Tools for plaque removal between the teeth

Trisha E. O`Hehir, RDH, BS

In the February 1998 column, I suggested that both professional and daily at-home plaque removal should start between the teeth, since periodontal disease begins in the interproximal areas. Dental floss still is the predominant choice for interproximal plaque removal, despite my personal opinions to the contrary. Don`t get me wrong, I use floss every day myself, and never discourage patients who are flossing effectively. Floss as well as oral irrigation are the best choices for periodontally healthy patients who have never lost any interdental bone. However, I discourage flossing for periodontal patients who are not flossing daily or not flossing effectively. Alternatives to floss should be encouraged.

Flossers or not, everyone can benefit from the floss-squeak test. Getting a squeak with unwaxed floss is a quick way to test for plaque removal. Flossers should listen for the squeak to be sure they are flossing effectively. Non-flossers can use this quick test to measure the effectiveness of whatever interdental aid they use.

Dental hygienists have become the unofficial dental floss police! This is understandable since our alternatives have been predominated by floss, with other choices limited to Stim-U-Dents and oversized interdental brushes. Consumers are overwhelmed with floss choices and have to hunt for other alternatives. Look at any discount or drugstore dental-products display and you will see at least a 10 to 1 ratio of floss over other interdental aids. It takes some detective work to find alternatives to dental floss. As preventive experts in the office, we need to be knowledgeable of all the tools available for cleaning between the teeth.

For periodontal patients, alternatives to dental floss include wooden sticks, plastic picks, brushes of various sizes and materials as well as oral irrigation. A few automated alternatives to dental floss also are available, such as the Interclean, the Floss Plus sonic flosser, and electric toothbrush adapters for flossing. Power approaches aside, let`s look at the non-automated choices.

The most common wooden sticks are Stim-U-Dents by J & J. The triangular shape is perfect for interdental spaces. Although effective, their large size and tendency to splinter have limited their appeal. Other companies have made copies of Stim-U-Dents. Some are the same color, while others are green; but, they are all similar in size. Wooden sticks that are thinner and made of firmer wood are used commonly in Europe and only now are becoming available from several sources in North America.

Oral-B sells Woodsticks, double-ended, triangular sticks that were at one time available in all grocery and drugstores. Unfortunately, this information was never passed on to the profession and, when they didn`t sell, Oral-B took them off the consumer market. The only way you can get them now is to order them directly from Oral-B or have patients order them direct on the patient`s ordering phone number (800-765-2959). To use this service, patients must place a minimum order of $10.00.

Jordan Sticks, which are thinner than Stim-U-Dents and made of firmer wood, are available from Pearson Dental (800-535-4535). They offer both mint-flavored loose sticks in a handy plastic container and fluoride sticks in rows of 19 (five rows in a plastic container with a plastic case holding a single row of sticks).

The newest wooden stick to join the market is the micro-stick. These wooden sticks are about one-third the size of Stim-U-Dents. If you have been looking for a thin, wooden stick, these are quite sturdy and effective in the narrowest interdental spaces. These sticks are available from either your dental dealer under the name of Mircro-Sticks from Paro, through Hager Worldwide (www.HagerWorldwide.com), or from Curaprox® (877-387-2779) as Micro-Stimusticks.

Plastic picks also are available with designs much more appropriate than the toothpick found in the Swiss Army Knife. The white Rota Points from Pro-Dentec (800-228-5595) are the most commonly known, but this category is growing daily. In addition to drugstores, many health-related catalogues offer plastic picks. For some reason, pale green and pale blue seem to be the colors of choice for these picks.

OraCare makes both blue and green Brushpicks with a tapered triangular tip on one end and a six-filament tip on the other end. The Brushpicks also are sold together with the Travel Pick, a metal mini-scaler with cover and attachment for your key chain. OraCare products are available in discount and drug stores. A plastic version of the covered travel pick is available in stores from the T-4 Corporation.

Flossbrush was developed in Sweden and is distributed by Cirrus Health Care Products worldwide (800-327-6151). It is a pale green, tapered, triangular tip with a piece of fluoride-impregnated floss webbing molded into the base of the triangle and curled around the sides of the triangle. This floss webbing will adapt to the surfaces of the teeth and assist in plaque removal. It also can be used to deliver an antimicrobial to the interdental area. Flossbrushes are available in Walgreens stores, CVS stores, and Eckerd Drug stores. They are sold in packages of 30.

Interdental Cleaners, available from Greg Enterprises in Arkansas (501-846-2121), also are pale green with a narrow, tapered, triangular tip. Also from Arkansas, under the brand name of Dr. Du-More`s, are two blue picks. Individual floss picks have a round pick handle, and triangular picks are sold in packages of 50.

The newest addition to this category is a tapered, conical-shaped, plastic tip, coated with a fuzzy, flocking material. The textured surface enhances plaque removal and provides a surface that can hold an antimicrobial, for delivery to the interdental space. These are available in red as Brush Stick by Paro and in green as Brushpic from Curaprox®.

Interdental brushes today fit into two categories: miniature bottle brushes and brush and handle systems. Bottle brushes come in various sizes made of either metal or plastic-coated metal. The most popular brush and handle systems have been those by Butler and Oral-B. Handle choices include the long toothbrush-type and short, travel sizes. Fingertip pivoting of the brush angle on the Oral-B Compact Interdental Brush is a clever idea.

A slightly more expensive, but very easy to use, system is produced by Wisdom Dental. The brushes just snap into the handle; no twisting, no turning, no clamping. Each handle comes with five brushes. Another choice is the Pic Brush, which is available from Hager International through your dental dealer.

An all-plastic interdental brush, the Proxi-Tip™, is available from AIT Dental (800-876-4620). These white, conical-shaped, plastic brushes simply screw into the purple handle.

An interdental brush system by Curaprox® provides various brush sizes and an interdental probe to determine which brush will best fit each interdental space. The color-coded probe is inserted into the interdental space just as the brush would be. Based on color, the corresponding color-coded brush is used. This system offers nine brush sizes. These brushes insert into the handle and lock in place with a quarter turn. Once locked, the brush can be rotated 180 degrees for easy access to all areas of the mouth. This interdental brush system is available through Curaprox®.

All these choices suggest the need for research to determine clinical effectiveness and patient compliance. It would be interesting to see comparisons between all these new tools, so that we could base our clinical recommendations on science. Despite the long list of new tools, chances are I`ve missed your absolute favorite interdental cleaner. In that case, please write and let me know so I can add it to the ever-growing list. Remember, start inbetween!

Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is www.perioreports.com. Her e-mail address is trisha@perioreports. com.

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