CLEANING THE PROBLEM AREA
by Graham Barnby (published October 2006)
Ask any dentist or hygienist about the greatest challenge they have and it won’t be treating the nervous, avoiding the uncontrollable tongue or trying to stem the Niagara-like saliva flow from some of their patients. No the biggest problem is getting the patient to clean the interdental area effectively on a regular basis.
Most patients think that a 30 second thrash with the toothbrush is enough and so they find the 3-minute routine advised by most dental professionals to be an enormous effort. When cleaning between the teeth is then added to your daily routine instruction the patients eyes glaze over, the shoulders drop and you get the feeling that the floss will never be used – or not for its real purpose. We know that the patient is saying yes with the nodding head – but inside the head is really saying No to using the floss.
And yet it is the interdental area that is most important in controlling the periodontal health of the mouth, although as periodontal disease is silent, painless and slowly progressive (in a majority of cases) patients are far less worried about it. Decay and its progress can mean having “a root canal” which is much feared, especially after films like Marathon Man. Telling a patient that the teeth will become loose in about 20 years time usually gets a “So what” or “I’ll deal with that at that time” type of response.
How do you motivate these people to try and reduce the progress of their periodontal breakdown so that they will have a functional dentition into old age? This is a challenge faced by all the dental team and the new products that have been designed to work interdentally have come to our aid.
There are two other factors that can be of some help in combating periodontal diseases. These are the link with heart disease and the social problem of bad breath. Both these can help us guide the patient to better dental health as many will see “being nice to be near” as a definite plus in social and work situations.
The initial weapon in the oral health battle is the toothbrush. This can be simple in design as long as there is a small head with a flat trim and a handle that is easy to hold. All the TePe range fit these parameters and the design has hardly changed in 20 years and they are still the dentists favourite in Sweden. The brushes come in adult and child sizes with a medium or soft filament so that the potential for damage of even the most delicate mucosa is almost non-existent.
For patients who have a sore mouth or are recovering from surgery of the mouth there is the extra soft brush that is unique to the TePe range. This brush feels like velvet and can be a very effective tool for oral hygiene when a normal toothbrush would be too harsh to use. This can be a real help in the patient with recurrent apthous ulceration, generalised infection in the mouth and after radiotherapy.
All the toothbrushes can be autoclaved and are made of environmentally friendly plastic- an increasing need in the modern world.
Very often the first time the interdental brushes are used by the patient it is the first time they have attempted to clean this area on a regular basis. They have probably used floss in the past and given up due to the manual dexterity needed or because they made it snap through the contact point allowing it to cut into the gingival tissues. TePe produce soft floss, which many regular floss users find excellent and much less likely to shred. However those who really have not got into floss are the targets for using the interdental brushes
For health of the periodontium, fresh breath and reducing the potential for heart problems the interdental area must be cleaned on a daily basis. This is where the TePe range of products really comes into their own. With 8 sizes that range from 0.4 mm right up to 3mm there are sizes for each interdental space. With the colour coding it is very easy for the patient to remember the sizes they need for a variety of spaces in the mouth. The hygienist or dentist can make a chart for the different areas of the mouth and indicate the correct colour brush for each area.
And now there is the new proximal brush that has a long handle, similar to the toothbrush handle with a neat interdental brush head that fits tightly into it. The snap fit makes this very secure and the tips can be inserted into the head in two ways, giving different angles. This allows the brush to fit into areas that would be almost impossible with the hand held TePe interdental brush. For instance the less than a right angle way allows easier access to the lingual areas whilst the greater than a right angle is better for the back of the mouth. These handle held brush heads are a perfect compliment to the popular original hand held brushes.
These new tips for the long handle are colour coded in the same colours as the original range so that patients find it easy to add this to their oral hygiene regime. To make life easy for patients the tips can be carried in a handbag or pocket in the travel case that comes with the handle. This is a feature of the hand held brushes as they come with a cover the doubles as a handle and cover.
For those patients who cannot use even the hand held brushes TePe do offer the interdental plastic sticks. These come in a travel case and so are easy to keep with you for dislodging food and cleaning between the teeth. Not as good as the interdental or Proximal brush – but better than nothing.
Both the proximal and standard toothbrushes can be adapted easily for use by anyone with a manual dexterity problem. The slip on Grip makes the handle easier to grip – a boon for many disables patients. The grip is useful for any patients having difficulty with the muscle strength or arthritic conditions, as they get older. It is simplicity itself to fit – you just slide it over a TePe toothbrush and it locks perfectly. By experimenting you will find that the handle fits either way and so fitting it one way gives a grip nearer the neck and fitting it the other way makes the grip be further away from the neck. The Grip handle can be cleaned in the dishwasher, come in a variety of colours and are comfortable to hold with a non-slip texture.
So you now have the products that can give your patients a clean and healthy mouth making them confident that they had fresh breath and healthy gums to support the teeth. Cleaning this difficult area also will get fluoride interdentally and so help reduce the decay rate. And one final tip, get the patient to brush their tongue on a daily basis as this is perhaps the commonest area for bacteria to lodge and cause bad breath.
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