1. Interdental Aids Seminar-2 Dr.Leena Parmar MDS 1st yr
Department of Periodontics
2. INDEX Interdental Area Planning of Interdental Care Various
Interdental Aids Dental floss and tape Knitting Yarn Gauze strip
Interdental tips Toothpick in Holder Wooden interdental
cleaner
3. Interdental Area In health interdental gingiva fills the
interproximal area Three types of gingival embrasure I. Type I II.
Type II III. Type III
4. Classificaton of Gingival Embrassures TYPES OF EMBRASSURES
CONDITION OF GINGIVA IN EMBRASSURE RECOMMENDED CLEANING AIDS I II
III IV V Embrassures are completely occupied by healthy interdental
papilla About 75% of embrassure is occupied by the gingiva About
50% of the embrassure is occupied by gingiva About 25% of the
embrassure is occupied by gingiva Complete los of Superfine and
thin dental floss, used only for cleaning Sulcus Medium or coarse
and thick dental Floss Thin fine pointed small spiral interdental
Brushes Thick spiral interdental Brushes and fine bristle ended
unitufted b Brush Bristle ended unitufted
5. Anatomy of Interdental Area Posterior teeth- -two
papilla(one facial and one palatal) -connected by col anterior
teeth- -single pyramidal papilla Epithelium of col is thin and non
keratinized
6. Inflammation, edema, Deepening of col Biofilm formation in
interdental area and inaccessibility for tooth brush Initiation of
gingival diseases
7. Planning of Interdental Care History of personal oral care
Dental and gingival anatomy assessment-teeth position, embrassure,
probing depth Extent and Location of Dental Biofilm Personal
Factors- handicap or disability,knowledge of interdental oral
care
8. Various Interdental Aids Dental floss and tape Knitting Yarn
Gauze strip Interdental tips Toothpick in Holder Wooden interdental
cleaner
9. Image
10. Dental Floss Most widely recommended interdental aid
Material- silk, nylon, expanded PTFE(plastic Monofilament
polytetrafluoroethylene) Types a) twisted/nontwisted b)
Bonded/nonbonded c) Waxed/nonwaxed d) Thick/thin
11. Features of waxed or Expanded PTFE Smooth floss surface
which prevents trauma to soft tissue Slides through contact area
easily Monofilament resist breakage or shredding Wax gives strength
and durability
12. Features of unwaxed floss Thinner floss-used in tight
contacts Pressure against tooth surface spreads nylon on wider
surface for biofilm removal Sharper edges require special
attention
13. Enhancements Color and flavors have been added Therapeutic
agents like fluoride and whitening agents have also been added
Power flossing devices are available-moves in short circular motion
when device is switched on
14. Method
15. Video
16. Tufted dental floss Regular dental floss alternated with
thickened tufted portion Two variables Single,precut lengths
Superfloss 2 foot length ,5 inch tufted portion adjacent to 3 inch
stiffened end. Roll or NuFloss- Tufted portion (1 inch long )
alternated with plain floss about one and a half inch long.
17. Indications adjacent to wider embrassures with loss of
interdental papilla. Mesial & distal abutments and under
pontics of FPD or orthodontic appliances.
18. Knitting Yarn Indications 1. Tooth surface adjacent to wide
proximal spaces 2. For mesial & distal abutment of FDP and
under pontics
19. Gauze Strip Indications 1. Proximal surface of widely
spaced teeth 2. Surfaces of teeth next to edentulous area 3. Distal
& mesial surface of abutment teeth. 4. Under posterior
cantileverd section of fixed appliance
20. Interdental Brushes Types : 1. Small Insert brushes with
reusable handle 2. Brushes with wire handles
21. Indications Proximal tooth surfaces adjacent to open
embrassures , orthodontic appliances , Fixed Prosthesis,
Periodontal splints Concave proximal surfaces Exposed class IV
furcation For application of chemotherapeutic agents Fluroide
dentifrices, antibacterial agents, desensitizing agents.
22. Single-Tuft brush (End-Tuft , Unituft) Single tuft or group
of small tufts , 3- mm in diameter, flat or tapered with staright
or contra-angled handle.
23. Indication for use 1. For open interproximal areas 2. For
dental prosthesis 3. Difficult to reach area Lingual surface of
mandibular molars.,Abutment teeth , distal surface of posterior
most teeth Procedure 1. Direct the end of tuft into the
interproximal area along the gingival margin. 2. Combine a rotating
motion with intermittent pressure
24. Interdental tip Conical or pyramidal flexible rubber tip
attached to handle.
25. Indications 1. For cleaning debries from interdental areas
2. Biofilm removal at and just below gingival margin. Procedure 1.
Trace along the gingival margin with the tip position just beneath
the margin (1-2 mm ) 2. Rub the tip against the teeth as it is
moved in & out of an embrassure and under a contact area.
Position with gingival form.
26. Tooth pick in holder Round tooth pick inserted into a
plastic handle with contr-angled ends. Also known as
Perio-Aids
27. Indications Patients with periodontitis Orthodontic
patients.
28. Procedure Insert the round tapered tooth pick into the end
of the holder, twist the tooth pick firmly into place and break off
the long & cleanly to prevent sharp edges. Apply tooth pick at
the gingival margin at right angle application with moderate
pressure, trace the gingival margin. To remove biofilm just below
the gingival margin apply the end at less than 45 degrees. Maintain
the tip on the tooth surface following the sulcus.
29. Wooden Interdental cleaner 2 inch long device made of Bass
wood or Birch wood. Used for wider gingival embrassures.
30. Procedure First teach the patient to use a rest by placing
the hand on cheek/chin/ or by placing a finger on the gingiva ,
convenient to the place where tip will be applied. Soften the
pointed end of wood in mouth & moistening with saliva. Hold the
base of the triangle towards the gingival border of interdental
area & insert horizontally. Clean the tooth surface by moving
the wedge in & out while applying the burnishing stroke with
moderate pressure , 1st on one side of the embrassure & then on
other. Four strokes each
31. Dental water flosser
32. Irrigation-Irrigation helps to reduce the levels of biofilm
and debris from around crowns, bridges, orthodontic appliances and
implants, and in interdental areas. There are a variety of devices
on the market. Usually power driven and handheld, these deliver a
pulsating jet of water (or prescribed solution) from a reservoir to
the required area . The pressure at which the solution is delivered
can be altered by the patient. A selection of tips are often
available,depending on manufacturer,for targeted delivery of the
solution.
33. Method of use-The manufacturers instructions should be
followed, The tip should be directed towards the interdental area
and held at 90 to the long axis of the tooth. Patients should start
with a low pressure setting until they are used to the device. The
temperature of the liquid should be comfortable to them A sink or
basin should be nearby, so water or solution can be drained away
Tissues/towels should be nearby
34. conclusion only tooth brushing does not remove the
interdental biofilm Patient should be educated and motivated about
the interdental cleaning Interdental aids should be selected as per
the anatomy of gingival embrassures.
35. References Clinical periodontology-Carranza,9th edition
Essentials Of Community Dentistry-Soben Peter,3rd edition Clinical
practice of the dental hygienist-Esther M Wilkins,3rd &10th
edition Interdental oral hygiene aids and their application-Leanna
Wynne, Dental Nursing March 2012 Vol 8 No 3