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Education and Promotion of Interdental Hygiene

 

What are interdental brushes?

WHAT ARE INTERDENTAL BRUSHES AND WHY ARE THEY SO IMPORTANT? Interdental brushes are small cylindrical or conically shaped brushes that scrub in-between teeth where most periodontal and tooth decay problems start.  Interdental brushes are manufactured in different sizes, shapes and quality.  Most are fabricated with short handles which can be easily carried for use throughout the day. Some versions are made with longer handles and replaceable brush tips.  Better brands have plastic coated wires making them gentler on sensitive teeth and safe to use around dental implants.

 

Interdental Brush 3Interdental Brush 2Interdental BrushesWhy is it so important to
clean the space between teeth?

Although the hidden areas between your teeth amount to about 40% of the tooth surface, these areas account for about 80% of the problems. Adequate cleaning of these surfaces, where toothbrushes cannot reach, is essential to arrest tooth decay and gum disease. Most frequently, problems in-between teeth are initially silent and go unnoticed. By paying adequate attention to these areas, you not only reduce your chance of tooth destroying decay, root canal treatments and crowns, but you substantially reduce your tendency toward periodontal disease which causes tooth loss and unwanted by-products of infection from entering your bloodstream.

 

How do interdental brushes compare to floss?

HOW DO INTERDENTAL BRUSHES COMPARE TO DENTAL FLOSS Any oral hygiene aid, which reduces food and plaque from around teeth and gums, can be helpful.  There are still indications to use dental floss.  However, interdental brushes are usually easier to use and much more effective.  When you want to clean something well, most will agree that rubbing with a “bristle” will be more thorough than “a piece of string”.  Many people find flossing awkward and become discouraged as it is difficult to use around fillings and very cumbersome around bridges. In-between back teeth are concavities called furcations. Floss cannot reach into the depths of the furcations whereas interdental brushes have bristles which “fan-out” into them.

Many studies have shown that interdental brushes are superior to floss when we measure their affect on the reduction of gingival inflammation. (CLINICAL STUDIES). Another major advantage to interdental brushes is that they help keep too much loose detached gum from growing up and around your teeth; helping to prevent periodontal pocket formation. In areas where the tip of the triangle of gum in-between teeth called the papilla is essential for cosmetic appearance, perhaps around the front teeth or within the borders of your smile, floss may be preferred.  Interdental brushes should not be forced between teeth. If there is no room to insert them, as in areas of dental crowding or very thick gums, floss is a better option.  However, with various size brushes including extra small, even these areas can frequently, but not always, be adequately approached with the correctly fitted brush.

 

What size brush to use?

This is a tricky question with a simple answer…”The largest size that fits”.  Proper sizing is essential for maximum efficacy.  If the brush is too small for a larger area it will obviously not be as effective. However, if it’s too large, it will simply not fit, bend and frustrate the user.  With a full set of 32 teeth, there can be up to 30 different sized interdental areas. I suggest finding 2 different sizes—one for the smaller spaces and one for the larger.  Part of the IBBC mission is to provide your dental professional with adequate sample supplies to help educate and promote interdental brushes, enabling proper sizing and trial and error.  

 

How to use an interdental brush:

HOW TO USE AN INTERDENTAL BRUSH Choose the largest size that inserts without force. The correct size should fit snuggly but easily. Use light pressure to insert the brush straight (90 degrees) in-between teeth with a gentle wriggling action. Ease the brush in so that the wire does not buckle. Sometimes a slight bending or curving of the wire will allow for a better angle, especially on back teeth.  If the brush is pushed too hard, or the wrong size is used and the wire buckles, discard the brush.  Be careful not to overly stress the wire to avoid breakage. Move the brush back and forth between you teeth, between implants (only if wire is plastic coated) and under crowns and bridges. Orthodontic patients can also use interdental brushes as they slide between the arch wire and the tooth, removing plaque from around the brackets. It’s a simple skill that has a short learning curve. Stay with it for a few days and you will become more aware of how to angle the wire and shimmy the bristles between your teeth.

 

How long do interdental brushes last?

If carefully maintained, an interdental brush may last for a few days.  Of course this is also dependent upon the quality of the brush.  Like standard toothbrushes you can wash them out and re-use them until the bristles deteriorate or until bending has weakened the wire.  Preferably, you can dispose of them after a few uses.  Although interdental brushes may cost more than less effective oral hygiene aids, their use is far less costly than the need for additional treatment.  Dental and periodontal hygiene visits are an essential part of continued stability but what you do on a daily routine is foremost to maintain stable health. Unlike a toothbrush, it is convenient to keep an interdental brush in your pocket.  I suggest you always have one within reach.

 

What is periodontal (gum) disease?

Periodontal disease is a chronic inflammatory disease triggered by bacterial infection which ultimately destroys the supporting gums and bone around teeth. The inflammatory reaction is your body’s way of removing the toxins released by bacteria that live on your teeth and within your gums. However, when the inflammation lasts for too long, or is too strong, it starts to persistently erode the supporting tissues around your teeth. This may cause teeth to become loose and unable to be saved.

The all important benefits of healthy gums go well beyond the confines of the mouth. Periodontal disease is the most common cause of bacteria and by-products of inflammation entering the untreated patient’s bloodstream. The relationship of inflammation and other diseases is an intense field of study in medicine today. The role of inflammation has linked periodontal disease to heart disease, strokes, diabetes, pregnancy complications, respiratory ailments, rheumatoid arthritis, kidney disease and to even include certain types of cancers and dementias. More research is needed to pinpoint the precise biologic mechanisms responsible for the relationship between periodontal disease and other diseases. However, since the overwhelming evidence is that periodontal disease is linked to a higher risk for other diseases, it is crucial to maintain periodontal health in an effort to achieve overall health. A computer search can reveal millions of articles explaining and supporting these associations.

 

How does periodontal disease start?

Adult periodontitis is by far the most common form of periodontal disease. Describing the progression of periodontal disease can be simplified and relatively easy to understand. The bacteria found in dental plaque wedges between the gum and the tooth to a point where it is no longer possible for you to reach it with the bristles of your toothbrush or any oral hygiene aid. We call these areas periodontal pockets. Pockets are generally considered to extend 3mm or more under the gum line. Unfortunately the bacteria find a place to hide, thrive, and become more aggressive, creating adhesive bio-films on the roots of the teeth, above and below the gum line. Fortunately your body’s immune system will try to fight this off as it would any other infection. Unfortunately this inflammation leads to the destruction of the bone that supports the teeth.  This may not cause an acute infection that generates pus, pain and swelling (although frequently it does) but make no mistake; it is an infection, causing inflammation and the destructive process that ensues.

 

Why is it so important to use interdental brushes after pocket reduction gum surgery? 

Why is it so important to use interdental brushes after pocket reduction gum surgeryIt has become very apparent to me, as a periodontist with 30 years of experience, that when we evaluate the success of our results during the years following pocket reduction gum surgery, those that maintained the habit of interdental brushing sustain much better periodontal health.  Failures that occur due to lack of interdental brushing are at first mostly due to a rebound of loose and detached gums creeping back

between the teeth. This will allow the bacterial bio-film to hide once again, reforming new periodontal pockets and subsequently defeating the improvements obtained with treatment. I have found that interdental brushing is the best way to help prevent too much growth of this unwanted gum. I am suggesting that mild, frequent, painless abrasion from the bristles scrubbing between the teeth will help keep the gums healthy and thin. This is especially important for the back teeth where the triangle of gum that forms between the teeth is cosmetically less important.  Of course, all questions and concerns need to be evaluated and discussed with your dental professional.