9th January 2013 0
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In this issue we will ask dentists and hygienists the best practices and tools for achieving optimal oral health through interproximal space cleaning.

“We recommend interdental cleaning after the 3 main meals”
Elvira Fernández
Periodontist (Seville)

We advise our patients to perform interdental cleaning as well as proper toothbrushing depending on the condition of their gums, after the 3 main meals.This way we can reduce plaque build-up and interproximal caries incidence.
We recommend that patients with gingivitis use dental floss or tape, since they normally do not have wide interdental spaces.
We recommend patients with periodontitis to use interproximal toothbrushes, choosing the size that best adapts to the interdental space that caused the bone loss.

“To use interproximal brushes at least once per day”
Germán Barbieri, Periodontist, 
and María Jesús Naves, Hygienist (Gijón)

We recommend the use of interproximal brushes at least once per day – if possible, at night. Because of the difficulty of this technique at the beginning of periodontal treatment, and after having treated many patients using different techniques, our current protocol consists of teaching patients in their own mouths with a mirror in hand, so that they can see how we do it.
During the first visit, we select 2 interproximal brushes, at most, with different diameters. We always tell them: “it should enter with a bit of pressure, but it should not hurt.” That way the patient understands that there is a proper size for every interdental space. We recommend that it be used without toothpaste and that brushing be done in the direction from vestibular to lingual/palatine. During future examinations and maintenance visits, if needed, we modify the diameters and the number of brushes. We even instruct [patients] on how to carry out lingual/palatine to vestibular motions.
In short, as patients improve their hygiene, we increase the difficulty. It is important to do this progressively so that the patients do not get frustrated and so that they achieve optimal hygiene in order to maintain periodontal health.

“To rinse 3 times per day in order to access hard-to-reach areas”
Elisabet Ferrer
Dentist (Palma de Mallorca)

In order for our patients to follow adequate interproximal hygiene guidelines and to use them over time, we must follow certain steps. Patients must be informed on the consequences of carrying out deficient oral hygiene, including the occurrence of diseases such as caries and periodontal diseases (gingivitis and periodontitis), with halitosis, gingival bleeding and inflammation and tooth insertion loss in the latter.
Patients must brush teeth 3 times per day for 2 minutes, using the technique that best removes dental plaque. And we inform them of the toothpaste needed depending on their current condition.
They should also use the different tools available for properly cleaning interproximal spaces.
For tight spaces: dental floss. We should teach how to use dental floss, wrapping it around the middle finger so that the pointer and thumb can clamp it for more cleaning precision.
For wide spaces: interproximal brushes.
After trying the brushes in the patient’s mouth, we choose the interproximal brushes that best suit the space to be treated, and we write down the correct diameter on the prescription pad. They should adapt to the teeth, and it should be the filaments and not the wire that sweep the plaque. 
5 in-and-out movements should be used against each side of the tooth for each space, dipping the brush in toothpaste and rinsing it off every time a new space is chosen.Rinsing 3 times per day to access hard-to-reach areas. And in orthodontic patients, fixed prostheses and implants can be finished off with oral irrigators.
We also motivate patients by showing them the progress they have made in subsequent dental visits.



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