1. Interdental AidsSeminar-2Dr.Leena ParmarMDS 1st yrDepartment of Periodontics

2. INDEX Interdental Area Planning of Interdental Care Various Interdental Aids Dental floss and tape Knitting Yarn Gauze strip Interdental tips Toothpick in Holder Wooden interdental cleaner 3. Interdental Area In health interdental gingiva fills the interproximalarea Three types of gingival embrasureI. Type III. Type IIIII. Type III 4. Classificaton of Gingival EmbrassuresTYPES OFEMBRASSURESCONDITION OFGINGIVA INEMBRASSURERECOMMENDEDCLEANING AIDSIIIIIIIVVEmbrassures arecompletely occupied byhealthy interdental papillaAbout 75% of embrassureis occupied by the gingivaAbout 50% of theembrassure is occupiedby gingivaAbout 25% of theembrassure is occupiedby gingivaComplete los ofSuperfine and thin dentalfloss, used only forcleaning SulcusMedium or coarse andthick dental FlossThin fine pointed smallspiral interdental BrushesThick spiral interdentalBrushes and fine bristleended unitufted bBrushBristle ended unitufted 5. Anatomy of Interdental Area Posterior teeth--two papilla(one facial and one palatal)-connected by col anterior teeth--single pyramidal papilla Epithelium of col is thin and non keratinized 6. Inflammation,edema,Deepening ofcolBiofilm formationin interdental areaand inaccessibilityfor tooth brushInitiation ofgingivaldiseases 7. Planning of Interdental Care History of personal oral care Dental and gingival anatomy assessment-teethposition, embrassure, probing depth Extent and Location of Dental Biofilm Personal Factors- handicap ordisability,knowledge of interdental oral care 8. Various Interdental Aids Dental floss and tape Knitting Yarn Gauze strip Interdental tips Toothpick in Holder Wooden interdental cleaner 9. Image 10. Dental Floss Most widely recommended interdental aid Material- silk, nylon, expanded PTFE(plasticMonofilament polytetrafluoroethylene) Typesa) twisted/nontwistedb) Bonded/nonbondedc) Waxed/nonwaxedd) Thick/thin 11. Features of waxed or ExpandedPTFE Smooth floss surface which prevents trauma tosoft tissue Slides through contact area easily Monofilament resist breakage or shredding Wax gives strength and durability 12. Features of unwaxed floss Thinner floss-used in tight contacts Pressure against tooth surface spreads nylon onwider surface for biofilm removal Sharper edges require special attention 13. Enhancements Color and flavors have been added Therapeutic agents like fluoride and whiteningagents have also been added Power flossing devices are available-moves inshort circular motion when device is switched on 14. Method 15. Video 16. Tufted dental floss Regular dental floss alternated with thickenedtufted portionTwo variablesSingle,precut lengthsSuperfloss 2 footlength ,5 inch tuftedportion adjacent to 3inch stiffened end.Roll or NuFloss-Tufted portion (1 inchlong ) alternated withplain floss about oneand a half inch long. 17. Indications adjacent to wider embrassures with loss ofinterdental papilla. Mesial & distal abutments and under pontics ofFPD or orthodontic appliances. 18. Knitting Yarn Indications1. Tooth surface adjacent to wide proximal spaces2. For mesial & distal abutment of FDP and underpontics 19. Gauze Strip Indications1. Proximal surface of widely spaced teeth2. Surfaces of teeth next to edentulous area3. Distal & mesial surface of abutment teeth.4. Under posterior cantileverd section of fixedappliance 20. Interdental Brushes Types :1. Small Insert brushes with reusable handle2. Brushes with wire handles 21. Indications Proximal tooth surfaces adjacent to openembrassures , orthodontic appliances , FixedProsthesis, Periodontal splints Concave proximal surfaces Exposed class IV furcation For application of chemotherapeutic agents Fluroide dentifrices, antibacterial agents,desensitizing agents. 22. Single-Tuft brush (End-Tuft , Unituft) Single tuft or group of small tufts , 3- mm indiameter, flat or tapered with staright or contra-angledhandle. 23. Indication for use1. For open interproximal areas2. For dental prosthesis3. Difficult to reach area Lingual surface ofmandibular molars.,Abutment teeth , distal surfaceof posterior most teeth Procedure1. Direct the end of tuft into the interproximal areaalong the gingival margin.2. Combine a rotating motion with intermittentpressure 24. Interdental tip Conical or pyramidal flexible rubber tip attachedto handle. 25. Indications1. For cleaning debries from interdental areas2. Biofilm removal at and just below gingival margin. Procedure1. Trace along the gingival margin with the tipposition just beneath the margin (1-2 mm )2. Rub the tip against the teeth as it is moved in &out of an embrassure and under a contact area.Position with gingival form. 26. Tooth pick in holder Round tooth pick inserted into a plastic handlewith contr-angled ends. Also known as Perio-Aids 27. Indications Patients with periodontitis Orthodontic patients. 28. Procedure Insert the round tapered tooth pick into the end ofthe holder, twist the tooth pick firmly into placeand break off the long & cleanly to prevent sharpedges. Apply tooth pick at the gingival margin at rightangle application with moderate pressure, tracethe gingival margin. To remove biofilm just below the gingival marginapply the end at less than 45 degrees. Maintainthe tip on the tooth surface following the sulcus. 29. Wooden Interdental cleaner 2 inch long device made of Bass wood or Birchwood. Used for wider gingival embrassures. 30. Procedure First teach the patient to use a rest by placing thehand on cheek/chin/ or by placing a finger on thegingiva , convenient to the place where tip will beapplied. Soften the pointed end of wood in mouth &moistening with saliva. Hold the base of the triangle towards the gingivalborder of interdental area & insert horizontally. Clean the tooth surface by moving the wedge in &out while applying the burnishing stroke withmoderate pressure , 1st on one side of theembrassure & then on other. Four strokes each 31. Dental water flosser 32. Irrigation-Irrigation helps to reduce the levelsof biofilm and debris from around crowns,bridges, orthodontic appliances and implants,and in interdental areas. There are a variety of devices on the market.Usually power driven and handheld, thesedeliver a pulsating jet of water (or prescribedsolution) from a reservoir to the required area. The pressure at which the solution isdelivered can be altered by the patient. A selection of tips are oftenavailable,depending on manufacturer,fortargeted delivery of the solution. 33. Method of use-The manufacturersinstructions should be followed, The tip shouldbe directed towards the interdental area andheld at 90 to the long axis of the tooth. Patients should start with a low pressuresetting until they are used to the device. The temperature of the liquid should becomfortable to them A sink or basin should be nearby, so water orsolution can be drained away Tissues/towels should be nearby 34. conclusion only tooth brushing does not remove theinterdental biofilm Patient should be educated and motivated aboutthe interdental cleaning Interdental aids should be selected as per theanatomy of gingival embrassures. 35. References Clinical periodontology-Carranza,9th edition Essentials Of Community Dentistry-SobenPeter,3rd edition Clinical practice of the dental hygienist-Esther MWilkins,3rd &10th edition Interdental oral hygiene aids and theirapplication-Leanna Wynne, Dental Nursing March2012 Vol 8 No 3