Interdental cleaning- Why? what with? how? where and when!

In today's market place, we are faced with a huge range of interdental cleaning aids. Over the last few years we have seen a move forward from conventional aids such as floss and interdental wood sticks to more effective and easy to use solutions.


Why clean in between? When we examine the structure of the gum tissue under the microscope, we can see that gum is constructed of many layers and in between the teeth in an area we refer to as the interdental col, the top layer of gum is naturally absent. This gives harmful plaque bacteria easy access to get underneath the gum and cause gingivitis, and in some cases periodontitis. If we were making similar comparisons with skin, it would be like comparing the very soft, almost translucent skin on the underside of the wrist to the thicker skin on the palm of the hand.

Due to the nature of this weakness, it becomes just as important if not more, to remove the plaque thoroughly from in between teeth every day. Manual toothbrushes generally only remove approximately 60 % of plaque between teeth so removing the other 40% is just as important for good dental health!
At absolute dental, we know that there is no " One size fits all" strategy to finding out what suits our patients as individuals.

Different shapes of teeth also need different methods of cleaning and this can also be made more challenging by the different positions of teeth and the fact that there is a certain amount of "give" in the fibres of the periodontal ligament, which means that one size of interdental brush on one appointment, may change due to the movement of a tooth and a different size required at the next visit.

What to clean with and where:

Here are a few of the range of interdental aids which are now available on the market and their suitability.

Dental floss:

There are several types of floss available and include unwaxed, waxed, dental tapes, ultra floss and superfloss which was designed particularly for use around bridges.

Floss works best in between anterior teeth where the sides of the teeth are generally uniform in structure, and particularly helpful where there is very little room between teeth.

As we look at the areas in between posterior teeth, there are slight concavities in the natural shape of teeth which means that floss does not easily remove all dental plaque.

Floss works very well at removing plaque from underneath the gum margin in these areas and can often be made more comfortable to use by tying the floss in a small loop, and using the fingers as a frame. Floss holders or floss picks can also make flossing much easier.
Interdental brushes:

This is an area which has expanded considerably in the last few years, with the advent of Tepe brushes. These are based around the concept of a variety of diffentent lenghts of bristles on a plastic coated wire, colour coded for easy use. They are very effective at removing plaque from in between pre molar and molar teeth but do need careful attention so that the wire doesn't bend and loses its shape. These type of brushes are mainly used above the gum margin and only get 2-3mm underneath the gum margin. They also some in a range which has a longer handle, making it easier to reach the areas towards the back of the mouth.

Denti brushes are a new range of rubber interdental brushes, which are tapered and some makes also contain fluoride. These work well throughout the mouth and can be particularly helpful where there are different sizes of space in between teeth and they also reach 2-3mm under the gum margin.
Single tufted brushes:

These brushes are designed to be used anywhere in the mouth but are particularly helpful for patients who have periodontal pockets, crowded teeth and those who have orthodontic appliances. They can be used with or without toothpaste and if held in a pen grasp, give the best flexibility and control of the brush to the user.
Interdental heads for electric toothbrushes:

Oral b Braun have an interdental brush head, which is very helpful in particular for molar areas and also lingual areas next to the tongue which collect plaque more readily. The fit onto most makes of Oral B Braun electric brush handles and if you are unsure if it will fit onto the model you have, we can try this for you at Absolute Dental, particularly as these brush heads are only sold in single units through dental practices.
Dental woodsticks:

These still have a place in plaque removal and removal of food debris but are not as effective as other forms of interdental cleaning due to their rigidity and shape. There is also a possible risk of innoculation.

Air floss:

This is a very new device made by philips within their sonicare range. It works by the use of a very fine and powerful spray of air and water to the interdental areas. It resembles an electric toothbrush in that it has a handle and charging unit and it is most suitable for patients who have a slight space interdentally. The air flosser is used from the outside of the teeth inwards which makes positioning easy.
Water Piks:

These work on a similar principal to the air flosser and can be used and the aim of both is to disrupt the plaque on the tooth surface so that it is unable to settle and release the harmful substances which can cause gingivitis. Many of the water piks can be used throughout the insides and outsides of the dental arch.

When and how often should you clean in between?

At least once daily and generally before you brush. This allows you to remove the harmful plaque and food debris first, and then your toothpaste will have a clearer channel to get much further between your teeth.