Dental Tribune Asia Pacific Edition No. 11, 2016

08 Dental Tribune Asia Pacific Edition | 11/2016 TRENDS & APPLICATIONS Why interdental brushes are essential for good oral health Prof. Denis Bourgeois is not only the Dean of the University of Lyon’s dental faculty in France but also a pioneer in research on oral prophy- laxis, interdental biofilm manage- ment and interdental brushing techniques. He was the first to test for 19 major pathogens in the interdental biofilm known to be involved in periodontitis in young healthy adults. Furthermore, he has suggested interdental brushes to prevent interdental biofilm accu- mulation as well as to decrease the development of periodontal dis- eases and even systemic diseases. “An interdental brush can remove around 16 billion bacteria from each interdental space,” said Bourgeois during his presentation at the FDI Annual World Dental Congress in Pozna´ n, Poland. Despite advances in good oral health care, many patients and dental professionals remain un certain about oral physiopathol ogy and the concept of disruption of biofilm instead of elimination of dental plaque. According to var ious studies, conventional tooth brushing is not effective in re moving interproximal plaque suc cessfully. Recommendations on oral hygiene practices from dental practitioners have focused on the methods of daily toothbrushing and interdental cleaning instru ments as standard for achieving and maintaining good oral health. However, uncertainty has re mained about oral physiopathol ogy and the concept of disruption of interdental biofilm. Sixteen billion bacteria in one interdental site So why does interdental clean ing actually matter? The anatomy of the interdental space does not allow for an efficient salivary self-cleaning mechanism and makes cleaning this area difficult. As a means of further understand ing the mechanism of periodontal pathologies, Bourgeois was the first to use real-time polymerase chain reaction to quantify and qualify the interdental biofilm in healthy adults and explain the role of interdental biofilm management in preventative oral health. In his study, an astounding approximately 16 billion bacte- ria were collected on average from each interdental site. Of the 19 major periodontal pathogens quantified in the study, bacteria of red and yellow complexes consti tuted the majority of interdental bacteria. In particular, red com plexes such as Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola were recognised as the most important pathogens in adult periodontal disease. P. gingivalis was detected in 19 per cent of healthy subjects and represented 0.02 per cent of the interdental biofilm. As dental research has confirmed, P. gingi valis alone can induce alveolar bone loss, and in combination with T. denticola and T. forsythia, periodontal disease is likely to occur. This means that the inter dental biofilm of even healthy in dividuals is composed of bacteria that could lead to periodontitis. “The effective presence of these periodontal pathogens is a strong indicator of the need to develop new methods for disrupting in terdental biofilm in daily oral hygiene,” concluded Bourgeois. Bleeding as a clinical reference Despite good oral hygiene habits, many patients experience interdental bleeding. “As we have seen, the interdental space is a source of bacterial contamination and has an effect on overall health,” said Bourgeois in his presentation. According to the lat est research, 41 per cent of young adults without periodontal dis ease or clinical gingivitis have experienced interdental bleeding at least once. This information should be considered critical for daily oral hygiene and interdental cleaning in particular. “There is a need to use interdental cleaning tools in order to achieve optimum oral health. If you do not use them, you could essentially stop using a toothbrush, as bleeding will occur otherwise anyway in the future.” In a study titled “Efficacy of interdental calibrated brushes on bleeding reduction in adults: a 3-month randomized controlled clinical trial”, a test group was asked to use a standard manual toothbrush twice daily and an interdental brush daily. Based on the hypothesis that interdental brushes reduce interproximal bleeding, Bourgeois and his team instructed periodontally healthy and young individuals how to use interdental brushes daily and correctly. In addition, a calibrated colorimetric probe helped to ef fectively determine the inter dental space and right brush size. As the study suggests, the overall interproximal bleeding was re duced by 47 per cent after one week and 71 per cent after three months. Bourgeois and his team concluded that interdental clean ing can be considered as “an effec tive means to help individuals maintain and/or achieve optimal oral health.” As the general access widths of interdental spaces were mostly unknown in young adults, Bour geois and his colleagues also as sessed the distribution of these widths in this group in a study titled “Access to interdental brush ing in periodontal healthy young adults: A cross-sectional study”. Importantly, 40 per cent of the sites studied showed bleeding upon passage of an interdental brush. An unexpected finding was the high number of adults (69.9 per cent) with greater than 30 per cent of bleeding sites. It was observed that this did not have a significant effect on the width of the interdental space. By measur ing the interproximal space, the researchers concluded that the latest generation of interdental brushes was able to access 94 per cent of interdental spaces. Over 80 per cent of the sites required a small-diameter interdental brush (0.6–0.7 mm) from the Curaprox CPS Prime series. As a result, the study concluded that most inter dental sites can be cleaned using interdental brushes, but accessi bility of interdental spaces would need to be established in the den tal practice by the dental profes sional. Interdental brushes prove to be superior Conventionally, interdental brushes were only recommended for patients with large interdental spaces, while dental floss was recommended for narrow spaces. As technology advanced, so did the innovation with interdental brushes, and as a result, interden tal brushes can now be used for very small interdental spaces to clean the space between teeth effectively. “Dental floss used to be the common tool for narrow spaces. However, dental floss is no longer preferred, as its use is not supported by conclusive scientific evidence. For interdental brushes, we have scientific evidence. Inter dental brushes have now become the best tool for cleaning inter dental spaces,” said Bourgeois. As Bourgeois concluded at the end of his presentation, “The interdental brush currently re presents the primary and most effective method available for in terproximal cleaning. Interdental brushes are specifically designed to clean between the teeth in accordance with the interdental spaceaccessdiameter.Themethod of choice for interdental cleaning when brush space permits is to select the largest size that can penetrate into the interdental space and then to fill this space completely without causing dis comfort or trauma.” By using a calibrating Curaprox IAP colori metric probe, a suitably sized interdental brush will help indi viduals achieve optimal biofilm disruption through thorough in terdental cleaning with minimal trauma. For all studies, Bourgeois and his team selected the CPS prime series of interdental brushes of the Swiss oral care brand CURAPROX. More information can be found at www.curaprox.com. “There is a need to use interdental cleaning tools in order to achieve optimum oral health.” © DTI Prof. Denis Bourgeois spoke about the efficacy of CURAPROX interdental brushes during his presentation at the FDI congress in Poland this year. Prof. Denis Bourgeois is working as a professor in the Faculty of Dentistry at the University of Lyon (11 Rue Guillaume Paradin, 69372 Lyon Cedex 08), France, and can be contacted by phone at +33 478778684 or by e-mail at denis.bourgeois@ univ- lyon1.fr. contacted by phone at +33478778684

Dental Tribune Asia Pacific Edition No. 11, 2016

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