Oral Infection Control: Interdental Care

Chapter 27: Oral Infection Control: Interdental Care

• Learning Objectives (1 of 2):

  • Review interdental anatomy; explain why brushing alone is insufficient for periodontal infection prevention.
  • Assess embrasure size and patient health to select appropriate interdental tools.
  • Describe different interdental brush types and their suitability for various patients.

• Learning Objectives (2 of 2):

  • Describe dental floss types and flossing techniques.
  • Identify various floss aids, their purposes, and rationales for selection.
  • Demonstrate and recommend alternative biofilm removal devices.

• Interdental Care: Removal of biofilm from the proximal surfaces.

Patient Assessment & Planning Interdental Care

• Personal Oral Care History
• Dental and Gingival Anatomy (including embrasure spaces, CAL: Periodontal condition, prostheses)
• Extent and Location of Biofilm (using biofilm scores and plaque records)
• Personal factors (dexterity, health literature (Dental IQ)

Embrasure Types

• Type I: No gingival recession
• Type II: Moderate papillary recession
• Type III: Complete loss of papilla or extensive recession
• Unitufted brush

Selective Interdental Biofilm Removal

• Relation to toothbrushing techniques
• Brushing vertically for access
• Floss (healthy sulcus, good dexterity): slides through contacts
• Floss Holder (problems with dexterity): slides through contacts
• Water Flosser/Irrigation (gingivitis, implants, deep pockets)
• Interdental brushes (embrasure spaces II & III, periodontitis patients, exposed roots)
• Wood Sticks (embrasure spaces II & III, periodontitis patients, exposed roots)

Interdental Brushes

• Types:
  • Small insert brushes with reusable handles
  • Travel interdental brushes
  • Rubber interdental cleaners
• Procedure: Gently move brush into the embrasure space, emphasizing proximal surfaces.
• Care: Rinse and store or dispose of as disposable.

Indications for Use (Interdental Brushes)

• Proximal surfaces adjacent to open embrasures
• Orthodontic appliances
• Fixed prostheses
• Implants
• Exposed furcations
• Application of chemotherapeutic agents

Dental Floss and Tape

• Common interdental aids for Type I embrasures
• Waxed and unwaxed floss
• Flossing tape
• Materials: Silk, Nylon, PTFE
• Enhancements: Color, flavor, therapeutics

Use of Dental Floss

• Illustrated steps for correct flossing technique.

Tufted Dental Floss

• Single precut or roll ("Super Floss")
• Used to clean teeth with wide embrasures (loss of papilla)
• Abutment teeth, pontics, orthodontics.
• Illustrated method of use.

Gauze Strips

• Used for widely spaced teeth, areas near edentulous areas, abutment teeth

Flossing Injury

• Cuts or clefts beside or in the middle of papilla
• Too long of floss
• Snapping floss through contacts
• Improper C-shape curve
• Excessive pressure without rest

Flossing Aids

• Power flossing instruments
• Floss holders
• Floss threaders

Use of a Floss Holder

• illustrated technique

Use of Floss Threader

• Illustrated technique

Disposable Single-Use and Two-Handle Floss Aid

• Illustrated examples

Air Flosser using bursts of air and water

• Uses a stream of water or other agent
• Purpose: reduce biofilm bacteria
• Effective alternative to floss
• Delivers solution to 50% of pocket depth

Oral Irrigation

• Benefits:

  • Reducing gingivitis and bleeding
  • Reducing/altering biofilm
  • Access to pathogenic microorganisms
  • Subgingival delivery of antimicrobials or water.

• Other indications

  • Orthodontics
  • Crowns and bridges
  • Removal of food debris

Tips for Water Irrigator

• Placement in interproximal areas for 3 seconds, followed by a sweep across gingival margins.

Documentation

• Includes all interdental aid recommendations and demonstrations for the patient.

Factors to Teach the Patient (1 of 2)

• Use disclosing solution for visual understanding of toothbrush limitations in interdental cleaning.
• Explain biofilm accumulation on proximal surfaces.
• Explain the interdental area's vulnerability to infection.

Factors to Teach the Patient (2 of 2)

• Demonstrate interdental aid usage.
• Emphasize the need for patients to discuss any new products with dental professionals.

Single Tuft Brush (End-Tuft)

• Single or multiple small tufts for interproximal use.
• Used for fixed prostheses, orthodontics, implant abutments.

Interdental Tip

• Conical, flexible rubber/plastic tip
• Cleans interdental areas, just below the gingival margin.
• Useful for furcations, and recontouring after periodontal surgery.

Wooden Interdental Cleaner

• Bass/birch wood stick
• Triangular cross-section.
• Used for proximal surfaces where papilla are missing.

Tooth Pick Holder

• Perio-Aid: Round toothpicks
• Used by patients with periodontitis and orthodontic patients

This quiz covers the principles of interdental care and its importance in oral infection control. Learn about various interdental tools, floss types, and techniques for effective biofilm removal. Assess patient needs and suitable care options for optimal dental health.