tape use

Class I embrasures; also consider dexterity and patient preference.

Dental floss materials

Synthetic monofilaments or multifilaments.

Coated monofilament floss

Slides easily between teeth and does not fray.

Multifilament floss

Allows separation.

Waxed vs. unwaxed floss effectiveness

No difference in effectiveness.

Dental tape

Ribbon-shaped floss that is wider and flatter.

Tufted floss segments

Three segments: waxed or unwaxed floss, nylon meshwork, and nylon threading needle.

Braided floss

Removes more plaque.

Spool floss length

12–18 inches.

Spool floss finger placement

Wrap around middle fingers, leaving ½ inch between.

Spool floss direction

Guide floss using index fingers.

Spool floss through contact area

Use a gentle seesaw motion.

Spool floss around tooth

Wrap tightly in a C shape.

Spool floss strokes

Move floss up and down 3–4 strokes.

Spool floss advancement

Advance to a clean section of floss.

Loop floss method use

Children.

Loop floss length

8–10 inches.

Loop floss preparation

Tie the two ends together in a knot.

Loop floss technique

Follow the spool flossing steps.

How is floss advanced in the loop method?

Slide floss away from the knot to a new area.

Loop floss completion

Repeat until all teeth are completed, continuing to grasp floss with thumb and index fingers.

How should floss pass the contact point?

Use a gentle seesaw motion.

What should be done after passing the contact point?

Move floss up and down.

Floss holders and threaders use

For patients who have difficulty using string floss.

Floss holders and threaders effectiveness

As effective in reducing gingivitis.

Patient preference for floss holders

Patients may prefer them over string floss.

Floss holders and threaders for prosthetics

Used under fixed prosthetics and around abutments.

Dental water flossers

Devices that deliver a stream of water for interdental cleaning.

Water flosser research populations

Studies include fixed orthodontics, implants, crowns, bridges, gingivitis, and periodontal maintenance programs.

Pulsating water flosser effects

Reduces plaque, bleeding, gingivitis, pocket depth, bacteria, and calculus.

Steady-stream water flossers

Devices attached to showers or faucets have not been clinically tested for efficacy.

Hydrokinetic activity

Produces compression and decompression.

Water flosser pressure

Medium to high pressure; start on low.

Water flosser pressure range

50–90 psi.

Water flossers and pocket depth

Reach deeper into pockets than toothbrushes, interdental aids, or rinsing.

Standard water flosser tip reach

Can reach 71% in pocket depths of 0–3 mm.

Specialty water flosser tip reach

Can deliver up to 90% of solution in pockets ≤6 mm.

Interdental brushes

Most effective method of interdental plaque removal and inflammation reduction.

Common interdental brush shapes

Cylindrical or tapered.

Interdental brushes vs. floss

Equal to or more effective than floss in type II and III embrasures and furcations.

Interdental brush size

The brush must be slightly larger than the embrasure space to clean effectively.

Interdental brush insertion angle

Insert into the embrasure at a 90-degree angle.

Interdental brush access

From facial and/or lingual.

Interdental brush cleaning

Rinse to remove debris from bristles and handle.

End-tufted or single-tufted brush use

Type II and III embrasures, furcations, site-specific areas, fixed dental appliances.

End-tufted brush examples

Sites distal to molars and lingual of sextant 5.

End-tufted brush movement

Use a rotating motion.

Household toothpicks

Have no oral benefit beyond removing food between teeth.

Recommended toothpick alternatives

Toothpick holder or triangular toothpick (wedge).

Triangular toothpick placement

Place at proximal surface, angled occlusally at 45 degrees.

Triangular toothpick movement

In-and-out motion from facial only.

Triangular toothpick strokes

About four strokes per surface.

Triangular toothpick stopping point

Stop with slight resistance.

Rubber tip stimulators

Primarily used for gingival stimulation, not plaque control.

Effects of gingival massage with rubber tip stimulators

May improve circulation and increase keratinization.

Tongue cleaners

Often overlooked and should be included in oral care.

Tongue food putrefaction products

Hydrogen sulfide and methyl mercaptan.

Primary cause of halitosis listed

Putrefaction of food on the tongue.

Tongue cleaner and gag reflex

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

Tongue cleaner direction

Start at the posterior and move toward the tip.

Tongue cleaner technique if gagging

Move from lateral to lateral border.

Powered tongue cleaner attachments

Can be used for tongue cleaning.

Tooth towelettes use

When toothbrushing is not possible.

Tooth towelette direction

Move from cervical margin toward incisal or occlusal.

Clasp and denture brush

Additional oral self-care device.

Oral piercing locations

Perioral areas such as cheeks, nose, and eyebrows.

Oral piercing sterilization risk

Piercing professionals may lack enforcement of sterilization procedures.

Long-term oral piercing risks

Tooth fractures, gingival recession, and alveolar bone loss.

Oral piercing patient instruction

Brush the piercing daily.

Oral piercing jewelry instruction

Avoid clicking jewelry against teeth.

Causes of gingival trauma during flossing

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

Patient education humanistic approach

Ask permission before giving advice.

Interdental and subgingival cleaning education

Explain its importance in preventing and controlling periodontal disease.