Dental care has a high priority today. Well-groomed teeth are considered attractive and radiate joie de vivre, health and well-being. To keep the teeth healthy and free of caries and periodontitis for life, the essential factors of an optimal basic oral hygiene are first:
- Twice a day the use of a fluoride toothpaste.
- The choice of an efficient toothbrush
- The correct use of an efficient brushing technique throughout the dentition, including hard-to-reach places such as the interdental spaces and the areas behind the last molars (the large molars).
However, in individual cases, these basic measures are often not enough. For the effective prevention of oral diseases, the extension of basic hygiene to include the use of additional aids is essential.
Indications (areas of application)
The use of oral hygiene aids to supplement basic measures is recommended whenever the teeth are not in a gap. Since the dental arch is usually shaped without gaps, this means that the vast majority of people should use daily aids that increase the effectiveness of interdental hygiene (hygiene between teeth). It also means that parents, who should continue to rebrush their children’s teeth into school age, should already make flossing for interdental cleaning of children’s six-year molars a daily routine.
I. Flossing
Dental floss is used to clean narrow interdental spaces (proximal spaces, interdental spaces) that are completely filled by the interdental papilla (triangular-shaped area of gum between teeth), making it impossible to use an interdental brush. It is used once a day to loosen and remove food debris and plaque (bacterial plaque) in the interdental spaces, as these narrow spaces cannot be completely reached even with an efficient brushing technique using a toothbrush. For this reason, the approximal spaces are a so-called predilection site for the development of caries: it is precisely between the teeth that caries preferentially forms, which is referred to here as approximal caries (interdental caries). Dental floss is commercially available in different variants:
- Smooth waxed
- Smooth unwaxed
- Fluffy: adhesion of plaque to the floss is favored, but it is difficult to move over very narrow contact points.
- With reinforced end (Superfloss): for threading, for example, under pontics (middle part of a bridge), splinted (interconnected) crowns, bars or attachments.
- Loaded with fluorides
- Mounted on small carriers for easier handling (eg Oral B Flossette).
The process
- A piece of dental floss about 40 cm long is first wrapped around both middle fingers, so that slipping or giving way is no longer possible, leaving a center piece about 10 cm long.
- This is stretched and inserted into the interdental space, moving it with feeling over the contact point (point of contact of the teeth) to avoid injury to the interdental papilla.
- Below the contact point, the silk, still taut, is guided up and down with light movements – no sawing movements!
- After each interdental space clean the floss under running water, if necessary, use a new piece, so as not to carry germs and bacteria that may be present in other areas.
II. Interdental brushes
Interdental brushes (interdental brushes) are the means of choice for cleaning the interdental spaces. Even in young adults, the interdental spaces usually provide enough room to use a small-diameter interdental brush. This does not necessarily mean that the interdental papilla has receded. This means that interdental brushes can and should be used even with periodontally healthy teeth (with healthy periodontium). Interdental brushes are available from a number of manufacturers in ascending ISO sizes and are used like dental floss once a day. The brushes must be replaced more frequently than the toothbrush, as they bend easily, especially in the case of beginners, and are subsequently more difficult to handle. Their service life is approximately 14 days.
The procedure
- The brush is inserted horizontally into the interdental space without toothpaste. For the front molars is recommended to insert from buccal (from the cheek side of the teeth), while the last molars may need to work from oral (from the tongue side).
- If the brush is inserted at an angle, the gum pocket may be injured.
- The brush is gently moved horizontally back and forth a few times.
- If gingivitis (inflammation of the gums) is present, the gums may react with bleeding at the beginning of the application. After a few days, the gingivitis will have receded. If the brush is now easier common, the cause of this is not a pathological (pathological) gum recession, but the decrease in inflammation-related gum swelling.
- After each interspace, the brush is cleaned under running water. If heavily soiled, the last interspace should be cleaned again.
III Toothpick
Toothhills are used to clean interdental spaces that are wide open because the papilla (triangle-shaped gum area between the teeth) has greatly receded. They have the shape of a triangle and, like interdental brushes, are inserted horizontally from buccal (from the cheek side of the teeth). Compared to larger-diameter interdental brushes, they have the advantage that they cannot bend, but they can break. In their cleaning performance they are inferior to the brushes.
IV. Tongue cleaner (tongue scraper)
In the furrows and niches of the tongue, the finest food residues and other organic matter accumulate, which serve as food for the bacteria living in the mouth. If these bacteria produce volatile sulfur-containing compounds, they are the cause of halitosis (synonyms: foetor ex ore, halitosis), a very unpleasant bad breath. To reduce the food base of bacteria, the tongue must also be cleaned daily. Aids for tongue cleaning are available in different variants. Bristles or nubs and flaps loosen the tongue coating. Tongue scrapers can be used to remove the loose coatings. The bristles of the anyway available toothbrush are recommended as the simplest variant, but their smaller width is a disadvantage compared to the tongue cleaners. Special halitosis toothbrushes offer a nap field on the back of the brush head for tongue cleaning (e.g. meridol halitosis toothbrush). What all cleaners have in common is that one, like the other, can trigger the gag reflex. With practice, the reflex will not decrease, but you will learn to avoid the area that triggers it.
V. Mouth rinses
Mouth rinses should not be used by preschool children as a matter of principle. Mouth rinses show their effect less through the rinsing process itself than through their ingredients, which, however, can also be found in toothpastes:
- Mouth rinses containing chlorhexidine reduce the number of bacteria in the mouth and are used to treat gingivitis (inflammation of the gums) and periodontitis (inflammation of the periodontium). They are indicated in acute inflammatory phases, but not for daily supplementation of oral hygiene.
- Fluoride-containing mouthwashes are used for caries prophylaxis. The most common fluoride compounds in this country are sodium, tin and amine fluoride. Fluorides are caries-protective in several ways:
- They promote remineralization (incorporation of minerals) of the tooth structure,
- Reduce their acid solubility,
- Form a calcium fluoride covering layer on the tooth surface, which is important for remineralization,
- Inhibit bacterial sugar degradation and
- Inhibit the adhesion of bacteria to the tooth surface.
- Rinsing solutions against halitosis (bad breath) neutralize the odor-forming sulfur compounds (eg tin lactate in Meridol Halitosis mouthwash) and have an antibacterial effect due to the fluorides contained. The rinse solution has the advantage over toothpaste that it also reaches the base of the tongue, which can not be cleaned with a toothbrush and toothpaste due to gagging.
- Mouthwashes against sensitive necks of teeth have a pain-relieving effect due to potassium salts and mechanical closure of the open dentinal tubules in the neck of the tooth.
Possible side effects of mouth rinses are discoloration, taste disorders (dysgeusia) and mucosal irritation.
