Interdental cleaning on a scientific foundation

By Dr Anna Nilvéus Olofsson, TePe
March 12, 2019

COLOGNE, Germany: Caries and periodontitis are the two most common oral diseases in the world. Periodontitis affects around half of all adults globally, and severe cases are found among 10–15 per cent of the population, increasing with age. The build-up of plaque around the teeth is the most important risk factor for the development of periodontitis. Besides its role in the treatment process, high-quality oral hygiene is therefore of the utmost importance to prevent the disease from developing and to prevent the disease from coming back and causing further bone loss. Studies show that a manual toothbrush used alone reduces plaque scores by 42 per cent on average and does not reach the interdental surfaces. Consequently, additional tools for interdental cleaning, such as floss, toothpicks or interdental brushes, are needed. The recommendation about which tools to use must always be individually tailored and based on clinical experience and scientific knowledge.

Several studies have compared interdental brushes and other interdental cleaning devices, especially floss, with respect to their influence on plaque and gingivitis. Patient preference is also a factor that has been evaluated. The research results in favour of interdental brushes are convincing.

As early as 1970, interdental brushes, toothpicks, and dental floss were compared with respect to plaque reduction in wide interdental spaces. The interdental brush was reported to be the preferable device for plaque removal. Since then, a large number of scientific articles have been published investigating the efficiency of interdental brushes and other interdental cleaning devices, such as floss and toothpicks. The conclusion is that interdental brushes, compared with other manual cleaning devices, have the highest efficacy regarding plaque removal and periodontal parameters.

Interdental brushes and dental floss have also been compared from a patient preference perspective, again with results in favour of the interdental brush. Studies have shown that most patients preferred the interdental brush over floss, that they felt the interdental brush to be both more efficient and easier to use, and that they were more willing to use it.

However, all recommendations concerning interdental cleaning devices need to be tailored to the individual patient. The sizes and shapes of the interdental spaces must be considered. Floss can be an alternative only when sites are too narrow for the interdental brush and show gingival and periodontal health. An individual who has been advised to use interdental brushes must also be instructed regarding the appropriate size or sizes and on a proper technique. All these factors may contribute to enhancing the individual’s oral self-care compliance, which is vital in preventing oral disease.

Current research emphasises the importance of good oral hygiene in maintaining oral health and preventing oral disease. There is growing scientific support for a link between periodontal disease and several systemic diseases, such as cardiovascular disease, diabetes and obesity. In addition, research has shown a significant association between periodontal disease and oral health-related quality of life. Oral diseases are no longer seen as problems affecting just the mouth, but rather diseases with consequences for overall health.

In order to achieve optimal plaque control, toothbrushing must be complemented by interdental cleaning. The interdental brush is the preferred device for most of the adult population globally. However, evaluating individual needs and conditions and weighing them together with scientific support must be the basis for instructions and recommendations. This is how to create the best possible foundation for patient compliance and long-lasting oral health.

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