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Dental Tribune Middle East & Africa Edition | 6/2016 news 36 Why interdental brushes are essential for good oral health ByDentalTribuneAsiaPacific 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 tech- niques. He was the first to test for 19 major pathogens in the interdental biofilm known to be involved in per- iodontitis in young healthy adults. Furthermore,hehassuggestedinter- dental brushes to prevent interden- tal biofilm accumulation as well as to decrease the development of peri- odontal diseases 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 Con- gressinPoznań,Poland. Despiteadvancesingoodoralhealth care, many patients and dental pro- fessionals remain uncertain about oral physiopathology and the con- cept of disruption of biofilm instead of elimination of dental plaque. Ac- cording to various studies, conven- tional toothbrushing is not effective in removing interproximal plaque successfully. Recommendations on oral hygiene practices from dental practitioners have focused on the methods of daily toothbrushing and interdental cleaning instruments as standard for achieving and main- taining good oral health. However, uncertaintyhasremainedaboutoral physiopathology and the concept of disruptionofinterdentalbiofilm. Sixteenbillionbacteriainone interdentalsite So why does interdental cleaning 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 understanding the mechanism of periodontal pathologies, Bourgeois was the first to use real time poly- merase chain reaction to quantify and qualify the interdental biofilm in healthy adults and explain the role of interdental biofilm manage- mentinpreventativeoralhealth. In his study, an astounding ap- proximately 16 billion bacteria were collected on average from each in- terdental site. Of the 19 major peri- odontal pathogens quantified in the study, bacteria of red and yellow complexes constituted the major- ity of interdental bacteria. In par- ticular, red complexes such as Por- phyromonas gingivalis, Tannerella forsythia and Treponema denticola were recognised as the most impor- tant pathogens in adult periodontal disease. P. gingivalis was detected in 19 per cent of healthy subjects and represented 0.02 per cent of the in- terdental biofilm. As dental research has confirmed, P. gingivalis 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 interdental biofilm of even healthy individuals is composed of bacteria that could lead to periodontitis. “The effectivepresenceoftheseperiodon- tal pathogens is a strong indicator of the need to develop new methods for disrupting interdental biofilm in daily oral hygiene,” concluded Bour- geois. Bleedingasaclinical reference Despite good oral hygiene habits, many patients experience inter- dental bleeding. “As we have seen, the interdental space is a source of bacterial contamination and has an effect on overall health,” said Bour- geois in his presentation. According to the latest research, 41 per cent of young adults without periodontal disease 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 donotusethem,youcouldessential- ly stop using a toothbrush, as bleed- ing will occur otherwise anyway in thefuture.” In a study titled “Efficacy of inter- dental calibrated brushes on bleed- ing reduction in adults: a 3month 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 inter- dentalbrushesreduceinterproximal bleeding, Bourgeois and his team in- structed periodontally healthy and young individuals how to use inter- dental brushes daily and correctly. In addition, a calibrated colorimetric probe helped to effectively deter- mine the interdental space and right brush size. As the study suggests, the overall interproximal bleeding was reduced by 47 per cent after one week and 71 per cent after three months. Bourgeois and his team concluded that interdental cleaning can be considered as “an effective means to help individuals maintain and/orachieveoptimaloralhealth.” As the general access widths of inter- dental spaces were mostly unknown in young adults, Bourgeois and his colleagues also assessed the distri- bution of these widths in this group in a study titled “Access to interden- tal brushing in periodontal healthy young adults: A cross sectional study”. Importantly, 40 per cent of the sites studied showed bleeding upon pas- sage of an interdental brush. An un- expected inding was the high num- ber of adults (69.9 per cent) with greater than 30 per cent of bleeding sites.Itwasobservedthatthisdidnot haveasignificanteffectonthewidth of the interdental space. By measur- ing the interproximal space, the re- searchers concluded that the latest generation of interdental brushes was able to access 94 per cent of in- terdental spaces. Over 80 per cent of the sites required a small diam- eter interdental brush (0.6–0.7 mm) from the Curaprox CPS Prime series. As a result, the study concluded that mostinterdentalsitescanbecleaned using interdental brushes, but acces- sibility of interdental spaces would need to be established in the dental practicebythedentalprofessional. Interdental brushes prove to besuperior Conventionally, interdental brushes were only recommended for pa- tients with large interdental spaces, while dental loss was recommended for narrow spaces. As technology ad- vanced, so did the innovation with interdental brushes, and as a result, interdental brushes can now be used for very small interdental spaces to clean the space between teeth ef- fectively. “Dental loss used to be the common tool for narrow spaces. However, dental loss is no longer preferred, as its use is not supported by conclusive scientific evidence. For interdental brushes, we have scien- tific evidence. Interdental brushes have now become the best tool for cleaning interdental spaces,” said Bourgeois. As Bourgeois concluded at the end of his presentation, “The interden- tal brush currently represents the primary and most effective method available for interproximal cleaning. Interdental brushes are specifically designed to clean between the teeth in accordance with the interdental space access diameter. The method of choice for interdental cleaning whenbrushspacepermitsistoselect the largest size that can penetrate into the interdental space and then to ill this space completely without causing discomfort or trauma.” By using a calibrating Curaprox IAP col- orimetric probe, a suitably sized in- terdental brush will help individuals achieve optimal biofilm disruption through thorough interdental clean- ingwithminimaltrauma. For all studies, Bourgeois and his teamselectedtheCPSprimeseriesof interdental brushes of the Swiss oral carebrandCURAPROX. 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.” Prof.DenisBourgeois,isworkingasa professorin theFacultyofDentistryat theUniversityofLyon(11RueGuillaume Paradin,69372LyonCedex08),France, andcanbecontactedbyphoneat +33 478778684orbye-mailat denis.bour- geois@univ-lyon1.fr.