Dental flossDental floss is the most widely recommended tool for removing plaque from proximal tooth surfaces.59 Floss is available as a multifilament nylon yarn that is twisted or nontwisted, bonded or nonbonded, waxed or unwaxed, and thick or thin. Monofilament flosses made of a Teflon-type material are preferred by some individuals because they are slick and do not fray. A variety of individual factors determine the choice of dental floss, such as the tightness of tooth contacts, roughness of proximal surfaces, and patient’s manual dexterity, not the superiority of any one product. Clinical research so far has not been able to show any significant differences in the ability of the various types of floss to remove dental plaque; they all work equally well.Technique. The floss must contact the proximal surface from line angle to line angle to clean effectively. It must also clean the entire proximal surface, not just be slipped apical to the contact area. The following description is a primer in floss technique: 1- Start with a piece of floss long enough to grasp securely; 12 to 18 inches is usually sufficient. It may be wrapped around the fingers, or the ends may be tied together in a loop. 2- Stretch the floss tightly between the thumb and fore-finger, or between both forefingers, and pass it gently through each contact area with a firm back-and-forth motion. Do not snap the floss past the contact area, because this may injure the interdental gingiva. In fact, zealous snapping of floss through contact areas creates proximal grooves in the gingiva. 3- Once the floss is apical to the contact area between the teeth, wrap the floss around the proximal surface of one tooth, and slip it under the marginal gingiva. Move the floss firmly along the tooth up to the contact area and gently down into the sulcus again, repeating this up-and-down stroke several times. Then move the floss across the interdental gingiva and repeat the procedure on the proximal surface of the adjacent tooth.4- Continue through the whole dentition, including the distal surface of the last tooth in each quadrant. When the working portion of the floss becomes soiled or begins to shred, move to a fresh portion of floss.
Flossing can be made easier by using a floss holder. Although use of such devices can be more time consuming than finger flossing, they are helpful for patients lacking manual dexterity and for nursing personnel assisting handicapped and hospitalized patients in cleaning their teeth. A floss holder should possess these features:
(1) one or two forks that are rigid enough to keep the floss taut when penetrating into tight contact areas, and
(2) an effective and simple mounting mechanism to hold the floss firmly in place. The disadvantage of floss tools is that they must be rethreaded whenever the floss becomes soiled or begins to shred.
Cleaning of concave or irregular proximal tooth surfaces. Dental floss (A) may be less effective than an interdental brush (B) on long root surfaces with concavities.
Wooden or Rubber Tips
Wooden tips are used either with or without a handle. Access is easier from the buccal surfaces for those tips without handles, primarily in the anterior and bicuspid areas. Rubber tips come mounted on handles or the ends of toothbrushes and can easily be adapted to all proximal surfaces in the mouth. Various plastic tips are also available and can be used in a manner similar to wooden tips. Both rubber and plastic tips can be rinsed and reused and easily carried in a pocket or purse, features that are attractive to some patients.
A large variety of interproximal cleaning devices are available: wooden tips (A and B), interproximal brushes (C-F), and rubber tip stimulators (G).
Interproximal embrasure spaces vary greatly in patients with periodontal disease. In general, embrasures with no gingival recession are adequately cleaned using dental floss (A); larger spaces with exposed root surfaces require the use of an interproximal brush (B); and single-tufted brushes clean efficiently in interproximal spaces with no papillae (C).
ORAL IRRIGATION DEVICES
Oral irrigators for daily home use by patients work by directing a high-pressure, steady or pulsating stream of water through a nozzle to the tooth surfaces.
Oral irrigation has been shown to disrupt and detoxify subgingival plaque and can be useful in delivering antimicrobial agents into periodontal pockets.
Oral irrigation. A, The most common devices have a built-in pump and reservoir. B, Conventional plastic tips are used for daily supragingival irrigation at home by the patient. C, A soft rubber tip is used for daily subgingival irrigation by the patient at home. D, A canula tip is used for subgingival irrigation by the dentist or dental hygienist in the office.
Subgingival irrigation performed both in the dental office or by the patient at home, particularly employing antimicrobial agents, has been shown to provide some site-specific therapy. It is performed by aiming or placing the irrigation tip into the periodontal pocket, attempting to insert the tip at least 3 mm. This is achieved by using a soft rubber tip at home or a canula in the dental office