Dental Floss Holder
The floss holder is a device that eliminates the need for placing fingers in the mouth. It is recommended for individuals with physical disabilities, poor manual dexterity, large hands, limited mouth opening, a strong gag reflex, and/or low motivation for traditional flossing.
A variety of different floss-holder designs are available. Most commonly, they consist of a yoke-like device with a 3/4- to 1-inch space between the two prongs of the yoke. The floss is secured tightly between the two prongs and the handle is grasped to guide the floss during use.
When using a holder, the floss is inserted interproximally (between the teeth), using the same technique employed for finger-manipulated flossing. Once through the contact point, the floss and holder are pushed distally (back) to clean the mesial surface of a tooth or pulled mesially (forward) to clean the distal surface. This pulling or pushing motion adapts the floss to the tooth, thus allowing the floss to slide into the sulcus.
Flossing under Bridges or Appliances
One type of variable-thickness floss (Superfloss) has a stiff end to allow for threading under bridges, beneath tight contact areas, under pontics, through exposed furcations, and around orthodontic wires. This floss combines a section of unwaxed floss with an area of thicker nylon meshwork to clean larger surface areas.
A dental floss threader is a plastic loop into which a length of floss is inserted, similar to threading a needle. The threader is used to carry the floss between the teeth (interproximally), or under a bridge, appliance, or splint. The floss threader is inserted from the facial (cheek-side) of the bridge and pulled completely through to the lingual (tongue-side) aspect. The floss may then be disengaged from the threader, adapted (pulled around) to one abutment tooth surface and moved up and down to remove plaque from the proximal surface. It is important to glide the floss through the space between the pontic (fake tooth in the middle of the bridge) and the gingiva in order to clean the underside of the pontic. After cleaning the underside of the pontic, it is necessary to slide the floss to the opposite proximal surface. Removal of the floss from between the abutment and pontic is accomplished by releasing one end of the floss pulling it out from the facial aspect.
Toothpicks are used to dislodge food debris and plaque. Consistent use of the toothpick can result in firm, resilient gum tissue. Toothpicks are generally considered easier to manipulate than floss and indeed are used more than floss for oral hygiene. A drawback with toothpick utilization is the possibility of contributing to recession, blunting the papillae, or causing even more severe damage with improper use.
Interproximal brushes can be utilized to clean spaces between teeth and around root furcations (where the roots split), orthodontic bands, and fixed prosthetic appliances with spaces that are large enough to easily receive the device. Interproximal brushes are preferable to the use of dental floss for cleaning between teeth where the papilla (pink triablge of tissue between the teeth) does not fill the space between the teeth, or where root concavities are present. The brushes are tapered or cylindrical in shape and are available in a variety of sizes. The core of the brush that holds the bristles may be made of plastic, wire, or nylon-coated wire.
When determining the approximate size of interproximal brushes, the diameter of the bristles should be slightly larger than the space to be cleaned. The brush can be moistened, and then inserted into the area. A bucco-lingual movement (cheek side of the tooth-tongue side of the tooth) is used to remove plaque and debris. Caution should be exercised to prevent damage to the tooth or soft tissues from the firm wire or plastic core of the brush.
Implant abutments are easily cleaned with interdental brushes however, extreme caution should be exercised to prevent scratching of the titanium surface. Only plastic coated wires are recommended. Foam brushes can also be utilized for this purpose.
Rubber or Plastic Tip
These devices consist of a cone-shaped, flexible rubber or plastic tip attached to a handle or to the end of a toothbrush. Primarily utilized for gingival massage, they can be used to remove plaque and debris from exposed furcation areas, open embrasures, and along the gingival margin.
The tip is placed at a 90-degree angle to the tooth and traced with moderate pressure along the gingival margin. In an open embrasure area, the tip is moved in and out in a bucco-lingual direction.
When used to massage the gingiva the rubber tip stimulates the tissue leading to increased keratinization (toughening of the tissue).
Some practitioners also recommend the rubber tip following periodontal surgery to aid in tissue re-contouring (healing).