Interdental Aids Objectives

What is the role of oral irrigation in plaque biofilm removal?

"water jets" - disruption of loosely attached or unattached plaque biofilm sub and supragingivally, and food debris. Provides steady stream of water. Does not replace toothbrushing. Indicated for ortho appliances, crowns, bridges, and implants, pts with lack of dexterity, pts with jaws wired shut from surgery

What are indications for tooth pick use?

- type II and III embrasures -Biofilm removal and gingival stimulation -extends less than 4mm into pocket -crowns margins -implants -accessible furcations -concave surfaces -ortho and fixed protheses

What role does sugar-free and xylitol chwing gum play in caries control?

-Increases salivary flow -decreases oral bacteria -strategy for caries control -addition of xylitol is antimicrobial and reduces plaque pH

What are indications for wooden/plastic triangular stick use?

-Type II or III embrasures -accessible furcations -can remove plaque 2-3mm subgingivally -less damaging than round toothpicks

What is tufted dental floss used for?

-biofilm removal from tooth surfaces adjacent to wide embrasures where interdental papillae have been lost. -Biofilm removal around abutments, pontics, implants, or ortho appliances

What are the indications for a rubber tip stimulator?

-gingival massage -recontouring papilla after perio therapy -exposed furcations -type II and III embrasures -used along gingival margin

What are the 5 flossing adjuncts?

1. floss handles 2. Floss PIK 3. Floss threader 4. Superfloss 5. Battery-powered devices

What are the 9 considerations for selection of self-care adjucts?

1. interproximal device selection based on architecture of the tissues 2. Removal of supragingival plaque biofilm does influence subgingival plaque biofilm composition 3. Desire to select an aid extending subgingivally for that individual 4. Select based on the assessment data and risk factors 5. Incorporate evidence and research into professional advice 6. Consider lifestyle issues 7. Involve patient in decision making 8. Teach and reevaluate at each appointment 9. document

Define oral health self-care

Activities and decisions made by an individual in relation to prevention, diagnosis, and treatment of personal ill health and the maintenance and control of chronic conditions

Define interproximal/interdental aids

Addresses proximal tooth surfaces and interproximal spaces

Discuss strategies for promoting flossing behavior

Discuss willingness to floss or use another aid or floss aids (floss holder, threader, picks, tufted, or power device)

What are signs of improper flossing?

Gingival cuts or clefts - mostly on facial and palatal from snapping floss up without curving to shape of tooth

How are volatile sulfur compounds created from gram negative bacteria?

Microbial degradation of organic substrates. Sulfur contains proteins and peptides are hydrolyzed to be gram negative bacteria in an alkaline environment resulting from putrefaction

Describe the no one size fits all approach to self-care adjuncts

No universal method, device, sequence, or frequency. Critical thinking applied for individual based on oral conditions, personal preferences, abilities, dexterity, and lifestyle

Define OPT aids

Oral Physiotherapy Aids - all adjuncts to toothbrushing

What is the use of a floss handle?

People with physical disabilities, poor dexterity, large hands, limited opening, strong gag, low motivation, care provider assisting with oral care

What type of teeth would you need to use self-care adjunctive aids?

Proximal areas, hard to reach areas, rotated teeth, malaligned teeth, partially erupted teeth, irregular tooth morphology, embrasure spaces, isolated teeth, furcations, ortho appliences, implants, fixed prosthetic appliances

What is tufted dental floss?

Regular floss alternated with thickened tufted portion.

What is a prevention strategy for malodor?

Regular mechanical cleaning of tongue

What are indications for using end-tufted brushes?

Single/uni-tuft brush a. Small head of brushes b. Straight or angled handle c. For type III embrasures d. Distal of posterior teeth e. Proximal surfaces without adjacent f. Lingual md teeth g. Crowded, malaligned teeth h. Ortho appliances

What is the Circle/loop method of flossing?

Tie 2 ends of floss together to form circle. Wrap floss around middle fingers and rotate around cicle as you floss the teeth

What is a Class I grade of tooth mobility?

Tooth can be moved up to 1mm in any direction

Why is interproximal plaque biofilm control is so important for individuals to practice daily?

Toothbrush cannot reach interproximal spaces, need interdental aid to cleanse • Incomplete removal increases the rate/growth of new biofilm • Regrowth occurs first in the interproximal areas • Remaining biofilm on some surfaces facilitates growth of complex microflora on other clean surfaces • Individuals who clean interproximally daily have less biofilm and calculus • Gingivitis, periodontitis, and caries occur more frequently in interproximal areas • Beneficial for controlling caries and periodontal diseases and preventing new infections

Identify the indications for dental floss.

Type I embrasures

Who should use interdental brushes?

Type II and III embrasures, root concavities, class IV furcations, ortho bands, fixed prosthodontics, small diastemas, implants, apply chemotherapeutic agents

What is the Spool method of flossing?

Wrap around the middle fingers, use index and thumb to manipulate and guide floss between contacts. 1 inch space between thumb and index fingers

What is the role of water rinsing in the oral cavity?

a. Aids in the removal of food debris and materia alba. Not recommended for caries/erosion prevention. No effect on number bacteria in mouth

What are some considerations for children + flossing?

a. Dexterity doesn't develop until 10-12 years, until then adults should preform b. Young children with to interproximal contacts might not require flossing

What are causes of malodor?

a. Elevated levels of volatile sulfur compounds (VSC) b. Gases from gram negative anaerobic bacteria c. Food debris d. Periodontal/peri-implant disease e. Unclean dentures

What are the techniques for using interdental brushes?

a. Moisten brush tip b. Insert at angle that follows gingiva c. Move buccolingually d. Assess emprasure or furcation to select size and shape, brush tip slightly larger than the space and reach lateral borders, teach pt to avoid trauma if brush too big, pressure is used

What is the technique for plastic triangular stick biofilm removal?

a. Moisten wood b. Insert from buccal to interprox c. Base of triangle towards the papilla d. Use fulcrum to avoid too much pressure, then press against inderdental papilla to flatten e. Aim slightly coronally or apically f. Move in buccolingual direction g. Do 4 burnishing strockes on each side of embrasure with moderate pressure h. Discard when splayed (can be washed an reused)

What are some treatments for oral malodor?

a. Professional care b. Increasing salivary flow c. Tongue debridement with toothbrush/tongue scraper d. Antimicrobial agents (CHX, essential oils, etylpyridinium chloride, chlorine dioxide, zinc containing mouthrinses) e. Anti-odorants: sodium bicarbonate f. Masking products: mouthrinses, mints, gum, sprays g. TheraBreath

What does dental flossing accomplish?

a. Removes biofilm, debris and food b. Aids in identification of interproximal calculus, margins, interproximal caries c. Controls calculus formation d. Controls interproximal carious lesions e. Reduces malodor f. Vehicle for applying polishing of chemotherapeutic agents

What factors affect selection of interdental aids?

a. Size of embrasure space b. Shape of embrasure c. Shape of interdental papilla d. Furcations/mobility e. Food impaction f. Brushing method

What is the procedure for supragingival irrigation?

a. Start at lowest pressure setting b. Tip at right angle towards interdental area until almost touching tooth c. Lean over sink and spend 5 seconds/area d. Stream is directed perpendicular to long axis of tooth

Discuss toothpick plaque biofilm removal technique

a. Wooden pick - moisten with saliva b. Place blunt end at a right angle to tooth surface c. Place at less than 45 decree angle to extend below gingival margin d. Pull/push it across f/l surface from one interproximal space to the other e. As tip becomes frayed, use as brush f. Interproximally angle horizontally & use the sides to clean g. Use care with subgingival and interproximal à avoid tissue damage

Define self-care adjucts

all adjuncts to toothbrushing

What is the flushing zone in oral irrigation?

area where solution is deflected from tooth surface

What is a Class I furcation involvement?

beginning involvement. Concavity of furcation can be detected with an explorer but cannot be entered. Not radiographically visible

What are the advantages of using a toothpick holder?

enhanced effectiveness, especially on lingual. The projecting end is broken off for easier reach

Who is the Circle/loop flossing method used for?

for children and uncoordinated adults.

What is a gauze strip in relation to self-care adjuncts?

for proximals adjacent to edentulous areas, widely spaced teeth, implant abutments. Wrap like floss in c-shape

What is the use of a floss threader?

for tight contacts, splinting, abutment, pontic of bridge, and ortho appliances

What is a Class II furcation involvement?

furcation can be entered from one aspect but cannot penetrate through to the opposite side. Radiographically visible

What is variable thickness floss?

increments of soft tufts alternating with standard floss for Class II and III embrasures, furcations with access, distal of last molars, missing teeth, under bridges of ortho retainers

What is a Type I embrasure space?

inderdental gingiva fills the interproximal area and under the contact of the adjacent teeth

What is the battery powered floss device used for?

people with physical limitations, limited dexterity, diffictult to clean areas and ortho appliences

What is the technique for using end-tufted brushes?

place in embrasure space, use rotary motion and sulcular strokes, moderate pressure used

What is the impact zone in oral irrigation?

point where solution makes initial contact with the tooth

Who is the Spool method for?

requires coordination (teens and adults

What is waxed floss?

smooth surface that aids in sliding through contact area, minimized trauma, wax gives strength to reduce breakage

What is unwaxed floss?

thinner floss for when contacts are tight, puts pressure against tooth, gives wider surface for biofilm removal, could cause injury to gingiva

What is a Class III furcation involvement?

through and through involvement but gingival tissue covers the area. Definite radiographic visibility

What is a Class IV furcation involvement?

through and through involvement that is not covered with gingival tissue. Clinically open and exposed.

What is a Type II embrasure space?

tissue does not extend to the contact

What is a Type III embrasure space?

tissue is blunted and does not fill the interproximal space

What is a Class III grade of tooth mobility?

tooth can be moved in a buccolingual direction and is depressible in socket

What is a Class II grade of tooth mobility?

tooth can be moved more than 1mm in any direction but isn't depressible in socket

What is knitting yarn in relation to self-care adjuncts?

used around fixed appliances, abutments and pontics. Used like floss threader

What is a pipe cleaner in relation to self-care adjuncts?

used for class II and IV furcations, but metal core can cause trauma. Not for implants, used in a "shoe-shine" method

What is waxed dental tape?

wide, broad and flat for class I & II embrasures