The report states that increasing disposable income in developing countries including India, China, and Japan is leading to the market growth of interdental cleaning products. Many products such as dental floss, electric interdental toothbrushes, dental tapes, and tongue cleaners are being adopted by more people worldwide.1
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Dental professionals have had a big part in this growth, as they understand that sometimes brushing and flossing alone is not enough for some patients’ oral health. But getting patients to understand this can be another story. They tell you that they brush for two minutes, they floss every single day, and yet, when they visit the dentist, they’re told they have tooth decay, foul breath, gingivitis, or another malady. These all have a common thread: bacteria build-up that leads to biofilm
So, now it’s up to dental hygienists and dentists to offer additional tools—interdental cleaning products—even though patients are truly doing a stellar job with both of those. In fact, many patients may have stood in the oral health-care aisle themselves and pondered an additional oral health tool, only to leave frustrated about the many choices and not knowing which one would be best for them.
Usual brushing techniques cover only the front of the teeth and conventional brushes cannot reach interdental spaces. These remain undisturbed and the perfect place for bacteria accumulation. So, even with great brushing habits, patients can still have dental plaque accumulation in interdental spaces. With the current advancements, thinner and smaller brushes have been devised that are instrumental in cleaning interdental spaces. These are deemed more effective than brushing as a monotherapy, and they’re swiftly replacing traditional dental floss.
Video: Interdental cleaning devices
Interdental brushes are user-friendly and widely available. They’re a good topic of discussion because chances are, your patients have no idea what to choose and they look to you for guidance. Some key features to look for when choosing an interdental brush are the size of the brush, the softness of the bristles, its geometry (straight or angled), and reusability.
Interdental brushes come in various sizes to suit different dental structures. They’re designed for people with braces and dental bridges and those with wider embrasures, while thin brushes are available for regular interdental cleaning. Metal wires in the middle of interdental brushes might be a little harsh for people with sensitive root surfaces. Rubber brushes are more recent developments emerging as viable alternatives to conventional brushes. These are as effective as metal brushes and offer greater compliance and acceptance among people in terms of comfort. And the goal, of course, is compliance.
It’s also important to choose an interdental brush based on its alignment to achieve better cleaning. Straight brushes provide access to hard-to-reach interdental cavities, while angled brushes facilitate precision and proper cleaning of frontal interdental spaces. For a deep-clean, waist-shaped brush heads are a good choice as they remove more biofilm than straight brushes, which results in minimal plaque deposit. Apart from this, conical and triangular brush heads are also recommended to clean molar cavities.
Because interdental brushes are small, the bristles are susceptible to wear and tear, resulting in sharp edges that might damage gums. On the earth-friendly side, many companies offer interdental brushes with detachable heads to minimize plastic waste, and this is more cost-effective for the consumer in the long run.
If there are patients who simply will not give up flossing, perhaps you can suggest dental tape. Tapes are not terribly different from floss. It’s broader and flatter, making interdental cleaning more convenient for people who have trouble handling thin strands of dental floss. Both tools effectively reach interdental spaces. However, a combination of brushing, flossing, and interdental brushing is recommended to keep plaque build-up low.
Don’t forget to remind patients that flosses are available in waxed and unwaxed and come in a wide array of flavors. They need to be careful that the nylon material doesn’t shred or tear between teeth with high contact points. While single filament polytetrafluorethylene floss is more expensive than regular floss, it slides easily between teeth and is shred-resistant. When used properly, both options work well at removing debris and plaque.
And don’t forget to discuss “electric flossers,” otherwise known as oral irrigators. These work well for people with braces, dental implants, and arthritis.
Oral irrigators are electronic handheld flossing devices that eject water or air with water droplets to blast away debris, plaque build-up, and food particles from the interdental spaces. For people with periodontal disease, these are ideal for flushing out mucus and residue. Oral irrigators are ideal for people with sensitive gums, orthodontic appliances, diabetes, and dental implants.
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In addition to the ability to remove bacterial cells and adherent plaque, oral irrigators effectively reduce inflammation in gums caused by crevicular fluid in diabetic and periodontic patients. By altering the host microbial interactions in subgingival spaces, water pulsations through oral irrigators effectively reduce inflammation without harming the soft gum tissue.
Several companies such as Panasonic, Waterpik, Phillips, and ToiletTree are launching efficient, battery-powered oral irrigators for at-home use. When it comes to traditional oral irrigators, the Waterpik Aquarius Water Flosser is among the most popular. It has 10 different pressure settings developed to suit varying interdental spaces and gum sensitivity.
Another Waterpik product, Sonic-Fusion Professional flossing toothbrush, combines brushing and water flossing in one appliance. It has a built-in timer and provides adjustable water pressure controll options for sensitive teeth, stimulating blood flow in the gums to reduce swelling. Philips Sonicare AirFloss Ultra is a good fit for those looking for portable options. The compact design comprises a built-in water reservoir, long-lasting battery, and five nozzle sizes and pressure settings.
There’s a reason the interdental market is increasing—patients are ready for a change. Start the conversation and offer your patients guidance and updates about the myriad of interdental products. Chances are they’ve stood in the oral care aisle and gotten overwhelmed. They want to have good oral health as much as you want them to.
Reference
Sir, in recent years interdental space cleaning brushes in various diameters have become an important part of patients' home plaque control because 'in order to achieve the highest standards of interdental cleaning, interdental brushes are the most effective'.1Many different manufacturers now provide these important aids to oral hygiene. The brush heads themselves may be parallel sided or tapered. Handles vary from those in line with the brush head to various angled devices, creating a wide range of options for prescribers and their patients.
Unfortunately, there is little commonality between the different diameters on the market and the colour codes used by the manufacturers to identify the handles of their own size range. This can cause problems for patients, particularly if they attempt to buy brushes, for example online, and choose the cheapest available in that colour, forgetting that they need to follow the definitive sizes for the original maker's brushes prescribed by their dentist or hygienist. It follows that dental professionals, when they prescribe brushes, also need to advise patients to use their chosen manufacturer's brushes.
An alternative to suggesting patients just buy further brushes is for practices to stock brushes and advise patients that they can buy replacements from them. This has the following advantages:
It ensures that the correct make, as prescribed, is used
It allows the prescriber to monitor each patient's usage, or lack thereof
It provides a further source of income for the practice.
Table 1 shows some of the choices available from internet research for parallel-sided brushes and is by no means exhaustive, particularly as some manufacturers do not disclose the diameters of their brushes online. It follows that patients seeking the cheapest possible brush could easily be confused by the plethora of options available. It is also clear from this study that patients requiring large diameter brushes where there is significant bone loss have limited choices; either Tandex or TEPE. There is no standard relationship between brush diameter and handle colour although it would appear that more follow the TEPE pattern. This could form the basis for standardisation. Manufacturers should also give brush diameters on their various packages.
A similar situation of non-standardisation existed with endodontic files in the past, before the current international standard colours were agreed. It seems to me that the time is now appropriate for a similar ISO standardisation programme for interspace brushes and that this should be brought to the attention of the relevant International Standards body.
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