Interdental aids

1. Department Of Periodontics TOPIC:- INTERDENTAL AIDS Presenter ; Dr. Priyansh Yadav

2. INTERDENTAL AREA The interdental area is the part of gingiva which extends in between two teeth, up to the contact point. In healthy individuals, interdental gingiva fills the interproximal areas. Anatomy of interdental area; Posterior teeth consists of two papilla (a facial and a palatal) which are connected by Col. Epithelium of ‘Col’ is thin and non-keratinized. Anterior teeth consists of a single pyramidal papilla.

3. Embrassure An embrassure is a ‘V’ shaped space present interproximally around the proximal contacts existing between adjacent teeth. A.k.a SPILLWAY They are named after the direction they radiate. Different gingival embrassures are; Buccal, Lingual, Gingival, Incisal/Occlusal

4. Types Of Embrassures Type 1 Type 2 Type 3

5. 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

6. Various Interdental Aids Dental floss Dental tapes Knitting yarns Gauge strips Interdental brushes Interdental tips Toothpick in holder Wooden interdental cleaner Dental water flosser

7. Dental Floss Most widely recommended interdental aid. Material- silk, nylon, expanded PTFE(plastic Monofilament polytetrafluoroethylene) Types ; Twisted/non-twisted Bonded/non-bonded Waxed/non-waxed Thick/thin

8. Dental Floss 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

9. Dental Floss 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

10. Dental Floss Enhancements C olor 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

11. Dental Floss Indications A djacent to wider embrassures with loss of interdental papilla. Mesial & distal abutments and under pontics of FPD or orthodontic appliances

12. Dental Floss PROCEDURE Start with a piece of floss long enough to grasp securely; 12 to 18 inches is usually sufficient. It may be wrapped around the fingers, or the ends may be tied together in a loop. Stretch the floss tightly between the thumb and forefinger or between both forefingers, and pass it gently through each contact area with a firm back-and-forth motion. Do not snap the floss past the contact area because this may injure the interdental gingiva. In fact, zealous snapping of floss through contact areas creates proximal grooves in the gingiva. Once the floss is apical to the contact area between the teeth, wrap the floss around the proximal surface of one tooth, and slip it under the marginal gingiva. Move the floss firmly along the tooth up to the contact area and gently down into the sulcus again, repeating this up-and-down stroke two or three times. Then, move the floss across the interdental gingiva, and repeat the procedure on the proximal surface of the adjacent tooth. Continue through the whole dentition, including the distal surface of the last tooth in each quadrant. When the working portion of the floss shreds or becomes dirty, move to a fresh portion of floss.

13. 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.

14. Dental Tapes It is flatter, broader, and a little more stretchy than dental floss. Also known as Ribbon tape. Dental tape is often made of waxed nylon or polythene fiber . Thanks to its flat surface, dental tape can slide between your teeth more easily. It’s also less likely to snap against your gums than dental floss.

15. Dental Tapes Procedure B reak off a piece of tape. Then, wind the ends around your middle fingers. Use your pointer finger and thumb to pinch the tape and gain control. A fter inserting the tape into the gap between your teeth, wrap it around your tooth’s edge to form a c-shape. Begin gently moving the floss or tape back and forth, working your way up the gap. Then change the end and using a clean section of tape clean the other tooth.

16. Knitting Yarns Indications Tooth surface adjacent to wide proximal spaces For mesial & distal abutment of FDP and under pontics

17. Gauge Strips Indications Proximal surface of widely spaced teeth Surfaces of teeth next to edentulous area Distal & mesial surface of abutment teeth. Under posterior cantileverd section of fixed appliance

18. Interdental Brushes The diameter of the interproximal brush should be slightly larger than the gingival embrasures to be cleaned so that bristles can exert pressure on both proximal surfaces as well as root concavities. These brushes are inserted through interproximal spaces and move back and forth between teeth with short strokes.

19. Interdental Brushes ADVANTAGE The advantage of interdental brushes over dental floss are that interdental brushes clean concave root surface & furcations more efficiently than dental floss. They are much easier to use.

20. Interdental Tips Conical or pyramidal flexible rubber tip attached to handle. Indications For cleaning debries from interdental areas Biofilm removal at and just below gingival margin. Procedure Trace along the gingival margin with the tip position just beneath the margin (1-2 mm ) Rub the tip against the teeth as it is moved in & out of an embrassure and under a contact area. Position with gingival form.

21. Toothpick in holder Round tooth pick inserted into a plastic handle with contr -angled ends. Also known as Perio -Aids Indications Patients with periodontitis Orthodontic patients.

22. Toothpick in holder 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.

23. Wooden interdental cleaner 2 inch long device made of Bass wood or Birch wood used for wider gingival embrassures . 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 , 1 st on one side of the embrassure & then on other. Four strokes each

24. Dental water flosser 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.

25. Dental water flosser Method of use- T he manufacturer’s 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

26. CONCLUSION Only tooth brushing does not remove the interdental biofilm. P atient should be educated and motivated about the interdental cleaning Interdental aids should be selected as per the anatomy of gingival embrassures .