Dental Tribune Pakistan Edition No.5, 2016

04 DENTAL TRIBUNE Pakistan Edition September 2016 To floss or to brush—that is the (interdental) question By Marc Chalupsky L EIPZIG, GERMANY - Should dental floss still be used as a tool to combat plaque, caries and periodontal disease? After almost 40 years, the US Department of Health and Human Services and Department of Agriculture have removed their recommendation to use dental floss from their latest Dietary Guidelines for Americans. And the dental world discussed a recent report which made worldwide headlines and concluded that no scientific evidence has proven the effectiveness of flossing. So: What are alternatives for dental professionals? Dental Tribune Online posed these questions to three dental hygienists. For a long time, dental professionals have recommended daily flossing as a necessary part of health care. However, the Associated Press reviewed 25 prominent studies that compared the combination of toothbrushes and floss and their effectiveness in plaque removal. As Dental Tribune Online reported earlier, the investigation found only weak and unreliable evidence. According to the article, some studies were not valid since they included very few participants and had a short duration of only a couple of weeks. When asked for a statement, dental floss manufacturers were not able to provide scientific evidence even though many of the previously mentioned studies were funded by this industry. In the meanwhile, manufacturers have already announced new funding for comprehensive research to determine the effects of flossing on oral health. As periodontal disease and caries develop over months and years, future research will have to focus on a larger study population over a longer period in order to measure periodontal health effectively. In the meantime, how should dental professionals deal with this issue? Do they have an alternative to dental floss? Are interdental brushes another solution? According to Swiss oral health care provider Curaden, not cleaning interdentally would be going too far. Choosing a suitable interdental cleaner and using the proper technique are always important. Floss is appropriate for anterior teeth, where long, flat approximal surfaces and narrow spaces make access with an interdental brush difficult. Ideally, one should use dental floss for the narrow interdental spaces between the anterior teeth and interdental brushes for the posterior teeth. According to the Swiss company, interdental brushes are very effective and extremely easy to use compared to dental floss, but must be used gently in order not to injure the gums. Interdental brushes help prevent build-up of plaque between teeth and that causes bleeding gums, gingivitis and periodontitis and dental caries. In addition to interdental brushes, the company produces toothbrushes and toothpastes under its CURAPROX brand and supports educational prophylaxis training called iTOP for dental professionals. CEO and owner of Curaden Ueli Breitschmid said, “Since 1972, our company has been the pacesetter for interdental brushes, which remove both food residue between the teeth and—more importantly—dental plaque. Since they do not damage tissue, our interdental brushes are not only recommended by the dental professionals globally, but are also prescribed to their patients and their use taught to each patient individually.” According to Curaden, the advantages of interdental brushes over flossing have been demonstrated in numerous Despite the recent dental floss discussion, patients should not conclude that less thorough dental care is advised. But what interdental cleaners should dental professionals recommend? studies. For example, in a study titled “Comparison of different approaches of interdental oral hygiene: Interdental brushes versus dental floss”, patients with periodontitis used dental floss and interdental brushes to reduce plaque over a six-week period. Interdental brushes were found to remove significantly more plaque than dental floss did. Furthermore, patient acceptance seemed to be higher with interdental brushes. “Everyone knows dental floss, but only few like to do it—because they do not know how,” according to Edith Maurer, a Swiss-based dental hygienist with 40 years of experience. She added: “A very short thread should be kept between the fingers, moving up and down the sides of the teeth. But most of the time, it slips away, cuts into the gums and so constantly injures the structure of the gingivae. Dental floss should be used if something is stuck between your teeth but not for cleaning below your gums. After all, it has been a razor-sharp tool for over 200 years and is quite dangerous if you do not use it correctly. Imagine cutting a pudding with floss. It will work perfectly, nothing will be attached to the floss. But if you use a fine interdental brush, it will take away more of the pudding. Interdental brushes should be the preferred tool if you want to clean your gums at least in the posterior region.” Individually trained oral prophylaxis is the key According to dental hygienist Catherine Schubert, the space below the contact area should be the focus. “We need to carefully differentiate between gum disease and dental caries. Interdental brushes are more effective for the prevention of gum disease owing to their space-filling properties. However, a thin shaft and longer bristles are necessary to reach below the interdental contact point where caries mostly develops. Interdental brushes can prevent interdental caries if applied correctly, which is below the interdental contact point. Of course, floss also cleans below the contact point. However, using floss just because it is normal, without thinking about the right technique, will not lead to the prevention of caries. At the same time, using an interdental brush without proper instruction will not lead to the prevention of gum disease. After all, it is not a government or institution that should decide about one’s oral hygiene, but the dental professional needs to choose which cleaning technique is most efficient for each of his patients. Individually trained oral prophylaxis has always been the key to one’s health." Elizabeth van der Ham, a South African dental hygienist, agrees that one has to choose carefully between flossing and interdental brushing: “Dental floss throughout the years has been a saving grace for many patients overcoming oral health issues. Continued on page 15 NEWS Review challenges dental health recommendation to avoid dried fruits DT International B ETHERSDEN, UK - Dental health associations worldwide, including the British Oral Health Foundation, usually advise against snacking on dried fruits. Owing to their stickiness, they adhere to the teeth and are thus considered to be detrimental to dental health. By reviewing scientific literature on this topic, a nutrition expert from A new study has cast doubt on the common perception that eating dried fruit can cause dental problems the UK has now found that this assumption might not be founded on scientific evidence. The review was undertaken by Dr Michèle Sadler, a registered nutritionist. “There is a lack of good quality scientific data to support restrictive advice for dried fruit intake on the basis of dental health parameters and further research is required,” she concluded. However, she found that there are a number of potential benefits of consuming dried fruits for dental health. For instance, eating dried fruits requires substantial chewing, which encourages salivary flow. In addition, they contain antimicrobial compounds and sorbitol. Furthermore, Sadler pointed out that advice Student develops artificial dental plaque DT International W ITTEN, GERMANY - As part of a research project, a dentistry student from Germany has developed a new formula to synthesise dental plaque, which could help facilitate research on oral biofilm significantly in the future. As the first dental student ever to speak at the congress, she presented her findings at the From left: Dr Tomas Lang, CEO ORMED - Institute for Oral Medicine at the University of Witten/ Herdecke, Ann-Kathrin Flad and Prof. emeritus Peter Gängler 94th General Session and Exhibition of the International Association for Dental Research, which took place from 22 to 25 June in Seoul in South Korea. “These results are important for the development of toothbrushes and other devices because their effectiveness has to be tested,” Continued on page 15

Dental Tribune Pakistan Edition No.5, 2016

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