Another Alternative to Floss: Interdental Brushes

If you want to make a dental hygienist laugh, show them stock photos of people flossing their teeth. Almost all of the models hold the floss like they have no real idea of how it works.

Of course, that doesn’t present a problem for them. They’re models, after all, just pretending to floss. In the real world, if you’re not flossing with the right technique, you might as well not be flossing at all.

In fact, difficulty with technique is one reason why so many people are so inconsistent about flossing. They find it too hard or they don’t get good results. They decide it’s an exercise in futility.

But if you’re a patient of Dr. Yoshida’s – or just a regular reader of this blog – you know that there are other tools you can use to clean between your teeth and along the gumline. One of Dr. Y’s favorites is an oral irrigator such as a Waterpik or Hydro Floss. Not only does it clean between your teeth; it flushes harmful bacteria from the space between your teeth and gums.

Then there are interdental brushes, which research suggests may be even more effective than floss, perhaps because many people find them easier to use. You just slide the small, round brush between your teeth and gently scrub their sides.

But as new research in the International Journal of Dental Hygiene shows, there’s at least one aspect of technique that can matter a lot: You shouldn’t use toothpaste when using an interdental brush.

tooth wear from interdental brushing with toothpasteThe main thing toothpaste does is provide a little grit to help break up and remove the sticky plaque that forms on your teeth between cleanings. Some toothpastes can be crazily abrasive, though, and can actually damage tooth enamel over time. An extreme version of this can be seen in a case history the study authors present to illustrate the potential problem. It involved a 66-year old man who used interdental brushes dipped in highly abrasive toothpaste three times a day. You can see the results in the image on the right.

So the authors devised a model to evaluate the effects of toothpaste in interdental cleaning. They set up a mechanical device to brush simulated interdental spaces at a rate of 120 vertical brush strokes per minute. Each sample underwent an hour of this brushing. Some were continuously treated with artificial saliva, while others were treated with a variety of materials: a povidone-iodine solution, slurries of chlorhexidine and fluoride gels, and toothpastes with varying levels of abrasiveness.

No dentin loss was observed when iodine or chlorhexidine were used, but a good deal of loss was seen with abrasive toothpastes. The more abrasive the paste, the greater the loss.

The laboratory study has shown for the first time – according to the author’s knowledge – that toothpastes when used as an additive to cleaning with interdental space brushes indeed have the clear potential for root damage like in ordinary toothbrushing, while the solutions and gels, however, did not.

Of course, like any study, this one had its limitations. For instance, there was no period of remineralization as would occur in real world circumstances. The study delivered a basic worst case scenario. But it’s an important one to keep in mind.

So if you use interdental brushes after regular toothbrushing, be sure to thoroughly rinse your mouth first, removing any trace of toothpaste that might remain on your teeth.

And if you want to add something to up your home hygiene game, try dipping the interdental brushes in ozonated oil instead, adding a bit of oil to the brush before each pass between your teeth. Ozone is an amazing weapon against harmful bacteria, not to mention viruses, fungi, and other pathogens. Regularly applying it to your gums in this way can be a real boon to improving your periodontal health.

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