Tough enough

May 1, 2006
Various conditions in the mouth often require a supplement to toothbrushing. Controlling plaque in difficult-to-reach areas is challenging, especially when implants, orthodontics, and tooth misalignment are present.

Various conditions in the mouth often require a supplement to toothbrushing. Controlling plaque in difficult-to-reach areas is challenging, especially when implants, orthodontics, and tooth misalignment are present. Patients often feel frustrated when a hard-to-keep-clean area becomes unhealthy despite diligent attempts at home care. Try as they may, using a conventional toothbrush to manage the space, the plaque is too extensive to remove. Because of the toothbrush head size (even a compact type), the abundance of bristles interferes with access to the trouble spot. For those tough-to-reach areas, try recommending supplementation tools with fewer bristles and which offer specific angles to reach the teeth.

Specialty toothbrushes are single-tufted tools and cleaning devices that loosen and remove food debris and bacterial plaque from difficult-to-maintain spaces. Patients with tricky areas find that standard toothbrushes may not always move about as needed to free the debris. At the completion of the recare visit, these adult patients tend to request smaller, compact-head toothbrushes or youth-size toothbrushes, because they cannot reach a certain area well enough for proper plaque removal with larger-head brushes. When this situation occurs, suggest an end-tuft or single-tufted device. Patients are often unaware of these products specifically designed for hard-to-reach spots.

These end-type brushes work well around orthodontic appliances and bands, which naturally accumulate plaque. When patients have bonded lingual retainers, the thicker holding wire makes it difficult to maneuver a full toothbrush around to make contact with the lingual interproximal space. Leaving underlying plaque on the wire to rest upon the tooth surface places the tooth structure at risk for demineralization. An angled device with small tapered bunches of bristles directed at the fixed wire is easier to maneuver and thus more effective for bacteria and debris removal. Oral-B offers an end-tufted brush with end-rounded bristles, perfect for orthodontic care. This specialty brush has a slim, clear or tinted handle with an angle designed for lingual placement to gently and safely remove plaque. Because the small head is tapered, the bristles pinpoint the interproximal space and bonded wire.

Specialty brushes address special maintenance issues as well. Space maintainers are difficult for many youths to clean effectively with a standard toothbrush. The bonded band and soldered wire designed as a prosthetic replacement to hold open needed space for an erupting tooth is tricky to clean, because the tissues may become tender during the tooth eruption process. Furthermore, food debris easily lodges on and under the fixed device. An end-tufted or single-tufted brush, directed into the open space and around the bonded band, is simpler for a child to use. These brushes also work well for reaching deeper pits and fissures of erupting posterior molars.

Tufted brushes work well with abutments or precision attachments for overdentures as well. When a tooth’s crown is completely reduced to the level of the gingival margin, this crown reduction allows the denture to seat upon them for stability. Plaque can accumulate on the natural tooth and alveolar ridge area. Focused debris removal is easily achieved with a specialty brush that addresses single-tooth needs. These brushes make it easy to maneuver around any fixed bars or supporting hardware.

Erupting third molars pose unique cleaning needs. The posterior area of the second molar may become neglected when the tissue is sore from the erupting tooth. Plaque removal becomes increasingly difficult if the erupting tooth is angled. To avoid inflammation and bleeding, the tissue must be kept clean. An end-tufted brush, namely the GUM brand specialty End-Tuft, works well to efficiently reach the area, massage the tissue, and remove debris from the cresting occlusal tooth surface. This toothbrush has a straight, sturdy ergonomic handle with a rubberized comfort thumb grip that makes it easy to guide along the occlusal to reach the retromolar area.

A dual-ended product, Sulcabrush® features bristles that may be simply screwed from the ends and replaced when worn. This specialty brush reaches the difficult areas of the third molars as well as the distal of the molars. Certainly, anterior crowding is a challenge for a manual-type toothbrush. Teeth will naturally retain bacteria when misaligned. Using a Sulcabrush, which has only a few compacted uni-tuft bristles at the very end, works well to access those misaligned teeth and loosen laden bacteria. The tool is angled differently on each end and has an inside and outside position to provide effective cleaning. Another double-end product, by Lactona Dental, offers replaceable, soft nylon brushes. Because of the angle of the handle, easy access to unevenly positioned teeth makes this product specially designed for tight-spaced cleaning. When replaceable brushes are desired, try AIT Dental’s Proxi-Tip. This versatile system has interchangeable replacement tips and also a replacement wire-free brush. The perio brush fits onto the plastic handle and offers a flatter designed brush which may be safely used on orthodontic brackets and bands as well as implants.

Placing a toothbrush as far back as possible in the mouth to access the distal end of a molar is tough. End-tufted brushes and smaller tufted tools allow for an easy reach to the lingual and palatal aspects of the teeth. Specialty brushes and devices work well around bonded orthodontic appliances, fixed space maintainers, implants, natural denture abutments, crowded teeth, and on a single tooth that is crowded. Additionally, angled handles with sturdy thumb rests are simple and convenient for patient at-home use. When the goal for home care is concentrating on a difficult-to-maintain area, use an end-tufted brush to remove debris.

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