Dental Health Education Module: Interdental Aids
Toothbrushing: Frequency & Timing
Frequency Recommendations:
Brush at least 2 times daily using fluoride toothpaste.
Emphasize the importance of brushing at night as it is most crucial for effective oral hygiene.
Minimum brushing duration of 2 minutes is recommended.
Techniques:
Utilize a toothbrushing technique suited to the patient’s individual needs, such as:
Bass technique
Modified Bass technique
Other relevant methods.
Why Interdental Care?
Toothbrushing Limitations:
Toothbrushing alone is insufficient to adequately remove biofilm from the proximal surfaces of teeth.
Benefits of Interdental Devices:
Daily use of interdental devices may significantly reduce the incidence of gingivitis and help manage dental biofilm.
Device Criteria:
Interdental care devices should be:
Easy to use
Effective in cleaning
Non-damaging to hard or soft oral tissues.
Where to Use Interdental Aids?
Class II Gingival Embrasure:
Recommendations for the type of interdental aid may vary based on several factors:
Size of the embrasure: Defined as the triangular space beneath the contact area that may be partially or completely filled by gingival tissue.
The periodontal condition of the patient.
The presence of prostheses might affect oral hygiene practices.
Accessibility to hard-to-reach areas within the mouth.
Anatomy of the Posterior Interdental Area - Question
Which of the following statements accurately describes the anatomy?
❑ Between adjacent teeth, there is a single papilla that forms a col under the contact area.
❑ Between adjacent teeth, there are two papillae, one on the facial aspect and one on the lingual aspect.
❑ The col area is thick and keratinized.
Planning Interdental Care
Considerations for Effective Care:
Conduct thorough patient assessment.
Review the patient’s history of personal oral care practices.
Evaluate the dental and gingival anatomy of the patient.
Assess the extent and location of dental biofilm (using a biofilm score with a disclosing agent).
Take into account personal factors such as disabilities and oral health literacy.
Utilize evidence-based clinical decision making, particularly in relation to the patient's gingival health status.
Create a dental hygiene care plan focused on:
Clear objectives
Initial care plan frameworks.
Selective Interdental Biofilm Removal
Relation to Toothbrushing:
Various methods of toothbrushing can effectively remove the majority of dental biofilm located near the line angles of teeth, including:
Charters method
Stillman method
Bass method.
Vertical brushing may also provide additional access for effective cleaning.
Selection of Interdental Aids:
Important to choose appropriate aids based on the patient’s needs.
Interdental Brushes
Types of Interdental Brushes:
Small insert brushes designed with a reusable handle.
Travel-sized interdental brushes for convenience.
Rubber interdental cleaners available for gentle cleaning.
Indications for Use:
Effective in the removal of dental biofilm and debris:
See Figure 27-2 for examples of interdental brushes and cleaners.
Can be used for the application of chemotherapeutic agents.
Procedure and Care:
Discuss proper care and technique for utilizing brushes effectively.
Interdental Aids: Various Types of Interdental Cleaners
Assessment of Floss Effectiveness:
Evaluate the effectiveness of dental floss in the context of open embrasures and attachment loss:
Consider various types of floss such as:
Waxed
Unwaxed
Dental tape
Polytetrafluorethylene floss (PTFE)
Super floss
Flossers
Water flossers.
Interdental Aids: Use of Dental Floss
Technique Demonstrations:
Hold floss using different grips:
For maxillary insertion, hold the floss between the thumb and index finger.
For mandibular teeth, guide the floss down with index fingers.
Procedure:
Use a short sawing motion to work the floss slowly between teeth.
Curve the floss around the tooth in a C shape.
Press the floss firmly against the tooth, moving gently beneath the gingiva, and sliding the floss up and down with adequate pressure.
Start flossing with the distal surface of the most posterior tooth.
Interdental Aids: Additional Tools
Floss Threader:
Optional tool for enhancing the ease of flossing.
Tufted Dental Floss:
Features a stiffened end for easier insertion under pontics.
Floss Holder:
Techniques to avoid incorrect use of floss holders.
Interdental Aids: Gauze Strips and Power Flossers
Use of gauze strips for effective cleaning between teeth.
Advantages of power dental flossers in improving oral hygiene efficiency.
End-tuft brushes for specific cleaning areas.
Rubber tips and rubber stimulators:
Used for massage and stimulation of gingival tissues.
Toothpicks in holders (Perio Ace):
Indicated for conditions such as periodontitis and for use around orthodontic appliances.
Water Flosser
Types and Attachments:
Discuss capabilities and types of water flosser attachments:
Identify factors for choosing suitable attachments.
Interdental Aids – Frequency & Timing
Recommendations for Use:
Employ interdental aids at least once daily, preferably before bedtime brushing to maximize the effectiveness of fluoride in interdental spaces.
Highlight the essential role of interdental aid usage in preventing gingivitis and periodontitis.
Documentation
Importance of Documentation:
Patient’s interdental care progress should be meticulously documented:
Include:
All recommendations for interdental aids.
Demonstrations performed with the patient related to the use of these aids.
Reference Box 27-1 for sample documentation formats.
Factors to Teach the Patient (1 of 2)
Visual Aids:
Utilize a disclosing solution to visually illustrate the limitations of toothbrush access in cleaning the interdental area.
Biofilm Education:
Discuss biofilm accumulation on proximal tooth surfaces and the consequences of neglecting these areas for infection risk.
Factors to Teach the Patient (2 of 2)
Hands-on Demonstrations:
Provide practical demonstrations to show proper use of interdental aids in cleaning proximal tooth surfaces.
Encourage patients to demonstrate their understanding of the recommended aid usage.
Stress the importance of seeking professional guidance regarding new oral care products to ensure suitability.
Key Takeaways - Interdental Aids
Toothbrushing alone is inadequate in reaching interdental areas.
Daily interdental cleaning is fundamental to reducing gingivitis and managing biofilm.
The choice of cleaning device varies based on:
Embrasure type
Individual anatomy
Patient dexterity.
Evidence suggests that interdental brushes are often more effective than floss in wider spaces.
Floss is primarily effective for Type I embrasures where papillae are intact.
Adjunctive aids, such as stimulators and water flossers, provide essential support for special needs.
Tailored recommendations for interdental care constitute the standard of care according to the American Dental Hygienists' Association (ADHA) and Commission on Dental Accreditation (CODA).
ADA Seal of Acceptance
Established by the American Dental Association (ADA) in 1931.
Products bearing the seal have undergone thorough scientific testing for safety and effectiveness.
The seal indicates that the product complies with both ADA and FDA standards.
Aids patients in identifying evidence-based oral health products.
Over 200 different products are certified with this seal.
Canadian Dental Association Seal of Acceptance (CDA Seal)
Independently validates specific oral health benefit claims made by products.
Manufacturers must present evidence for claims to be reviewed by expert opinions from the CDA.
The seal can be found on products like toothpaste, mouthwashes, toothbrushes, floss, and water flossers.
Aids both consumers and dental professionals in making informed choices about product effectiveness.
Highlights that claims verified by CDA Seal are reliable, though the absence of the seal does not always denote ineffectiveness, simply that the product has not undergone the review process.