Dental Floss

The use of dental floss is indicated for healthy patients, and for gingivitis and mild periodontitis cases, as well as for patients with crowded teeth. It is well known, however, that the acceptance of dental floss (floss, tape, super floss) is quite low for most patients, especially males! Alternative interdental hygiene aids should be recommended even if these are less efficient than floss if patients will at least use them daily.

Toothpicks, Interdental Brushes

498 Morphology (schematic) of the Periodontium

A Healthy B Periodontitis

C Treated, Healed Periodontitis

These three situations require differing techniques and various hygiene aids for interdental plaque control.

The diagrams portray the course of the alveolar bone, the gingival margin and the expanse of the interdental spaces (red).

499 Size of the Interdental Space and Oral Hygiene Aids

The choice of a hygiene aid for interdental plaque control depends primarily upon the size of the interdental space.

A Dental Floss

For narrow interdental spaces B “Tooth Sticks”

For slightly open interdental spaces

C Interdental Brushes

For widely open interdental spaces, root concavities and grooves

Toothpicks or interdental brushes are indicated for plaque removal if the interdental spaces are open, e. g., following completion of periodontitis therapy, as well as for patients who accept dental floss but seldom actually use it.

The newest “toothpicks” are no longer simply wooden throw-away articles, rather they are adorned with tiny hairlike bristles, they are elastic, multi-use, fine plastic files (“Brush Sticks”). Some patients become passionate about these devices!

With expansive areas of exposed root surface, especially in the molar regions, one often observes more or less severe grooves which can only be cleaned using interdental brushes.

These devices should be used without dentifrice except in special cases and then only short-term. The abrasive in dentifrice would rapidly abrade exposed dentin in the interdental space.

These devices can also be regularly used to apply fluoride or chlorhexidine gel into the interdental space to prevent caries or the recolonization of residual pockets.

Dental Floss

500 Choices: Floss, Tape,

Ultra - and Superfloss

Today's dental floss, with filaments of nylon, kevlar etc., is strong enough to traverse even the tightest contact points. For splinted teeth, bridges etc., various threading devices are available (e. g., Eez Thru, Butler). Both waxed and unwaxed dental floss can be recommended.

Right: Dental Tape (Colgate)

501 Use of Dental Floss

To avoid injury to the papillae, the dental tape is carefully maneuvered through the contact point using a sawing motion. Cleaning of both proximal surfaces is accomplished with up and down movements (double arrow) into the sulcus with the floss stretched tightly.

When the floss “sings” the tooth surface is clean.

“Tooth Sticks”

502 Selection

The traditional wood interdental cleaners exhibit a triangular profile. The various manufactures use either hard or soft wood (birch, balsa, linden). Some products are impregnated with various substances (fluoride, CHX, mint, nicotine!).

Right: The new acrylic “Brush Stick” (Esro) cleans very effectively.

503 Clinical Use of “Brush Sticks”

The red, felt-like tip is guided into the interdental space at a slight angle. Plaque removal is accomplished by horizontal back and forth movements (double arrow). If the interdental spaces are large, the brush stick is first pressed against the proximal surface of one tooth, and then the adjacent tooth. Concavities can be cleaned very well using the blunt end of the Brush Stick!

Interdental Brushes

504  Selection

Numerous companies offer interdental brushes. Excellent products include various bristle lengths, strength and diameter, with handpieces or separate holders (pictured is the assortment from Curaprox; at left, the coded measurement probe for the choice of brush type).


Oral-B (with handpiece),

Top Caredent, TePe, Oral Prevent, Paro (Esro).

505  Use of a Large Interdental Brush

Appropriate interdental brushes are available today for the smallest to the largest interdental spaces. They represent the ideal cleaning tool, especially for periodontitis patients. The brush is inserted obliquely into the interdental space, from apical.

Cleaning is performed with a back and forth motion (double arrow).

The trend today is toward long, flexible (soft) bristles.

Additional Hygiene Aids

506  Hygiene Aids for Special Problems

•  Round Solo Brush (P.229)

•  Pointed, Single-Tuft Brush,

E. g., for the furcation entrance

•  Stimulators

Massage in the area of the interdental papillae

•  Soft-FoamAttachment (Oral-B) Cleaning for titanium implants

•  “Fork” for dental floss

Left: Threader for floss and tape.

507  Threading Dental Tape

With fixed splints, bridges and bar constructions, the dental floss cannot be applied from the occlusal, but must be inserted.

In such cases this can be accomplished using a threading sling (e. g., Butler).

The threader is particularly helpful for patients with limited manual dexterity, and also for interdental spaces for which the superfloss threader is too “soft.”

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