The terms interproximal and interdental are interchangeable and refer to the space that is formed under the spot where teeth come together (area of greatest union). This area, called the interproximal space, is taken up by the gums and is considered to be a “protected” region that is hard to reach, even when teeth are normally positioned.

It is well documented that bacterial plaque (oral biofilm) is the main etiological factor in the development of chronic, inflammatory periodontal disease. The most common mechanic plaque-controlling method is toothbrushing, which was designed to keep plaque well under control.  Nonetheless, its success has only been proven in the disruption of buccal or vestibular plaque, lingual or palatine plaque and plaque on occlusal surfaces (chewing areas). However, access to interproximal surfaces with this method is limited, which is why, in most cases, a different means of hygiene, including penetration between teeth is also necessary for optimal overall oral hygiene.

Interproximal areas, particularly the posterior ones, are the least accessible (Asadoorian, 2006), although these are the areas where most periodontal and gingival lesions as well as caries are formed (Galgut, 1991). For this reason, in order to achieve good oral health (Lindhe, 2008) it is very important to ensure interdental plaque removal.

In young individuals whose interdental gum (papilla) fills the entire interproximal space, dental floss or tape is the only tool that will allow access to this area (Schmage et al., 1999), as is also the case for narrow interproximal spaces between teeth in the anterior portion of the oral cavity. The use of dental floss/tape for removing interdental plaque is the technique that has received the most attention. However, when the papilla retracts, interproximal space increases. In these cases, interproximal brushes are recommended.

Interproximal brushes

Interproximal brushes are frequently recommended to patients who have sufficient space between their teeth, i.e. premolars and molars, since the space between them is big and easy to access. Brushes with soft Tynex® filaments weaved with a thin, plastic-covered stainless steel wire are recommended because they do not cause discomfort, even in patients with sensitive root surfaces. The shape of the interproximal brush can be cylindrical or conical (like a Christmas tree). It is important that the cross-sectional filament length adapt well to the interproximal space so that the brush can be moved back-and-forth for optimal cleaning. They can also be used to apply antimicrobial substances, for instance chlorhexidine gel or CPC (Cetylpyridinium Chloride), to prevent caries or inflammation. The brush should be thrown away when its filaments become loose or deformed.

Gingival bleeding during interproximal cleaning can be the result of a traumatism or a sign of inflammation. Patients should know that bleeding does not imply that they should avoid interproximal cleaning, but rather, on the contrary, since this can indicate the presence of inflammation, a condition that needs to be treated.

It is important to point out that the efficacy of current interproximal cleaning methods depends on patients’ ability, motivation or commitment level more than on the method itself (Warren et al., 1996). Not all interproximal cleaning tools are suitable for all patients or dentition types.

In modern-day oral hygiene programs, more stress should be given to interproximal areas.

Different interproximal cleaning techniques range from the use of dental floss and tape to interproximal brushes, and electric tools as adjunct interproximal therapy including oral irrigators, whose pulsating irrigation system is of proven efficacy. In modern-day oral hygiene programs, more stress should be given to interproximal areas.

References:

Asadoorian J, Flossing. “Canadian dental hygienist association position statement”. CJDH 2006; 40:1-10. Galgut PN. “The need for interdental cleaning”. Dent Health (London) 1991; 30: 8-11. Lindhe. Periodontología Clínica e Implantología Odontológica. Quinta edición. Tomo 2. Editorial Panamericana Médica 2009. Pág.: 714-716. Schmage P, Platzer U, Nergiz I. “Comparison between manual and mechanical methods of interproximal hygiene”. Quintessence Int. 1999, 30.535-539. Fischman SL. “The history of oral hygiene products products: how far have we come in 6000 years?”. Periodontology 2000 1997; 15: 7-14. Warren PR, Chater BV. “An overview of established interdental cleaning methods”. J Clin Dent 1996; 7: 65-69. Hoenderdos NL, Slot DE, Paraskevas S, van der Weijden GA. “The efficacy of woodsticks on plaque and gingival inflammation: a systematic review”. Int J Dent Hygiene 6; 2008; 280-289. Slot DE, Dörfer CE, van der Weijden GA. “The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: a systematic review”. Int J Dent Hygiene 6; 2008; 253-264. Berchier CE, Slot DE, Haps S, van der Weijden GA. “The efficacy of dental floss in addition to toothbrush on plaque and parameters of gingival inflammation: a systematic review”. Int J Dent Hygiene 6; 2008; 265-279.