WILK ch27 Interdental Care

Why can't toothbrushing alone adequately clean the interdental area?

It cannot remove biofilm from the proximal surfaces and adjacent gingiva to the same degree as the facial, lingual, and palatal surfaces.

What is the col?

A depressed, concave area between the facial and lingual or palatal papillae of posterior teeth that follows the shape of the apical border of the contact area.

What type of epithelium covers the col, and why does it matter?

Thin, non-keratinized epithelium, which is less resistant to infection.

How many papillae are between adjacent posterior teeth?

Two: one facial and one lingual or palatal.

What shape is the papilla between anterior teeth in contact?

A single, pyramidal-shaped papilla.

Where is the incidence of gingivitis greatest?

In the interdental tissues.

Which three factors affect interdental papilla height?

Shape of the tooth, interproximal bone height, and thickness of the gingiva.

What happens to the papilla and col when inflammation is present?

The papilla enlarges from increased inflammatory cells and edema, and the col becomes deeper.

Which proximal features make biofilm removal harder after attachment loss?

Root concavities, grooves, and furcation areas.

What two factors are key in selecting an interdental device?

Embrasure size and the patient's status of health or disease.

Which device is indicated for a Type I embrasure with healthy tissue and a highly compliant patient?

Dental floss.

What are alternatives to floss for closed embrasures when the patient lacks motivation or dexterity?

Floss holders or easy flossers, rubber interdental cleaners or soft picks, oral irrigation, or small interdental brushes.

Which device is most effective for Type II and Type III (open) embrasures?

Interdental brushes.

Which interdental aid is preferred when gingival inflammation is present?

Interdental brushes.

What is the minimum recommended frequency of interdental care?

Twice daily.

Which communication approach is used to select appropriate interdental aids with a patient?

Motivational interviewing.

How should the initial care plan be designed?

Start with the simplest procedures, based on the patient's current knowledge, preferences, and habits, and keep the routine realistic for the time the patient will spend.

Why can an interdental brush clean concave proximal surfaces that floss cannot?

Floss bridges across a concavity without contacting it, while the brush filaments reach into the concavity.

What size requirement makes an interdental brush effective?

The brush must fill the embrasure.

How is an interdental brush used?

Insert it at an angle that follows the gingival form, move it in and out, and apply pressure toward the mesial surface and then the distal surface.

What is a rubber interdental cleaner or soft-pick?

A device like an interdental brush but without a wire, with small elastomeric fingers perpendicular to a plastic core.

What is the trade-off of rubber interdental picks compared with wire brushes?

They are more comfortable to insert but may remove less biofilm because they have fewer bristles.

How should an interdental brush be cared for?

Rinse under running water during use, clean thoroughly after use, dry in open air, and discard before the filaments become deformed or loosened.

Is there a difference in biofilm removal between waxed and unwaxed floss?

No, research shows no difference.

What are the three floss materials named in the chapter?

Silk, nylon, and polytetrafluoroethylene (PTFE).

What are the advantages of PTFE floss?

It is a monofilament that resists breakage and shredding and requires less force to pass through a contact, which may improve compliance and reduce tissue injury.

What are the features of waxed floss?

The wax helps it slide through contacts, may minimize tissue trauma, and adds strength and durability.

What is the downside of unwaxed floss?

It can fray on irregular surfaces, rough restorations, or calculus, which may frustrate the patient and reduce motivation.

How much floss is used and how much is held between the fingertips?

12 to 15 inches, with about 1/2 inch held between the fingertips.

What are the advantages of a floss circle or loop?

Improved compliance, easier handling, less waste, and better floss hygiene and biofilm removal; it may help children.

How is floss guided through a contact area?

With a gentle back-and-forth sawing motion, controlling the floss so it does not snap into the gingiva.

How is the cleaning stroke performed with floss?

Curve the floss in a C shape around the tooth, pass it below the gingival margin, and slide it up and down several times, using a fresh section for each surface.

Why should floss be looped around the distal surface of the most posterior teeth?

Those surfaces would otherwise be missed, so each quadrant's last tooth and teeth next to edentulous areas need separate cleaning.

What are floss clefts, and where do they occur?

Straight-line cuts that begin at the gingival margin on facial and lingual or palatal surfaces beside or in the middle of a papilla.

What are three causes of floss injuries?

Floss too long between the fingers, snapping it forcefully through the contact, and not curving it around the tooth.

What is a floss threader and when is it used?

A flexible plastic device like a needle with a large loop that carries floss under fixed partial dentures, implants, and orthodontic wires or appliances.

What is tufted dental floss?

Regular floss alternated with a thickened, spongy portion, with a stiffened end that is inserted like a floss threader (example: Super Floss).

Who benefits most from a floss holder?

Persons with a disability and parents or caregivers cleaning for a child or another adult.

What are the uses of a gauze strip?

Widely spaced teeth, teeth next to edentulous areas, outer surfaces of fixed partial denture abutments, and areas under posterior cantilevered sections of a fixed appliance.

How is a gauze strip prepared and used?

Cut 1-inch gauze into a 6 to 8 inch length, fold it in thirds or down the center, and work the fold back and forth at the cervical area next to the gingival crest.

What are two types of power flossers?

A battery-operated device with a disposable flexible nylon tip, and an air flosser that uses bursts of air and water droplets.

Who may benefit from a power flosser?

People who cannot use regular floss, have dexterity problems, or do not clean interproximally and want to try a tool.

What is an end-tuft brush used for?

Open interproximal areas, fixed prostheses, and hard-to-reach areas such as lingual surfaces of mandibular molars, distal surfaces of terminal molars, missing-tooth areas, and crowded teeth.

What is the interdental tip (rubber tip stimulator) used for?

Cleaning debris and removing biofilm at and just below the gingival margin, and shaping the interproximal area after periodontal surgery.

Is there evidence that the rubber tip stimulates gingival blood flow?

No, literature to support this is absent.

What is a toothpick in a holder, and what is it also called?

A round toothpick inserted into a contra-angled plastic handle, also called a Perio-Aid.

At what angle is the toothpick tip positioned for subgingival biofilm removal?

About 70 degrees to the long axis of the tooth, tracing slightly subgingivally along the gingival margin.

What are indications for the toothpick in holder?

Periodontitis patients, concave proximal surfaces, exposed furcations, and biofilm removal at the gingival margin above orthodontic bands.

What is the wooden interdental cleaner and a common brand?

A 2-inch triangular wooden wedge; a common brand is Stimudent.

When is a wooden interdental cleaner indicated?

When proximal tooth surfaces are exposed and the interdental gingiva is missing, with adequate space so tissue is not traumatized.

How is the wooden cleaner positioned and moved?

The base of the triangle is toward the gingival border, the tip points slightly occlusally or incisally, and it is moved in and out with a burnishing stroke, about four strokes to each side.

What are the limitations of the wooden interdental cleaner?

It cannot access root concavities, is difficult to use in posterior areas and from the lingual, and removes biofilm less effectively than floss.

How does the wooden cleaner compare with floss for patient use and gingival effects?

Patients use woodsticks more often than floss, and they significantly reduce bleeding and interdental inflammation.

What is another name for an oral irrigator?

A water flosser.

What is the effect of oral irrigators on gingival health and plaque?

They lower bleeding and gingivitis indices even if plaque levels are not affected, and they do not appear to reduce visible dental biofilm.

What caution applies to the research on water flossers?

Much of it has been funded by a single manufacturer, so there is a risk of bias and more research is needed.

For which patients are oral irrigators and interdental brushes recommended over floss?

Implant maintenance and orthodontic patients.

What is the purpose of irrigation?

To reduce the bacteria and inflammatory mediators that lead to the initiation or progression of periodontal infections.

What are the three types of oral irrigator devices?

Countertop, cordless, and shower models.

At what angle is the jet tip held for supragingival irrigation?

A right angle (90 degrees) to the long axis of the tooth.

What are key steps when using an oral irrigator?

Fill the reservoir, choose a tip, start on low power, lean over the sink, move systematically through the mouth, and empty the reservoir afterward to prevent bacterial growth.

What is the orthodontic tip for an irrigator used for?

Removing debris and loose biofilm from brackets, wires, and bands.

Why is the care plan varied within one mouth?

Embrasure types differ, so floss might be used on anterior teeth with tight embrasures and an interdental brush on posterior teeth with larger spaces.

What should interdental care documentation include at minimum?

All interdental aid recommendations and demonstrations with the patient.

What does SOAP stand for in the sample documentation?

Subjective, Objective, Assessment, and Plan.

Why is a disclosing solution used when teaching interdental care?

It gives the patient a visual understanding of the toothbrush's limits in cleaning the interdental area.

Why must the patient demonstrate the interdental aid back to the clinician?

Hands-on return demonstration is essential to confirm the patient can use the device correctly.

Is there an ideal time to floss?

No, but flossing before brushing may help dislodge food debris and plaque biofilm.