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prevention International magazine for oral health No. 1, 2017

science | interdental health Prof. Denis Bourgeois at the 2016 FDI World Dental Congress: “Dental floss is no longer a priority, as its use is not supported by scientific evidence. For interdental brushes, we have scientific evidence. Interdental brushes have now become the best tool for cleaning interdental spaces.” to incorporate interdental brushes for these spaces. However, many individu- als object to using these tools, as un- certainty about interdental spaces and the importance of cleaning them daily persists. Sixteen billion bacteria in one interdental site So, why does interdental cleaning actu- ally matter? As the average adult has 30 interdental spaces, should more than just toothbrushing be done in order to prevent gingivitis, periodontitis and re- lated diseases? Are there any scientific studies that describe the composition of the interdental microbiota among gen- erally healthy patients and explain the importance of disrupting this biofilm? Bourgeois wanted answers to these questions. To understand the mecha- nism of periodontal pathologies, he took a unique approach, using real-time polymerase chain reaction to quantify and qualify the interdental biofilm in healthy adults. By using interdental brushes to collect the interdental biofilm effectively, he contributed significantly to establish- ing the role of interdental biofilm manage- ment in preventative oral health. In his study, approximately 16 bil- lion bacteria were collected on average from each interdental site, an astounding figure. To identify these interdental bac- teria, Bourgeois and his colleagues used Socransky complexes, which reflect mi- crobial succession events in developing dental biofilms. While the blue, yellow, green and purple complexes are cor- related with periodontal health, orange and red complexes reflect periodontal disease. Of the 19 major periodontal patho- gens quantified in the study, bacteria of red and yellow complexes constituted the majority of interdental bacteria. In particular, red complexes such as Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola were recognised as the most important pathogens in adult periodontal disease, representing around 8 per cent of the 19 pathogens analysed. P. gingivalis was detected in 19 per cent of healthy subjects and represented 0.02 per cent of the interdental biofilm. As much pre- vious dental research has confirmed, P. gingivalis alone can induce alveolar bone loss, and in combination with T. denticola and T. forsythia, is likely to lead to periodontal disease. Bourgeois’s findings mean that even the interdental biofilm of healthy patients is composed september 2017 27

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