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06 Dental Tribune Asia Pacific Edition | 12/2016 TRENDS & APPLICATIONS Proving effective oral instructions in a clinical setting Despite advances in good oral health care, many patients and dental pro- fessionals remain uncertain about oral physiopathology and the con- cept of disruption of interdental bio- film. Although patients may have bought more oral care products and become more interested in their dental hygiene, many still do not know how to use them correctly. A previous article published in Dental Tribune Asia-Pacific 11/2016 intro- duced to the outstanding research done by Prof. Denis Bourgeois, Dean of the University of Lyon’s dental faculty in France. In his presentation at the FDI Annual World Dental Congress in Pozna´ n in Poland, he presented scientific evidence that interdental brushes, in particular CURAPROX CPS interdental brushes, are efficient tools to interrupt the interdental biofilm. However, ques- tions remain about the level of indi- vidual training that the dental staff should provide for their patients. Naturally, dental professionals agree that, despite clinical evidence that supports the importance of interdental biofilm management, effective daily cleaning of inter- dental spaces remains a challenge among their patients. Removal of interproximal plaque is considered important for the maintenance of gingival health, prevention of peri- odontal diseases and the reduction of caries, as well as the prevention of systemic diseases. However, den- tistry still argues whether today’s interdental cleaning tools are suf- ficient to interrupt biofilm devel- opment. Professionals debate on which tools to use and how to use them correctly, as uncertainty has remained about how to maintain clean interdental spaces. As Bourgeois concluded in his presentation, the majority of stud- ies have reported a positive signifi- cant difference in the plaque index when using an interdental brush compared with floss. In general, in- terdental brushes were found to be more effective in removing plaque compared with brushing alone or the combined use of toothbrushing and dental floss. Establishing the accessibility andwidthsoftheinterdentalspaces should therefore be part of the rou- tine examination of all patients. Its goal is to identify the distribution of interdental brush accessibility site by site and to choose the largest diameter that can pass between the teeth without causing discomfort or trauma. An interdental brush that is sized correctly for each inter- dental space is easy to handle and atraumatic, yet effective. Individual instruction important for good interdental health One major problem with inter- dental cleaning has always been patient ability and motivation. “In- terdental cleaning does not read- ily become an established part of daily oral hygiene,” said Bourgeois throughout his presentation. Dam- age to the interdental papilla and abrasive trauma to the dental sur- face result from a lack of motivation and training. Furthermore, bleeding may stop patients from using inter- dental brushes even though bleed- ing will stop after several uses if an interdental brush of the correct di- ameter is used. Oral and periodontal diseases are not only due to sugar consumption or heredity, but result from a lack of proper dental hygiene. “The reason for oral and perio- dontal diseases is not a lack of anti- septics, a lack of fluoride or a lack of massage of the gingivae. Antiseptics continue to be used, but mouth- wash does not stop bleeding. Only the right technique of cleaning in- terdentally, repetition of this tech- nique and regular training can re- duce the risk of bleeding and oral bacteria,” said Bourgeois. “From a clinical point of view, the oral prophylactic goal of achieving thor- ough cleaning with minimal dam- age, due to the misuse of interdental brushes, is important. It is necessary to emphasise individual instruction and selection of oral hygiene means with a view to attaining a high level of cleanliness with little or no harm to either soft or hard tissue.” Oral prophylaxis should there- fore be taught individually and not in lectures. By correcting and repeat- ing the right cleaning technique, prevention of oral and systemic disease can be achieved. Currently, Bourgeois offers prophylaxis train- ing courses for dental students. In these, they are taught the correct use of oral hygiene tools such as interdental brushes, cleaning tech- niques, and the importance of moti- vation and repetition. As observed by the course presenter, 95 per cent of the dental students continue to use interdental brushes after two yearsofcompletingthetraining.“In- terdental cleaning needs to become an established part of daily oral hy- giene for the reduction of interprox- imal plaque, the control of gingivitis and improvement of patient moti- vation. If you use a toothbrush twice a day, you have to use interdental brushes once a day. If not, you will risk your health,” Bourgeois said. A probe as key to successful interdental cleaning As an effective and predictable tool to objectively measure the size of the interdental spaces, inter- dental probes are now increasingly used by some dental hygienists to help choose the right access diame- ter defined by the thickness of the wire core. A study by Bourgeois et al., titled“A colorimetric interdental probe as a standard method to eval- uate interdental efficiency of inter- dental brush,”emphasised the need for choosing the right diameter so that the interdental brush can easily fit the interdental space. Apart from the individual anatomy, interproximal spaces can change with age, periodontal health or den- tal treatment. While under-sizing of the interdental brush will affect its efficiency, oversizing might in- fluence acceptability, comfort and could cause gingival trauma. Essentially, Bourgeois and his colleagues suggested that the use of a colorimetric probe and interdental brushes is more beneficial to both the patient and the practitioner than merely choosing interdental brushes based on the reference tech- nique of trial and error alone. By using the IAP CURAPROX calibrating colorimetric probe, a conical profes- sional instrument with a rounded tip, dental professionals were able to measure the interdental space and choosethemostsuitableinterdental brush for their patients. The study found that the brushes chosen had adiameterlargerthanthatindicated by the probe in 23.54 per cent of cases and a diameter smaller than the probe value in 33.41 per cent of cases. According to the study, the colorimetric interdental probe can be considered as a newly developed in-clinic professional procedure that will make interdental cleaning eas- ier and more predictable and help improve patient motivation. By measuring the interproxi- mal space correctly, Bourgeois and his team 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-diameter interdental brush (0.6 to 0.7 mm) of the Curaprox CPS Prime Series, and differences occurred between ante- rior and posterior sites. Participants were able to use the interdental brush easily following instructions. As a result, most interdental sites can be cleaned using interdental brushes, but accessibility of inter- dental spaces would need to be es- tablished in the dental practice with the use of the CURAPROX IAP Probe. More information can be found at www.curaprox.com. © DTI According to Prof. Denis Bourgeois, toothbrushing alone is not enough to prevent interdental plaque. Individually trained oral prophylaxis is key to success. © DTI Prof. Denis Bourgeois spoke about the role of interdental biofilm management in his presentation in Poland. 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. phone at +33478778684 or by e-mail