Interdental Space Hygiene

Interdental space hygiene refers to oral hygiene techniques that are tailored to the more difficult-to-clean interdental spaces (approximal spaces, interdental spaces), which are not covered by the electric or manual toothbrush. To keep teeth healthy and free of decay and gum disease for life, the essential factors of 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).

In individual cases, these basic measures are usually not enough. To effectively prevent the development of approximal caries (interdental caries) and periodontal pockets (pathologically inflamed gum pockets with bone resorption), basic hygiene must be extended to include additional aids for interdental hygiene.

Indications (areas of application)

The use of oral hygiene aids to supplement basic measures is always recommended when the teeth are without gaps. 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).

I. Dental floss

Dental floss is used to clean narrow interdental spaces (proximal spaces, interdental spaces) that are completely filled by the interdental papilla (triangle-shaped gum area between the 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 proximal spaces represent 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 proximal caries (interdental caries). The interdental spaces of the deciduous or mixed dentition must also already be cleaned. This means that parents, who are required to clean their children’s teeth until they reach school age, should routinely use dental floss once a day to clean the interdental spaces of the child’s six-year molars. Dental floss is commercially available in several varieties:

  • 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 need to be replaced more often than the toothbrush, as they bend easily, especially in the beginner, and are more difficult to handle afterwards. Their service life is about 14 days.

The procedure

  • The brush is inserted into the interdental space in a horizontal direction without toothpaste. For the front molars, it is recommended to insert from buccal (from the cheek side of the teeth), while for the last molars, it may be necessary 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. Mouth rinses

As a matter of principle, mouth rinses should not be used by children of preschool age. Mouth rinses show their effect less through the mechanical rinsing process itself than through their ingredients, which are transported into the interdental spaces by the rinsing process:

  • 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.
  • Mouthwashes against sensitive necks of teeth have a pain-relieving effect through potassium salts and mechanical closure of the open dentinal tubules in the neck of the tooth.