A study[ii] has been conducted looking into the composition of interdental biofilm and the impact this could have on periodontal health. The interdental bacteria of 25 healthy participants were qualified and quantified using a real-time polymerase chain reaction. The results demonstrated an average of 10 billion bacteria from each interdental site. A significant proportion of which (8.08 per cent of bacteria assessed) were red Socransky complexes, which are major contributors to adult periodontal disease. Another significant bacterium associated with periodontitis is P. gingivalis, which was found in 0.02 per cent of samples and in 19 per cent of participants.

Professor Denis Bourgeois, who was one of the authors of the paper, comments, “Even the biofilm of young, healthy adults contains pathogens that can initiate periodontitis. The use of interdental brushes still tends to be linked to treatment for periodontal disease, and they are often exclusively recommended to patients with large interdental spaces, whereas floss is recommended for narrow spaces. However, dental floss is no longer preferred, as its use is not supported by conclusive scientific evidence. For interdental brushes, we have that evidence. Given the association of those interdental pathogens with periodontal and systemic disease, the habit of daily interdental brushing may be the easiest way to maintain a healthy mouth and body.”

Consequently, it can be deduced that removal of bacteria from interdental spaces is a critical step in the prevention of periodontal disease. However, helping patients to both understand its importance and physically implement the relevant cleaning into their daily routines are two substantial barriers to success.

The former involves educating patients on the risk factors of gingivitis, giving them useful information in a way they can digest and apply to their own situation. It is also an on-going process – simply telling a patient once is rarely sufficient to instigate change. Though the exact numbers vary, most educational sources agree that repetition is key for retention of new information. In the dental setting, this can be applied by reiterating bite-sized chucks of information regarding oral health and hygiene practises. It is also beneficial to recap on hygiene techniques, by engaging with the patient and asking them to physically enact their routine so that specific advice can be provided.

Encouraging patients to introduce effective interdental cleaning into their daily routine is perhaps more complex. This requires a change in their behaviour and therefore they need to be properly motivated to implement interdental cleaning and keep it up. In part, this motivation can come from their renewed knowledge and enthusiasm for oral health gleaned from information provided during consultations. However, professionals should expect some resistance as human nature tends to make behavioural change a difficult, time-consuming process.

Beyond all of this, the products patients are using to dislodge bacterial biofilm and remove food debris from between the teeth are important too. Various factors might impact what type of product is selected, from the patient’s age and dexterity to their personal preferences, their anatomy and their budget. However, there are certain features to consider in every situation. Take interdental brushes as an example. There is an extensive body of research evidencing their effectiveness in removing interproximal plaque and bacteria.[iii] However, there are some specific features that should be tailored for the individual to truly optimise outcomes.

For young adults and adolescents, interdental brushes with fine bristles tend to be most effective. For other patient groups, the size of the brush and the availability of different brush sizes may be more important. The Curaprox CPS prime brushes cater to the needs of a wide range of patients, with super gentle and ultra-fine bristles arranged in an umbrella shape for efficient removal of bacteria across the entire interdental space.

Professor Bourgeois added, “The Curaprox CPS prime brushes used in the study are able to penetrate 94 per cent of interdental spaces. This allows people to clean interdentally easily and effectively.”

Helping your patients better understand the need for interdental cleaning is only one piece of the puzzle as we look to improve the health of the nation. Educating them on the billions of bacteria that live between their teeth and motivating them to do something about them is crucial for future success.

For more information visit www.curaprox.co.uk

[i] Adult Dental Health Survey 2009. March 2011. https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series [Accessed February 2022]

[ii] Carrouel F, Viennot S, Santamaria J, Veber P, Bourgeois D. Quantitative Molecular Detection of 19 Major Pathogens in the Interdental Biofilm of Periodontally Healthy Young Adults. Front Microbiol. 2016 Jun 2;7:840. doi: 10.3389/fmicb.2016.00840. eCollection 2016.

[iii] Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent J (Basel). 2019;7(2):56. Published 2019 Jun 1. doi:10.3390/dj7020056