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ePaper created 2018-02-22, 10:49:59 | version 1.38.0
Dental Tribune Middle East & Africa Edition | 1/2017 HYGIENE TRIBUNE C6 Why interdental brushes are essential for good oral health ByCuradenAG KRIENS, Switzerland: Prof. Denis BourgeoisisnotonlytheDeanofthe UniversityofLyon’sdentalfacultyin France but also a pioneer in research on oral prophylaxis, interdental bio- film management and interdental brushing techniques. He was the firsttotestfor19majorpathogensin the interdental biofilm known to be involved in periodontitis in young healthy adults. Furthermore, he has suggested interdental brushes to preventinterdentalbiofilmaccumu- lation as well as to decrease the de- velopment of periodontal diseases and even systemic diseases. “An in- terdental brush can remove around 16 billion bacteria from each inter- dentalspace,”saysBourgeois. 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,” concludes Bour- geois. Bleedingasaclinical reference Despite good oral hygiene habits, many patients experience interden- tal bleeding. “As we have seen, the interdentalspaceisasourceofbacte- rial contamination and has an effect on overall health,” says Bourgeois. According to the latest research, 41 per cent of young adults without periodontal disease or clinical gingi- vitis have experienced interdental bleeding at least once. This informa- tion should be considered critical for daily oral hygiene and interden- tal 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 otherwiseanywayinthefuture.” In a study titled “Efficacy of inter- dental calibrated brushes on bleed- ing reduction in adults: a 3-month randomized controlled clinical trial”, atestgroupwasaskedtouseastand- ard manual toothbrush twice daily andaninterdentalbrushdaily.Based on the hypothesis that interdental brushes reduce interproximal bleed- ing,Bourgeoisandhisteaminstruct- ed periodontally healthy and young individuals how to use interdental brushes daily and correctly. In addi- tion, a calibrated colorimetric probe helped to effectively determine the interdental space and right brush size. As the study suggests, the over- all 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 cleaning can be considered as “an effective means to help individuals maintain and/or achieveoptimaloralhealth.” 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 bleed- ing upon passage of an interdental brush. An unexpected finding was the high number of adults (69.9 per cent)withgreaterthan30percentof bleeding sites. It was observed that this did not have a significant ef- fect on the width of the interdental space. By measuring the interproxi- malspace,theresearchersconcluded that the latest generation of inter- dental 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 studyconcludedthatmostinterden- tal sites can be cleaned using inter- dental brushes, but accessibility of interdental spaces would need to be established in the dental practice by thedentalprofessional. Interdental brushes prove to besuperior Conventionally, interdental brushes were only recommended for pa- tients with large interdental spaces, while dental floss was recommend- ed for narrow spaces. As technology advanced,sodidtheinnovationwith 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 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 scien- tific evidence. Interdental brushes have now become the best tool for cleaning interdental spaces,” says Bourgeois. According to the French profes- sor, the interdental brush currently represents the primary and most effective method available for in- terproximal cleaning. Interdental brushes are specifically designed to clean between the teeth in accord- ance with the interdental space ac- cess diameter. The method of choice for interdental cleaning when brush space permits is to select the largest size that can penetrate into the in- terdental space and then to fill this space completely without causing discomfort or trauma. By using a calibrating Curaprox IAP colorimet- ric probe, a suitably sized interdental brush will help individuals achieve optimal biofilm disruption through thorough interdental cleaning with minimaltrauma. For all studies, Bourgeois and his teamselectedtheCPSprimeseriesof interdental brushes of the Swiss oral care brand CURAPROX. Patient ac- ceptance of these interdental brush- es has proven to be very high during allstudies. More information can be found at www.curaprox.com Prof. Denis Bourgeois recommends the regular use of interdental brushes, which can remove around 16 billion bacteria from each interdentalspace.(Photograph:CuradenAG)