Proper interdental cleaning is still neglected by the majority of people – even those who are truly interested in their oral health. It is estimated that more than 80% of the population is not cleaning their interdental spaces, and therefore suffering from gum bleeding and approximal caries. This statistic is alarming, and it should be our main mission and responsibility, as dental professionals, to stress the importance of proper and regular interdental cleaning – not only for patients who already have developed gum disease, but also for those with current good health.
We will guide you through the whole process of how to motivate your patients to clean their interdental spaces correctly, regularly and efficiently.
Step 1: Explain why neglected interdental spaces are a problem
If your patient has doubts about the importance of interdental cleaning, you can provide them with the fact that an overwhelming number of 16 billion bacteria can live in just one interdental site. This abundant bacteria will settle, thicken, and eventually turn to plaque. A build-up of toxic bacteria and plaque causes halitosis (bad breath). That may be considered only a social, or cosmetic problem, but the true danger lies elsewhere.
Over time, plaque attacks the gums, causing inflammation, gum recession, gingivitis and then periodontitis with eventual tooth loss. Plaque leads to tooth decay too, and many other serious problems.
Various studies have successfully proven that periodontitis can be linked to more than fifty other diseases and conditions, including chronic kidney disease, Alzheimer’s Disease, rheumatoid arthritis and certain types of cancer.
It is, therefore, essential to educate patients about these serious potential consequences of insufficient oral care, and stress the importance not only of proper home toothbrushing, but also regular cleaning of interdental spaces.
Step 2: Use the evidence to prove why healthy patients need to use interdental brushes
According to a clinical trial by Bourgeois et al, it has been proven that the presence of periodontal pathogens in the interdental biofilm of young, periodontally-healthy adults demonstrates the need for daily interdental brushing. Initially, 68% of the adolescents’ interdental spaces bled on interdental brushing. After three months of daily interdental brushing, interdental bleeding decreased to 10%, which means an overall bleeding reduction of 85%.
What is very interesting, is that the quantity of bacteria within the biofilm from the yellow and purple Socransky complexes (associated with periodontal health) increased, while the quantity of red and orange Socransky complexes (associated with periodontal pathogens) decreased.
According to the trial’s conclusion, the use of calibrated-diameter IDBs appears to be a key factor in disturbing the interdental biofilm and restoring the symbiotic oral microbiome. Therefore, it is very important to see interdental brushing as an effective form of prevention in healthy patients.
Step 3: Explain the difference between interdental cleaning and flossing
It has been stressed for many years that flossing should be incorporated into daily oral-hygiene routines. However, flossing is only effective in very narrow spaces between the teeth, such as between very tightly set teeth where there are practically zero other nooks and crannies.
When it comes to the interdental spaces between the majority of teeth, it is much more effective to use an appropriately sized interdental brush.
Floss is too thin to effectively reach all the hidden spaces and surfaces between the various shapes and sizes of our teeth, whereas interdental brushes (IDBs) – of the appropriate size for every patient – fan out to reach all hidden spots, and therefore clean very effectively.
According to Bourgeois et al, adherence to daily dental flossing is also low among patients because it requires a certain degree of dexterity, as well as motivation; whereas patients often prefer IDBs because they are easier to use.
Also, IDBs are more effective for plaque removal because the bristles fill the interdental space, while dental floss does not reach the anatomical concavities of the proximal surfaces of premolars and molars, which renders the flossing effort incomplete.
Many patients – mainly those that are used to floss, or who do not take care of their interdental spaces at all – are initially afraid that the interdental brush will be too big for their interdental spaces. Contrary to this belief, research has shown that the IDBs from the Curaprox CPS Prime range could penetrate into 94% of closed, healthy interdental spaces.
It is important to assure the patient that interdental brushes are safe, and also manufactured in different sizes so as to suit different needs. Patients need to be informed that effectively disrupting bacterial growth in the more hidden and thus often neglected areas, is essential. And interdental spaces are definitely those areas.
Step 4: Talk about the importance of using the correct-sized brush, and measure your patients’ interdental spaces
Since it is clearly proven that interdental spaces need regular and proper cleaning – both in healthy, and periodontitis-suffering patients – the most important question is how to find the optimal cleaning procedure.
Every dental professional knows that different patients have very different shapes and spacing of teeth, so there is no universal approach or tool for cleaning all the interdental spaces at once.
This was the reason why Curaden, in collaboration with various dental experts and on the basis of a number of studies, developed a set of interdental brushes of various sizes and functions, which proved to be the most effective tool for cleaning the vast majority of interdental spaces in all patients – including patients with implants or undergoing orthodontic treatment. Studies have concluded that the screening of the accessibility of the interdental space should be a component of a routine examination for all patients.
** Cleaning diameter (effectiveness)
To identify the right-sized brushes, spaces need to be measured using an adequate tool. For Curaden’s interdental brushes, we developed a tool called the Interdental Access Probe (IAP). It is a unique colour-coded calibration system for dentists, to ensure they can easily identify the right-sized brushes for every patient. The IAP probe is supplemented with special cards containing a chart, so the dentist can record and mark the right size (colour) of the interdental toothbrush for every single interdental space for each patient.
According to a study, colorimetric probes and subsequent interdental cleaning with an interdental brush of the right size is more beneficial than interdental brushing with randomly selected brushes. Calibrated brushes lead to more efficient interdental cleaning, which in turn motivates patients and avoids gingival trauma.
The IAP probe is part of the practical Chairside Box, which is filled with the full range of interdental brushes. The probe, which can be sterilised in autoclave, serves as the basic yet very effective tool for measuring interdental spaces.
The CPS prime range has five sizes of interdental brushes – from the smallest (blue colour) with an insertion diameter of only 0.6 mm (and cleaning diameter up to 2.2 mm), up to the largest (green) brush, with an insertion diameter of 1.1 mm (and cleaning diameter up to 5.0 mm). It is interesting to note that the CPS prime 06, the tiniest of our interdental toothbrushes, is the smallest interdental toothbrush in the world.
At their initial visit, the dentist measures each interdental space of a patient with this special colorimetric probe and marks the right-sized brushes (via the corresponding colours) to an Interdental Access Chart (IAC), or Curaden’s special app: the BOB-app.
This easy colour-coding system corresponds to the different-sized CPS prime brushes. The colour still showing outside the interdental space, when using the colorimetric probe, indicates the size of the corresponding CPS prime interdental brush your patient will need for that particular space.
Step 5: Instruct your patients how to use the interdental brush
It is important to instruct patients how to use an interdental brush correctly – and assure them that it is easy. All the patient has to do is gently insert the interdental brush into the space between the teeth, and pull it back out again. In and out, once daily – ideally at their night-time cleaning, before their regular toothbrushing. The only thing that they need to be careful of is to always use the right-sized brush, according to their previous measuring.
It is also important to educate patients with gingivitis about initial interdental bleeding, and underline that it is normal for them to bleed when they start using interdental brushes, since the gums are inflamed. After a few weeks of regular interdental brushing, the bleeding should gradually subside. Many patients avoid interdental brushing because they don’t know this, and are afraid to continue to do procedures that cause them to bleed.
If the brush sizes are correctly chosen, there is almost no risk of harm or injury since the IDBs are made with ultrafine filaments, and assembled with strong and flexible surgical CURAL® wire. The wire is also very durable, and lasts up to two weeks.
Beside the right size, another important aspect is the angle of insertion. Interdental brush should be positioned at a slight angle in front of the interdental gap. For even better reach, each CPS interdental brush can be placed into angulated holder thanks to the click system.
Step 6: Motivate your patients to use the right size
If interdental spaces are not measured using the colorimetric probe, there are two common outcomes – patients may use interdental brushes that are too small, or too big. Neither of these outcomes is good for a patient’s oral care.
In the first case, when an IDB is too small, the effectivity of the cleaning is not reached to its full potential. Cleaning with smaller interdental brushes can be more comfortable for a patient, and that is usually the reason they are inclined to this option.
However the danger lies in the fact that the patient thinks that they are doing everything correctly – brushing their interdental spaces daily – but unfortunately, since it is not effective, it is possible that over a longer period of time, the negative effects of insufficient interdental cleaning will occur anyway.
The second option – when the IDB is too big – brings the potential risk of injury or irritation of the gum. Gum bleeding will not recede this way; it will be present longer because of repeated injuries of the soft tissue.
Both options can be very demotivating for a patient’s future oral care, so it is essential to measure and advise each patient on the best brush sizes for their interdental spaces. The importance of interdental measuring is evidenced also in studies – it has been shown that using the IAP probe in combination with interdental brushes is more effective than brushing with randomly selected IDBs.
Based on the probe measurements, gift your patients with a set of interdental brushes that fit their interdental spaces, and also give them the IAC chart that will help them to remember which IDB should be used in which interdental space. This will help motivate them to start interdental brushing immediately, as they know they have the very best tools for their individual oral care.
And finally, don’t forget to check their interdental brushing progress at their next appointment.
How to Use Your Box?
1. Receive your box from Curaprox and read the attached booklet that explains how to work with it.
2. At your patients’ appointments, measure and record their interdental spaces with the IAP probe and record them to the IAC chart.
3. Instruct your patients on how to use IDBs, and why it is so important.
4. Give your patients an IAC chart and brush samples for them to take home.
5. Follow up with your patients’ interdental brushing progress at their next appointment.
6. Give feedback to your Curaprox Sales Representative.
Key points on why it’s important to measure your patients’ interdental spaces
- More than 80% of patients still don’t do any form of interdental cleaning, and are not aware of the importance of interdental oral care.
- The majority of patients use smaller interdental brushes than are required for their interdental spaces.
- Some patients use interdental brushes that are too big, which can cause injuries to their gum and damage of the oral hard tissues.
- Studies show the use of calibrated-diameter IDBs appears to be a key factor in disturbing the interdental biofilm and restoring the symbiotic oral microbiome.
- Interdental brushing with adequately sized interdental brushes is an effective form of prevention in healthy patients, as well as an effective part of treatment in patients with periodontal disease.
- IDBs are more effective for plaque removal than dental floss, because the bristles work like an umbrella. After the insertion they fill the entire interdental space, while dental floss does not reach the anatomical concavities of the proximal surfaces of premolars and molars.
- The screening of the accessibility of the interdental space should be a component of a routine examination for all patients.
- Curaden’s IAP probe is an effective and easy-to-use measuring system for the assessment of interdental spaces and recommendation of a suitable interdental brush for each interdental space.
Sources:
- Bourgeois D, Carrouel F, Llodra JC, Bravo M, Viennot S. A Colorimetric Interdental Probe as a Standard Method to Evaluate Interdental Efficiency of Interdental Brush. Open Dent J. 2015 Dec 23;9:431-7. doi: 10.2174/1874210601509010431. PMID: 26966470; PMCID: PMC4765511.
- Carrouel F, Llodra JC, Viennot S, Santamaria J, Bravo M, Bourgeois D (2016) Access to Interdental Brushing in Periodontal Healthy Young Adults: A Cross-Sectional Study. PLoS ONE 11(5): e0155467. doi:10.1371/journal.pone.0155467 – https://pubmed.ncbi.nlm.nih.gov/27192409/
- Bourgeois, D., Bravo, M., Llodra, JC. et al. Calibrated interdental brushing for the prevention of periodontal pathogens infection in young adults – a randomized controlled clinical trial. Sci Rep 9, 15127 (2019).https://doi.org/10.1038/s41598-019-51938-8
- Bourgeois D, Saliasi I, Llodra JC, Bravo M, Viennot S, Carrouel F. Efficacy of interdental calibrated brushes on bleeding reduction in adults: a 3-month randomized controlled clinical trial. Eur J Oral Sci. 2016 Dec;124(6):566-571. doi: 10.1111/eos.12302. Epub 2016 Sep 29. PMID: 27681016. – https://pubmed.ncbi.nlm.nih.gov/27681016/
