Toothbrushing alone is not effective in removing plaque from the proximal or interdental surfaces. In these areas where a normal toothbrush cannot reach, various interdental cleaning aids are available to assist with plaque removal. As with toothbrushing, interdental cleaning should be performed daily.
Like all oral hygiene aids the most important factor for interdental cleaning is ease of use. This in turn will encourage regular use and therefore be of clinical benefit to the patient concerned.
Dental Floss and Tape
Dental floss is made from fine strands of cotton that may be impregnated with wax or medicaments such as Chlorhexidine. Some people claim that wax impregnated floss is easier to hold than normal floss.
The use of floss is good for the removal of plaque from tight interdental spaces with intact dental papilla (e.g. the gum tissue inbetween teeth). However, its use requires a high level of manual dexterity. Flossing is often seen as time consuming and difficult to carry out, especially at the back of the mouth.
No difference has been shown in effectiveness between the various types of flosses and dental tapes, which are wider and easier to hold than floss. The floss is gently inserted through the contact point between two adjacent teeth and is guided into the interdental space to clean the tooth surfaces on both sides of the space and just under the gum line.
Floss Threaders and Holders
These are designed to aid flossing in difficult to reach sites and allow better access. However, the holder may keep the floss rigid and make it difficult to adapt the floss to the shape of the interdental space. Nevertheless, as they simplify the use of floss, threaders and holders may improve compliance for some patients.
Interdental Brushes (IDBs)
IDBs come in a range of sizes and should be used to clean any interdental spaces that are large enough for them to fit.
Their effectiveness in sites with breakdown of the interdental papilla is superior to that of floss and woodsticks, and should be the recommended product for these patients.
IDBs can also be found on a standard sized toothbrush handle. The head of these small tufted brushes has either a tapered or round shaped tip. They are designed for cleaning single sites or difficult to access areas (e.g. under the gum flap over a partially erupted wisdom tooth or around a single implant).
A great advantage over other brushes is that they can be used to clean subgingivally (under the gum) when periodontal pockets are present.
The use of woodsticks is most suited to a dentition with large interdental spaces. They are available in the UK but are used more widely in Scandinavia, where woodsticks tend to be favoured over floss or interdental brushes. They can be impregnated with flavouring and fluoride.
Oral irrigators (also referred to as dental water jets or water flossers) are devices that provide a steady or pulsating jet of water at high pressure. They are an effective means of removing food debris from interdental spaces, and are also recommended for cleaning around implants, bridges, crowns and orthodontic appliances.
Using an oral irrigator in addition to traditional toothbrushing helps reduce gum bleeding, gingivitis and plaque.