Interdental and Supplemental Oral Self-Care Devices

Interdental and Supplemental Oral Self-Care Devices

Learning Objectives

• Relate the removal and control of interdental bacterial biofilm to current evidence regarding the prevention of oral disease.
• Select effective self-care devices including interdental and supplemental self-care devices for each patient based on efficacy, individual patient needs, and preferences. Also, discuss oral piercings and their impact on dental procedures, as well as the risks involved.
• Educate patients as co-therapists in the safe and effective use of self-care devices designed for interdental and subgingival biofilm removal, considering oral conditions, patient preferences, risk factors present, and current evidence.

Introduction

• Removal of plaque biofilm from spaces where toothbrushing does not reach is important for the following reasons:
  • To prevent periodontal disease
  • To prevent halitosis
• Patients depend on dental hygienists to help them navigate the “oral care aisle.”
• Dental hygienists must remain current and familiar with different devices.

Interdental Devices

• Several clinical trials and meta-analyses have shown that alternatives to manual floss are as effective or more effective than dental floss:
  • Interdental brushes
  • Floss holders
  • Power flossers
• When interdental gingiva is reduced or missing and embrasures are open, other methods of interdental cleaning are needed.

Interproximal Embrasure Types

• Type A: Embrasure is filled completely by the interdental papilla.
• Type B: Embrasure is partially filled by the interdental papilla.
• Type C: Embrasure has a missing interdental papilla.

Benefits of Flossing

• Fluoride therapy has more impact on interproximal caries.
• Flossing is recommended for patients with healthy gingiva and normal gingival contour
• Reduction or prevention of inflammation caused by immune response to toxins produced by interdental plaque biofilm.

Dental Floss and Tape

• Choice of floss is influenced by:
  • Tightness of contact area
  • Contour of gingival tissue
  • Roughness of interproximal surface
  • User’s manual dexterity and preference
• Today’s dental floss is made of synthetic material monofilaments or multifilaments.
• Dental tape is wider/flatter than conventional dental floss.

Types of Floss

• Monofilament Floss: Example: Original Glide®
• Multifilament Floss: Example: J&J Unwaxed (Nylon)

Flossing Methods

• Two primary methods:
  • Spool method
    • Starts with all of the floss spooled on one finger of one hand; used section is taken up and spooled on other hand once it is used
  • Loop method
    • Ties two ends of floss together in a circle to move to a new section
• Important to demonstrate wrapping floss around each tooth to create a “C” shape around tooth.
• Hug and Scrub! C-shape flossing

Floss Holders and Threaders

• Floss holders: plastic handles that aid in holding floss strand.
• Studies have shown that use of floss with proper use of a floss holder reduced gingivitis as effectively as use of string floss.
• Floss threader: can either consist of a stiff end of floss that can be threaded or a separate device to use similar to a sewing needle and thread.

Dental Water Jets

• Mechanism of action:
  • Produces pulsating stream of fluid.
  • Works by impacting gingival margin with pulsed irrigant and subsequent flushing of gingival crevice or pocket.
• Depth of delivery of a solution:
  • Has ability to reach deeper into periodontal pocket than a toothbrush, interdental aid, or rinsing.
  • Standard jet tip has been shown to reach 71% in sulcus depths of 0 to 3 mm.

Interdental Brushes and Tips

• Interdental brushes: available in various sizes and shapes.
  • Most common brushes are cylindrical or conical/tapered; designed to be inserted into a plastic, reusable handle that is angled to facilitate interproximal adaptation.
• Interdental tips: also available in various sizes and materials.
  • Including plastic or foam for plaque biofilm removal to areas similar to interdental brushes.

Comparison of effectiveness

• Dental floss may be less effective than an interdental brush on long root surfaces with concavities.

Toothpicks, Toothpick Holders, and Triangular Toothpicks

• Toothpicks can either be wooden or plastic.
• Toothpick holders: designed to allow use from facial or lingual aspect and adapt better interproximally and posteriorly when compared with toothpicks alone.
• Triangular toothpicks: designed to remove interproximal plaque biofilm from type II and III embrasures.

Rubber Tip Stimulators

• Attached to end of metal or plastic handle
• Used primarily to stimulate gingiva and to remove plaque biofilm by rubbing it against the exposed tooth surfaces.
• Massaging gingiva with rubber tip or other device can lead to improved circulation, increased keratinization, and epithelial thickening.

Tongue Cleaners

• Doral surface of tongue hosts an abundance of organisms
• Halitosis (bad breath): common patient complaint
• Tongue cleaners, or scrapers, are designed and intended for removal of debris and bacteria from tongue’s dorsal surface
• Brushing tongue with toothbrush also can remove bacteria and debris

Additional Devices

• Tooth towelettes or finger-mounted wipes
  • Gauze squares usually treated with some form of mouthwash to freshen breath
  • Not meant to replace daily toothbrushing
• Clasp and denture brush
  • Designed with firm nylon filaments to clean dentures and clasps of partial dentures

Oral Piercings

• Cosmetic piercing for insertion of objects such as rings, studs, or pins
• Gingival recession is common risk to individuals with tongue or lip piercings
• Complications can occur immediately following procedure
  • Short-term risks:
    • Infection
    • Swelling
    • Bleeding at site

Dental Hygienist Engaging the Patient as Co-Therapist

• Patients are more likely to adhere to self-care recommendations if they are involved as clients or co-therapists
• Dental hygienists have responsibility for helping their patients select appropriate and effective interdental and supplemental self-care devices