Oral hygiene measures

1. Need for Interdental Cleaning in
Primary and Secondary
Prevention
Presented by,
Randa youssef Abd Al Gawad
Ass. Prof . Of Pediatric Dentistry &
Dental Public Health, Cairo university

2. Interdental cleaning

3. Interproximal problems
• Dental caries
and periodontal
diseases
• Once they occur their
manifestations persist
throughout life even
though the lesion is
treated.

4. The connection between the incidence of
gingivitis and the state of oral hygiene is
well established
• Benign gingivitis (47.1%)
• Gingivitis of medium severity (44.1% )
• However, no gingival lesions were
detected in children with efficient oral
hygiene (98.2%)

5. • The connection between the
incidence of dental caries and the
state of oral hygiene is
?

6. • There are two essential daily routines for
achieving good oral hygiene :
a) Tooth brushing
b) Interdental cleaning
• Tooth brushing is necessary, but it cannot reach
between the teeth

7. WHEN ?
• Patients should use the interdental devices
before toothbrushing:
1. The fluoride in toothpaste reach the proximal
surfaces, helping prevent dental caries.
2. More efficient plaque removal because people
are usually more meticulous about any task in
the beginning.
3. Patients will not be so motivated to perform
interdental cleaning after brushing because the
mouth feels clean with brushing alone.

8. In determining which method is most appropriate
for interdental cleaning, the following criteria
should be considered:
1. Patient’s periodontal condition
2. Restorative work
3. Teeth alignment
4. Orthodontic treatment
5. Prosthetic work
6. Age
7. Motivation
8. Manual dexterity

9. Cleaning between the teeth is made possible by the
use of:
I. ADA approved devices:
1. Dental floss
2. Interdental brushes
3. Single tuft toothbrushes
4. Dental sticks
5. Rubber tip stimulators
6. Swab tip
7. Pip cleaner
8. Interdental applicator
9. Interdental aid & mirror
10.Irrigation devices

10. II. Other interdental cleaning methods:
1.Knitting yarn
2.Gauze strip

11. 1. Dental floss:
• Is either a bundle of
thin nylon filaments or
a plastic (teflon or
polyethylene) ribbon
used to remove food
and dental plaque from
teeth

12. Indication:
1. Motivated patients
2. Intact interdental
papillae with normal
probe readings
3. Teeth in normal
contact with normal
teeth alignment
4. Good manual
dexterity

13. Contraindication:
1. Large embrasure areas
with little or no
interproximal papilla
2. Patients with moderate to
severe periodontal
diseases
3. Exposed concave root
surfaces.
4. Patients with restorations
(inability to properly
manoeuvre the floss and/or
lack of patience).

14. Dental flossing methods:
A) Spool method:
B) Loop method:

15. Frequency of flossing:
• The (ADA) advises to
floss once or more
per day.

16. Types of dental floss:
A) Waxed & unwaxed:
Unwaxed dental floss
does not clean better
than waxed floss
Waxed in ortho--------
not to shred

17. B) Flavoured & unflavoured:
Unflavoured dental floss
control halitosis by removal of
dental biofilm
Flavoured dental floss control
halitosis by removal of dental
biofilm & introducing flavours
which produce fresh breath
(mint)

18. C) Advanced dental floss:
• Advanced nylon floss
waxed to pass easily
between teeth and
impregnated with mint to
maintain fresh breath.
• Easy Glide - Anti-shred –
0.01% - 0.06% Sodium
Fluoride

19. D) Chlorhexidine :

20. Other variation of dental floss:
A) Dental tape:
Is a soft, flat and flexible
tape which glides easily
through narrow contact
surfaces between the
teeth (crowding/ tight
contact)

21. • Advanced dental tape:
Fluoride
Mint
Wax

22. B) Super Floss:
• Each strand has a hard
nylon end for threading
under the bridge then it
has a spongy section for
cleaning.
• Useful for cleaning under
fixed bridges, braces,
implants and wide spaces
• Using the stiffened end,
thread the spongy-floss
between teeth and
appliance or through wide
spaces

24. C. Post care:
• It is reusable braded-
nylon strand which
has a stiff hooked end
to be threaded
between implant
posts.
• It is rinsed after each
use and hung to dry.

25. • Cleaning a crown on
dental implant

26. D. Power flossers:
• Utilize vibration which
transfers through the
floss, originating from
the ends.
• Useful for orthodontic
patients and poor
manual dextrity

27. Floss threaders:
• Loop of thick plastic
that has a tail.

28. Flossing under bridge

29. Flossing with braces

30. Floss pick:
F-shaped and Y-shaped dental floss wands

31. Wisdom Easy Floss:

32. Floss Holders

33. Summary

35. 2. Interdental (interproximal)
brushes:
• Nylon fibers attached
to a wire that is then
mounted on various
types of plastic
handles.

36. • The two basic
shapes include:
• (a) cylindrical
• (b) tapered

37. • There are two styles of handles:
a) the long handle with replaceable brush
refills
b) the shorter handles that usually have
permanently attached brushes.

38. • Some brushes are treated with an
antimicrobial agent.
• The newest interproximal brush has a
plastic cylinder tube that can be filled with
a therapeutic agent.

39. • The interdental brush is used by placing it
at a 90° angle at the gingival margin in the
open embrasure area.
• The brush is moved back and forth from
the buccal to lingual and then lingual to
buccal using a short stroke.

40. Indications
• Periodontally involved
patients with wider
embrasure areas
• Restorative areas, such
as bridges, crowns, and
implants
• Orthodontic appliances
with wide embrasure
areas.
• Exposed concave tooth
surfaces

41. 3.End or single tuft
toothbrushes:
• Small brushes with
nylon bristles that are
attached to a plastic
handle.
• Placing the brush in the
interdental area, jiggle
the brush in a small
circular motion and/or
use a sweeping motion
away from the gingiva.

42. Indications:
• Open embrasure
areas .
• Ortho. appliances,
bridges, displaced
and rotated teeth.

43. 4. Interdental picks or sticks :
Wood sticks are
triangular in shape
and come in varying
sizes.
Plastic sticks are
smaller in size and
have varying shapes.

44. • The end of the stick should be moistened and
softened in the mouth before use.
• They are inserted in the interproximal space at a
90° angle with the flat surface, the base of the
triangle, resting on the gingival margin.
• The stick is moved in and out from buccal to
lingual using short strokes. It can also be rubbed
on each proximal surface using a gentle up and
down motion.

45. Indication
• Areas that do not
have gingiva filling the
interproximal space
• Can clean concave
tooth surfaces

46. • They are not suitable
for children.

47. 5. Interdental rubber tip
stimulators:
• These are pointed
rubber tips that are
fitted to a toothbrush
handle.
• Used to stimulate and
toughen up the
triangular soft gum
between teeth.

48. 6.Swab tip
• A miniature cotton
swab securely
attached to a twisted
wire stem.
• Available in 9 sizes

49. Indication
• Debride hard-to-reach
concavities such as
periodontal pockets,
craters, furcations &
root irregularities
• Deliver medications
• Effectively clean around
crowns, bridges and
implants.

50. 7. Pipe cleaner
• Wire surrounded by
soft covering, used in
exposed proximal
surfaces, open
furcation areas and
malposed or
separated teeth.

51. 8.Interdental applicator
• Chlorine dioxide
(cleansing agent).
• Fluoride (protection
against decay).
• Chlorhexidine
(antimicrobial gum
therapy).
• Breath freshening gels.

52. 9. Interdental aid & mirror
• “scale” away plaque,
tartar and surface
stains, remove food
particles and
improves gum health.
• Anti-fog mirror to
observe the inner
surface while you
scale.

53. Metallic
Plastic

54. 10. Irrigating water or
medicament spraying devices
• Irrigating devices provide a steady or
pulsating stream of water or
chemotherapeutic agent under pressure
through detachable nozzles.
• They are especially useful in mouths with
fixed bridges, and for cleaning between
teeth.

55. Water jet irrigator
Portable oral irrigator

56. • Family dental water
jet

57. Other methods
1. Knitting yarn;
Types:
Cotton, nylon and rayon
Indications:
• Isolated teeth
• Diastema
• Teeth adjacent to
edentulous areas

58. 2.Gauze strip:
• For cleaning proximal
surfaces of teeth
around edentulous
areas.

59. Consequences of neglect of interdental
cleaning: -------food impaction-----
Increase incidence of:
A) Gingival & periodontal
diseases:
• Gingival recession and clefting
• Periodontal pockets
• Exposed root surfaces
• Furcation involvement
• Mobility of teeth
• Finally tooth loss
B) Dental caries:
• Interproximal decay
• Recurrent decay
• Restorative failure especially
tooth colored restorations
C) Implant failure:
D) Halitosis:

60. Thanks