Hygiene Tribune Middle East & Africa No. 5, 2016
To floss or to brush—that is the (interdental) question / Subgingival air polishing: A new method
Table of contents
Array
(
[post_data] => WP_Post Object
(
[ID] => 69723
[post_author] => 0
[post_date] => 2016-09-29 09:16:31
[post_date_gmt] => 2016-09-29 09:16:31
[post_content] =>
[post_title] => Hygiene Tribune Middle East & Africa No. 5, 2016
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => hygiene-tribune-middle-east-africa-no-5-2016-0516
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:22
[post_modified_gmt] => 2024-10-23 04:59:22
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/epaper/htmea0516/
[menu_order] => 0
[post_type] => epaper
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69723
[id_hash] => 61b82a97b72e07bc196e7dcdb921e559d48d20d3bda15ad8fd1335e0b9c218c4
[post_type] => epaper
[post_date] => 2016-09-29 09:16:31
[fields] => Array
(
[pdf] => Array
(
[ID] => 69724
[id] => 69724
[title] => HTMEA0516.pdf
[filename] => HTMEA0516.pdf
[filesize] => 0
[url] => https://e.dental-tribune.com/wp-content/uploads/HTMEA0516.pdf
[link] => https://e.dental-tribune.com/epaper/hygiene-tribune-middle-east-africa-no-5-2016-0516/htmea0516-pdf-2/
[alt] =>
[author] => 0
[description] =>
[caption] =>
[name] => htmea0516-pdf-2
[status] => inherit
[uploaded_to] => 69723
[date] => 2024-10-23 04:59:16
[modified] => 2024-10-23 04:59:16
[menu_order] => 0
[mime_type] => application/pdf
[type] => application
[subtype] => pdf
[icon] => https://e.dental-tribune.com/wp-includes/images/media/document.png
)
[cf_issue_name] => Hygiene Tribune Middle East & Africa No. 5, 2016
[contents] => Array
(
[0] => Array
(
[from] => 01
[to] => 01
[title] => To floss or to brush—that is the (interdental) question
[description] => To floss or to brush—that is the (interdental) question
)
[1] => Array
(
[from] => 02
[to] => 06
[title] => Subgingival air polishing: A new method
[description] => Subgingival air polishing: A new method
)
)
)
[permalink] => https://e.dental-tribune.com/epaper/hygiene-tribune-middle-east-africa-no-5-2016-0516/
[post_title] => Hygiene Tribune Middle East & Africa No. 5, 2016
[client] =>
[client_slug] =>
[pages_generated] =>
[pages] => Array
(
[1] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-0.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-0.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-0.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-0.jpg
[1000] => 69723-a3bb10d1/1000/page-0.jpg
[200] => 69723-a3bb10d1/200/page-0.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69725
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-1-ad-69725
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-1-ad-69725
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-1-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69725
[id_hash] => 4545376ec6a681453f5cfbd5e548dc728c4c7a2d749f3d6efc78491687ba93a9
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/3846_capp_events.html
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-1-ad-69725/
[post_title] => epaper-69723-page-1-ad-69725
[post_status] => publish
[position] => 6.71,72.13,86.99,23.23
[belongs_to_epaper] => 69723
[page] => 1
[cached] => false
)
)
[html_content] =>
)
[2] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-1.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-1.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-1.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-1.jpg
[1000] => 69723-a3bb10d1/1000/page-1.jpg
[200] => 69723-a3bb10d1/200/page-1.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-2.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-2.jpg
[1000] => 69723-a3bb10d1/1000/page-2.jpg
[200] => 69723-a3bb10d1/200/page-2.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69726
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-3-ad-69726
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-3-ad-69726
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-3-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69726
[id_hash] => c464486a4ef5397655a815648f89e327cfe58b5807c39719c169e80c7884b980
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://me.dental-tribune.com/company/colgate/
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-3-ad-69726/
[post_title] => epaper-69723-page-3-ad-69726
[post_status] => publish
[position] => -0.14,0.55,99.06,99.45
[belongs_to_epaper] => 69723
[page] => 3
[cached] => false
)
)
[html_content] =>
)
[4] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-3.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-3.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-3.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-3.jpg
[1000] => 69723-a3bb10d1/1000/page-3.jpg
[200] => 69723-a3bb10d1/200/page-3.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69727
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-4-ad-69727
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-4-ad-69727
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-4-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69727
[id_hash] => 3fe0974928950afcb07026e473eba7feea5cd1ec0e43a864c33e8c6d6c974744
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://me.dental-tribune.com/company/sirona-ae-the-dental-company/
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-4-ad-69727/
[post_title] => epaper-69723-page-4-ad-69727
[post_status] => publish
[position] => 6.3,63.11,34.64,31.97
[belongs_to_epaper] => 69723
[page] => 4
[cached] => false
)
)
[html_content] =>
)
[5] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-4.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-4.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-4.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-4.jpg
[1000] => 69723-a3bb10d1/1000/page-4.jpg
[200] => 69723-a3bb10d1/200/page-4.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69728
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-5-ad-69728
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-5-ad-69728
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-5-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69728
[id_hash] => 28bb93978084129c8424c1ad1df287d860450db255a3af332a8d68f7ab33a541
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://me.dental-tribune.com/company/colgate/
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-5-ad-69728/
[post_title] => epaper-69723-page-5-ad-69728
[post_status] => publish
[position] => 0.66,0,98.26,99.45
[belongs_to_epaper] => 69723
[page] => 5
[cached] => false
)
)
[html_content] =>
)
[6] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-5.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-5.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-5.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-5.jpg
[1000] => 69723-a3bb10d1/1000/page-5.jpg
[200] => 69723-a3bb10d1/200/page-5.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69729
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-6-ad-69729
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-6-ad-69729
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-6-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69729
[id_hash] => c949bd6e59d8ec1d6fed9884f081bb0c25edcaba10073db946876c121f580256
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/3873_croixture.html
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-6-ad-69729/
[post_title] => epaper-69723-page-6-ad-69729
[post_status] => publish
[position] => 7.11,29.78,68.06,65.58
[belongs_to_epaper] => 69723
[page] => 6
[cached] => false
)
)
[html_content] =>
)
[7] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-6.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-6.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-6.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-6.jpg
[1000] => 69723-a3bb10d1/1000/page-6.jpg
[200] => 69723-a3bb10d1/200/page-6.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69730
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-7-ad-69730
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-7-ad-69730
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-7-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69730
[id_hash] => 28b96be2c851d50f0a77a1fdb50d7df4c8c38818c631c718e337aaeeacd2b70c
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/3767_glaxosmithkline.html
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-7-ad-69730/
[post_title] => epaper-69723-page-7-ad-69730
[post_status] => publish
[position] => -0.14,0.27,98.25,99.46
[belongs_to_epaper] => 69723
[page] => 7
[cached] => false
)
)
[html_content] =>
)
[8] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/2000/page-7.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/1000/page-7.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/200/page-7.jpg
)
[key] => Array
(
[2000] => 69723-a3bb10d1/2000/page-7.jpg
[1000] => 69723-a3bb10d1/1000/page-7.jpg
[200] => 69723-a3bb10d1/200/page-7.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 69731
[post_author] => 0
[post_date] => 2024-10-23 04:59:16
[post_date_gmt] => 2024-10-23 04:59:16
[post_content] =>
[post_title] => epaper-69723-page-8-ad-69731
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-69723-page-8-ad-69731
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-23 04:59:16
[post_modified_gmt] => 2024-10-23 04:59:16
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-69723-page-8-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 69731
[id_hash] => 74be5689d3550d902f36cba65c228efaa93cb1a4df02a6eaf3c41d992ebd43a5
[post_type] => ad
[post_date] => 2024-10-23 04:59:16
[fields] => Array
(
[url] => http://me.dental-tribune.com/company/oral-b/
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-69723-page-8-ad-69731/
[post_title] => epaper-69723-page-8-ad-69731
[post_status] => publish
[position] => 0.26,0.27,99.06,99.46
[belongs_to_epaper] => 69723
[page] => 8
[cached] => false
)
)
[html_content] =>
)
)
[pdf_filetime] => 1729659556
[s3_key] => 69723-a3bb10d1
[pdf] => HTMEA0516.pdf
[pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/69723/HTMEA0516.pdf
[pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/69723/HTMEA0516.pdf
[should_regen_pages] => 1
[pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/69723-a3bb10d1/epaper.pdf
[pages_text] => Array
(
[1] =>
www.dental-tribune.me
Published in Dubai
September-October 2016 | No. 5, Vol. 6
To floss or to brush—that is
the (interdental) question
By Marc Chalupsky, DTI
LEIPZIG, Germany: Should dental
floss still be used as a tool to combat
plaque, caries and periodontal disease? After almost 40 years, the US
Department of Health and Human
Services and Department of Agriculture have removed their recommendation to use dental floss from their
latest Dietary Guidelines for Americans. And the dental world discussed
a recent report which made worldwide headlines and concluded that
no scientific evidence has proven the
effectiveness of flossing. So: What are
alternatives for dental professionals?
Dental Tribune Online posed these
questions to three dental hygienists.
For a long time, dental professionals
have recommended daily flossing as
a necessary part of health care. However, the Associated Press reviewed
25 prominent studies that compared
the combination of toothbrushes
and floss and their effectiveness in
plaque removal. As Dental Tribune
Online reported earlier, the investigation found only weak and unreliable evidence. According to the article, some studies were not valid since
they included very few participants
and had a short duration of only a
couple of weeks. When asked for a
statement, dental floss manufacturers were not able to provide scientific evidence even though many
of the previously mentioned studies were funded by this industry.
In the meanwhile, manufacturers
have already announced new funding for comprehensive research to
determine the effects of flossing on
oral health. As periodontal disease
and caries develop over months and
years, future research will have to focus on a larger study population over
a longer period in order to measure
periodontal health effectively. In the
meantime, how should dental professionals deal with this issue? Do
they have an alternative to dental
floss?
Are interdental brushes another solution?
According to Swiss oral health care
provider Curaden, not cleaning interdentally would be going too far.
Choosing a suitable interdental
cleaner and using the proper technique are always important. Floss is
appropriate for anterior teeth, where
long, flat approximal surfaces and
narrow spaces make access with an
interdental brush difficult. Ideally,
one should use dental floss for the
narrow interdental spaces between
the anterior teeth and interdental
brushes for the posterior teeth. According to the Swiss company, interdental brushes are very effective and
extremely easy to use compared to
dental floss, but must be used gently in order not to injure the gums.
Interdental brushes help prevent
build-up of plaque between teeth
and that causes bleeding gums, gingivitis and periodontitis and dental
caries. In addition to interdental
brushes, the company produces
toothbrushes and toothpastes under
its CURAPROX brand and supports
educational prophylaxis training
called iTOP for dental professionals.
CEO and owner of Curaden Ueli
Breitschmid said, “Since 1972, our
company has been the pacesetter for
interdental brushes, which remove
both food residue between the teeth
and—more
importantly—dental
plaque. Since they do not damage
tissue, our interdental brushes are
not only recommended by the dental professionals globally, but are also
prescribed to their patients and their
use taught to each patient individually.” According to Curaden, the advantages of interdental brushes over
flossing have been demonstrated in
numerous studies. For example, in
a study titled “Comparison of different approaches of interdental oral
hygiene: Interdental brushes versus
dental floss”, patients with periodontitis used dental floss and interdental brushes to reduce plaque over a
six-week period. Interdental brushes
were found to remove significantly
more plaque than dental floss did.
Furthermore, patient acceptance
seemed to be higher with interdental
brushes.
“Everyone knows dental floss, but
only few like to do it—because they
do not know how,” according to
Edith Maurer, a Swiss-based dental
hygienist with 40 years of experience. She added: “A very short thread
should be kept between the fingers,
moving up and down the sides of
the teeth. But most of the time, it
slips away, cuts into the gums and
so constantly injures the structure of
the gingivae. Dental floss should be
used if something is stuck between
your teeth but not for cleaning below your gums. After all, it has been
a razor-sharp tool for over 200 years
and is quite dangerous if you do not
use it correctly. Imagine cutting a
pudding with floss. It will work perfectly, nothing will be attached to the
floss. But if you use a fine interdental
brush, it will take away more of the
pudding. Interdental brushes should
be the preferred tool if you want to
clean your gums at least in the posterior region.”
Individually trained
prophylaxis is the key
oral
According to dental hygienist Catherine Schubert, the space below the
contact area should be the focus.
“We need to carefully differentiate
between gum disease and dental
caries. Interdental brushes are more
effective for the prevention of gum
disease owing to their space-filling
properties. However, a thin shaft and
longer bristles are necessary to reach
below the interdental contact point
where caries mostly develops. Interdental brushes can prevent interdental caries if applied correctly, which is
below the interdental contact point.
Of course, floss also cleans below the
contact point. However, using floss
just because it is normal, without
thinking about the right technique,
will not lead to the prevention of
caries. At the same time, using an
interdental brush without proper
instruction will not lead to the prevention of gum disease. After all, it
is not a government or institution
that should decide about one’s oral
hygiene, but the dental professional
needs to choose which cleaning technique is most efficient for each of his
patients. Individually trained oral
prophylaxis has always been the key
to one’s health.”
Elizabeth van der Ham, a South African dental hygienist, agrees that
one has to choose carefully between
flossing and interdental brushing:
“Dental floss throughout the years
has been a saving grace for many
patients overcoming oral health
issues. Clinical observations over
many years of floss usage in patients
is strong evidence that floss indeed
does have a place in the oral hygiene
regime. Discarding the use of it total-
ly would be irresponsible to say the
least. In 1965, Prof. Harald Löe and
others did the famous ‘Experimental gingivitis in man’ study. The outcome was that gingivitis disappears
within two weeks if the tooth structure is sufficiently cleaned. Therefore, there are three criteria we as
dental professionals need to adhere
to when selecting a treatment option
for our patients: the regime needs to
be acceptable to the patient, it has to
be atraumatic to the soft and hard
tissue of the oral cavity, and it should
be effective in removing biofilm and
plaque to establish a healthy status
quo in the oral cavity.”
However, no matter what interdental cleaner one chooses, almost every
tooth has to be treated uniquely.
“Flossing is more acceptable in the
anterior and difficult crowded areas
of the mouth. The interdental brush
has easier access in the posterior regions that are more difficult to reach.
Flossing is not as effective in the molar regions because of the concaveshape of the root structures. Flossing
is also more technique-sensitive and
greater dexterity needs to be applied
when doing it effectively and without damage. Interdental brushes
need to be selected with careful consideration of the tooth and interdental shape and size,” stated Van der
Ham. “Most importantly, patients
need to be constantly educated and
their oral hygiene regime adjusted
to their individual needs and preferences.”
[2] =>
2
hygiene tribune
Dental Tribune Middle East & Africa Edition | 5/2016
Subgingival air polishing: A new method
The latest supra- and especially subgingival air polishing techniques, with innovative
powders offer new prospects in periodontal treatment and implant maintenance
By Dr Franck Simon and Dr Jérôme
Liberman, France
Teaching our patients correct oral
hygiene techniques is an obvious
and essential part of our treatment
of periodontal disease. Controlling
the bacteria is essential and the aim
of the etiological treatment phase
of periodontitis is to remove all the
elements that contribute to maintaining or developing inflammation.
These include iatrogenic blockages,
traumatic occlusion, calculus and supra- and subgingival biofilm.
Increasingly less aggressive instrumentation has been developed to
remove biofilm from the root surface. Root planning that causes irreversable removal of cementum
has evolved toward a concept of decontamination of the root and the
periodontal pocket. Manual curettes
can be substituted by ultrasonic micro-inserts. More recently, the new
supra- and especially subgingival
air polishing techniques, with innovative powders, appear to offer new
prospects in periodontal treatment.
Non-abrasive powder
The same applies for implant maintenance. Peri-implant cleaning is
very difficult to achieve. Indeed,
it is difficult to find effective biofilm removal instrumentation that
doesn’t cause deterioration of the
implant surface. Ultrasonics as well
as conventional mechanical instrumentation has been shown to damage titanium (Kawashima, 2007).1
Plastic curettes are not very effective
in biofilm removal and are difficult
to use in proximal areas (Schmage,
2012).2 Air polishing seems to be the
most suitable technique, provided
that a non-abrasive powder is used
for the implant surface. However,
only limited clinical success has been
achieved with early generations of
air polishing devices due to limited
access to the subgingival area.
The “Air-Flow” (EMS) method now
allows the spraying of a glycinebased powder (Air-Flow Perio) of
fine grain size (25 μm) or a new extra
fine powder, “Air-Flow Plus” (14 μm),
containing erythritol and 0.3% chlorhexidine subgingivally. The latter
powder is particularly interesting because it offers superior effectiveness
in the elimination of bacterial biofilm compared to powders of larger
grain sizes (Drago et al., 2014).3
with the disposable tips. These provide delivery of powder to the bottom of the periodontal pockets with
a duration of action of only five seconds per site (Figure 1).
Case No 1
A 25-year-old patient presented with
generalised aggressive periodontitis;
(Figures 2a-c). Periodontal treatment
was performed with ultrasonic debridement and povidone-iodine ir-
This powder can be used supra- gingivally or subgingivally thanks to the
handpiece (“Perio-Flow”) combined
Figure 2g. Absence of inflammation in 12
during the ODF treatment.
Figure 1. Disposable tip (“Perio-Flow”)
with three horizontal outlet openings
for the air-powder mixture and a vertical
outlet opening for water.
Figure 2a. 8 mm pockets on 12 and 22
with a mobility of 2 + on 12 were found
at the initial consult in 2011.
Figure 3a-b. Initial situation: Purulent discharge in the vestibule of 12 and 22 and
significant perio pockets in the palatine
areas.
Figure 4a-b. Retroalveolar x-rays at the initial consultation. Note the advanced bone
loss distal to 47 and at the level of 36.
Figure 2h. X-ray of 12 during the ODF
treatment.
Figure 3d-e. Absence of gingival inflammation and reduction of periodontal
pocket one year after periodontal treatment.
Figure 2i. Periodontal maintenance with
supra-gingival air polishing. The handpiece is oriented with an angle of 30° to
60° at a distance of 4 mm (according to
the recommendations of the EMS). Note
the very fine particles of the “Plus” powder.
Figure 3f. Long cone x-ray results at + one
year.
Figure 2b. Initial x-ray.
cal swallowing was found. Swallowing re-education sessions were conducted by a speech therapist.
Figure 2c. Periodontal abscess with purulent exudate on 43.
Figure 2j. The remaining deep pockets
(larger than 4 mm) are treated by spraying powder (“Plus”) and tips (“PerioFlow”).
rigation. Air polishing using powder
containing glycine was performed in
each session (Figure 2d-f).
The very small particle size has the
advantage of striking the tooth surface (dentine or cementum) as well
as the implant surface with minimal
impact per particle. The effectiveness against biofilm is due to the
large number of sprayed particles
as well as the combined action of the
erythritol and the chlorhexidine.
Recently, a Japanese study has
shown that this polyol inhibits biofilm formation, notably with an action on Porphyromonas gingivalis.
This gives the powder, if retained, a
possible effect on the treated periodontal pockets and a preventive
action against periodontal disease
(Hashino et al., 2013).4
Figure 3c. Initial long cone results showing the presence of subgingival tartar and a significant osseous alveolysis.
Throughout the orthodontic phase,
the patient undergoes maintenance
cleanings with supra-gingival air polishing and subgingival treatment of
the most sensitive sites (Figures 2g-j).
Periodontal treatment is performed
with ultrasonic debridement and
povidone-iodine irrigation.
Case No 2
Figure 2d-f. One year after the start of the
initial periodontal therapy, the disease
has been brought under control. A temporary restraint was put in place to secure 12
to 13. Orthodontic treatment could then
begin under good conditions.
A 50-year-old patient was referred
for periodontal assessment. Bacterial plaque was found in the area of
the crown and interdentally. Clinical
examination revealed periodontal
pockets of 6-8mm in the cuspid areas and in the palatine area from the
incisor-canine block to the maxilla.
It also revealed a purulent exudate
in the vestibule of 12 and 22 (Figures
3a-c). There was a II.1 class on the occlusal plane with retro palate bite. In
accordance with parafunction, atypi-
Figure 4c-d. X-rays in January 2014, six
months after periodontal cleaning and
night mouth guard.
After initial periodontal preparation,
three non-surgical cleaning sessions
were conducted in the maxilla under
LA. The removal of hard subgingival
deposits was carried out with ultrasonic micro-inserts and povidoneiodine irrigation. Following this, air
polishing via the use of a glycerinebased powder (“Air-Flow Plus”) was
carried out supra-gingivally. All
pockets deeper than 4mm were
treated with the handpiece (“PerioFlow”) and specific tips.
At four months, a decrease in pocket
depth of 3-4mm and an absence of
bleeding on probing was found. A
maintenance phase was established
with supra- and subgingival air polishing every four months. More than
a year after initial treatment, the situation is stable (Figure 3d to 3f).
Case No 3
A patient presented with a periodontal abscess in the 36-37 sector in April
2013 (Figures 4a-b). From the occlusal
perspective, an important class II was
found with only posterior contacts.
Evidence of bruxism was also discovered and associated with atypical
swallowing. Initial therapy involved
the construction of a nocturnal
splint as well as occlusal equilibra-
Figure 4e-f. Situation one year after the
start of periodontal and occlusal therapy.
The very good response of bone lesions
initially observed in 47 and 36 can be
observed.
tion conducted at the same time. Following this, the patient underwent
two sessions of periodontal debridement including the use of ultrasonic
scalers and subgingival air- polishing
(Figures 4c-f).
Case No 4
The patient presented with a chronic
ÿPage 4
[3] =>
HYPERSENSITIVITY DUE TO TOOTH EROSION
CAN BE GONE WITHIN SECONDS*
WITH COLGATE SENSITIVE PRO-RELIEF™ TOOTHPASTE
®
The risks that carbonated soft drinks, alcoholic mixers
regular toothpaste‡ to sensitive teeth. Change in hyper-
and wine pose to your patients’ teeth are well-known –
sensitivity was assessed using air blast sensitivity
increased consumption of acidic food and drinks can
scores, where a lower score indicates better pain relief.
lead to tooth erosion and hypersensitivity.
Not only did Colgate ® Sensitive Pro-Relief™ provide
However, even your patients following a healthy life-
instant relief of dentine hypersensitivity, both immedi-
style may be at risk due to the acidic nature of fruit
ately after direct application and after 3 days of use,
juices and sports drinks.1 Hypersensitivity results when
but it also provided superior pain relief when compared
the tiny dentine channels directly linking to nerves in
with the other toothpastes.
the tooth become exposed and is associated with pain and discomfort triggered
INSTANT AIR BLAST SENSITIVITY RELIEF IN VIVO
by heat, cold or touch.
Air blast sensitivity score
Addressing hypersensitivity is crucial for
3
providing relief to your patients.
COLGATE SENSITIVE PRO-RELIEF™ TOOTH-
2.5
*
FAST PAIN RELIEF* 2
The Pro-Argin™ Technology of Colgate ®
Sensitive Pro-Relief™ toothpaste physically seals dentine tubules with a plug
Sensitivity relief
®
PASTE TARGETS HYPERSENSITIVITY FOR
Ayad et al. 2009b,
Mississauga, Canada
*
*
*
2
*•
1.5
*•
1
0.5
that contains arginine, calcium carbon-
0
ate and phosphate. The plug effectively
Baseline
reduces dentine fluid flow reducing sen-
Control with
KNO3 and NaF
sitivity and relieving pain in seconds.* 2,3
Immediately
Control 2
with MFP
* p < 0.05 compared to baseline
COLGATE ® SENSITIVE PRO-RELIEF™ IS
CLINICALLY PROVEN TO RELIEVE PAIN IN SECONDS * 2
3 days
Colgate ® Sensitive
Pro-Relief™ toothpaste
• p < 0.05 compared to control
Recommend Colgate ® Sensitive Pro-Relief™ to your
In a double-blind, parallel group study, 120 patients
patients suffering from hypersensitivity due to acidic
directly applied either Colgate ® Sensitive Pro-Relief™
tooth erosion – clinically proven to treat hypersensitivity
toothpaste, a regular desensitising toothpaste† or a
and relieve pain fast.*2
YOUR PARTNER IN ORAL HEALTH
www.colgateprofessional.com
* When toothpaste is directly applied to each sensitive tooth for 60 seconds.
† Containing 5% potassium nitrate and 1450 ppm fluoride as sodium fluoride.
‡ Containing 1450 ppm fluoride as MFP. BRAND RECOMMENDED
#
1
References:
BY DENTISTS
1. Cummins D. J Clin Dent 2009; 20 (Spec Iss): 1 – 9
2. Ayad F et al. J Clin Dent 2009; 20 (Spec Iss): 115 – 122
3. Petrou I et al. J Clin Dent 2009; 20 (Spec Iss): 23 – 31
BRAND RECOMMENDED
BY DENTISTS
For more information:
Colgate Professional Oral Care
www.colgateprofessional.com
CONTACT DETAILS
PLACEHOLDER
[4] =>
4
hygiene tribune
Dental Tribune Middle East & Africa Edition | 5/2016
◊Page 2
be performed without anaesthesia
in most cases. Access to the deepest pockets is made easy thanks to
the tips (“Perio-Flow”). Finally, the
speed with which the pockets are
treated (five seconds per site) is very
attractive for both practitioner and
patient.
Figure 5d. Spraying particles deep into the
pocket with the tip (“Perio-Flow”).
Figure 6a. Periimplantitis with purulent
discharge.
Figure 5a-b. Probing through the fistula,
as well as distal to the implant. No infectious episode has so far been reported by
the patient.
Figure 5e. Healing of the fistula after
treatment.
Figure 6b. Significant bone loss as well as
the absence of bone walls distal to 46.
Today, air polishing has an important place in our line of work,
whether in periodontal treatments
or in periodontal and implant maintenance. Thus, when signs of inflammation are raised at the level of the
peri-implant mucosa, the sites are
treated immediately (Figure 7a-b).
Very quickly, we can see inflammation disappear (Figure 7c).
During periodontal maintenance
sessions, the use of subgingival air
polishing is very common, with apparently the same efficiency as ultrasonics, while being more accepted by
our patients (Müller, 2014).5
Hence, this is a method that is effective in removing bacterial biofilm
and is both curative and preventive.
References
Figure 5c. Bone loss distal to the implant.
fistula adjacent to an implant placed
ten years ago (Figures 5a-b). Periodontal probing showed loss of attachment distal to 21. A periapical
x-ray confirmed bone loss at the
level of the first three threads (Figure 5c). The implant was treated with
subgingival air-polising with the
Air-Flow Plus powder sprayed under
anaesthesia at the level of the loss of
attachment (Figure 5d-f).
Case No 5
The patient presented with periimplantitis on an implant put in place
in a context of aggressive periodontitis without the aid of periodontal
therapy. An 8mm pocket was found
in the vestibular, mesial and lingual
areas of the implant in 46 with purulent discharge (Figure 6a). Given
the extent of bone loss seen in the
x-ray, a non-surgical approach was
preferred for raising a flap (Figure
Figure 5f. Stability on bone level at + 1
year.
6b). The absence of bone walls distal
to the implant indicates that bone
regeneration via grafting is unpredictable. The goal was to achieve
decontamination of the implant
surface. Treatment by subgingival
air polishing was performed under
anaesthesic (Figure 6c). A clear improvement was quickly noticeable:
absence of purulent discharge and
inflammation, reduction of pockets
by 4mm (Figure 6d).
A method that is both healing and preventive
The use of this new powder has several advantages. First, its effective-
Figure 6c. Treatment by “Perio-Flow” and
powder (“Plus”).
Figure 6d. Three months post treatment.
ness in the removal of supra- and
subgingival biofilm without damaging the tooth and implant surfaces
is a real breakthrough. The ease of
implementing this protocol is also
significant. Subgingival air polishing
is well received by patients and can
1. Kawashima H., Sato S., Kishida M.,
Yagi H., Matsumoto K., Ito K. Treatment of Titanium Dental Implants
with Three Piezoelectric Ultrasonic
Scalers: An in Vivo Study; J. Periodontol. 2007 Sep;78(9):1689-94.
2. Schmage P., Thielemann J., Nergiz
I., Scorziello T.-M., Pfeiffer P. Effects
of 10 Cleaning Instruments on Four
Different Implant Surfaces; Int J
Oral Maxillofac Implants. 2012 MarApr;27(2):308-17.
3. Drago L., Del Fabbro M., Bortolin
M., Vassena C., De Vecchi E., Taschieri
S. Biofilm Removal and Antimicrobial Activity of Two Different Air-Polishing Powders; An in Vitro Study; J
Periodontol 2014 Jul 25:1-11.
4. Hashino E., Kuboniwa M., Alghamdi S.-A., Yamaguchi M., Yamamoto R.,
Cho H., Amano A. Erythritol Alters
Microstructure and Metabolomic
Profiles of Biofilm Composed of
Streptococcus Gordonii and Porphyromonas Gingivalis; Mol Oral Microbiol. 2013 Dec;28 (6):435-51.
Figure 7a. Bleeding on probing of the periimplant mucosa found during a maintenance appointment. Figure 7b. Treatment
by “Perio-Flow” during the same session.
Figure 7c. Appearance of the gingiva 15
days after treatment.
5. Müller N., Moëne R., Cancela J.-A.,
Mombelli A. Subgingival Air-Polishing with Erythritol During Periodontal Maintenance: Randomized
Clinical Trial of Twelve Months; J Clin
Periodontol. 2014 Sep;41(9):883-9.
Dr Franck Simon and Dr Jérôme Liberman
are dental surgeons and former assistants
at the Nancy Faculty of Dental Surgery.
They are both trained in surgical and
prosthetic implants (Paris VII) and preimplant and periimplant surgery (Paris XI)
and work in private practice limited to implantology, gnathology and peridontics.
Cleanliness is Key: How
hygiene improves our
quality of life
By Dentsply Sirona
The merger of DENTSPLY and Sirona
at the beginning of the year created
the largest manufacturer of technologies, equipment and consumables
in the dental sector. The company is
now working together as one combined force to develop solutions for
the current challenges in dentistry,
including products for enhanced
hygienic safety in practices. The recently published edition of the customer magazine VISION also focuses
on this topic, where international experts take a closer look at the various
facets of hygiene. The in-depth discussions clearly show that the scope
of this issue extends far beyond
germ-free dental practices.
“Hygiene is important and desirable because it protects us and oth-
ers against infection and promotes
health,” explained Jeffrey T. Slovin,
CEO of Dentsply Sirona. “It affects all
aspects of our lives and requires our
constant attention – everywhere in
the world.” Because this issue is so
prominent in the dental industry,
the latest edition of VISION, the customer magazine from Dentsply Sirona, focuses on and emphasizes the
significance of dental hygiene.
history and takes a look at the activities in clinics, which were initially a
pretty “dirty business,” as infection
protection based on hygiene and
disinfection did not emerge until the
middle of the 19th century. Hygiene,
what was treated back then as an innovation, is now standard practice
and its working conditions are now
the norm, especially in dental practices.
Hygiene is of central importance
when it comes to health. A prime
example here is water, which is
used for cleaning, personal hygiene
and drinking water. Water was long
considered to be harmful; it was not
until the 19th century that scientific
studies highlighted the cleansing
effect of water, which, in turn, had a
fundamental impact on society’s approach to hygiene. VISION traces this
Practice hygiene: High-quality standards do not mean
higher expenses
This starts with the treatment center:
The transmission instruments must
be kept germ-free, and the hygiene
features in the treatment centers
ÿPage 6
[5] =>
PATIENT SENSITIVITY
CAN BE GONE
IN SECONDS.
BEFORE
Open tubules
AFTER
Closed tubules in
60 SECONDS
with Colgate®
Sensitive Pro-Relief™
Toothpaste*
COLGATE® SENSITIVE PRO-RELIEF™ WITH PRO-ARGIN™ TECHNOLOGY
PROVIDES INSTANT AND LONG-LASTING RELIEF.
Extensive scientific research has shown that Colgate® Sensitive Pro-Relief™ protects against the triggers
and causes of sensitivity, and is proven to occlude dentin tubules in 60 seconds.*
Finally, a way to quickly improve your patients’ satisfaction and comfort.
YOUR PARTNER IN ORAL HEALTH
www.colgateprofessional.com
*When toothpaste is directly applied to each sensitive tooth for 60 seconds.
Ayad F, Ayad N, Delgado
et al. J Clin
Dent. 2009;20(4):115-122.
RECOMMENDED
# E,BRAND
BRAND RECOMMENDED
1 BY DENTISTS BY DENTISTS
www.colgateprofessional.com
BRAND MOST USED BY DENTISTS
www.colgateprofessional.com
[6] =>
6
hygiene tribune
Dental Tribune Middle East & Africa Edition | 5/2016
◊Page 4
Fig. 1: The current edition of the Dentsply Sirona’s customer magazine, VISION, provides interesting and entertaining information on the subject of hygiene.
Fig. 2: The treatment centers from Dentsply Sirona are being continuously developed – and not just in terms of
design: An article in the current VISION explains why inner values are so very important.
from Dentsply Sirona support this
goal. Intelligent, automated rinsing
programs satisfy the stringent hygiene requirements for instrument
and suction tubes as well as for water
hygiene, making everyday working
life easier. VISION offers a historical
overview of how treatment centers
have changed through the years.
Hygienic instrument reprocessing
has also undergone major developments: In Panama, the state health
authorities are prescribing the use of
Dentsply Sirona’s DAC Universal, the
combined autoclave for mechanical
instrument processing, in all clinics; a measure that is unique in the
world.
Hygiene in all spheres of life
Hygiene is not just a term that is associated with germs and infection
protection. A key element of practice life is radiation hygiene; X-rays
must not endanger the patient’s
health unnecessarily. In this edition
of VISION, Marco Ahonen, a dentist
based in Helsinki, explains how to
combine a safe, reliable diagnosis
with radiation protection. According
to Ahonen, the secret lies in embracing technical advances and applying
them to practice workflows.
We are also faced with hygiene-related issues in other spheres of life
too – this is often not apparent at
first glance; take company and process hygiene for example. A report in
this edition of VISION looks at how
Mr. and Mrs. Ritter (he is an OMS
surgeon and she is an orthodontist)
took over a joint practice in a clearly
structured manner and transformed
it into a specialist center.
Not just clean, but also safe
and quick
CEREC Zirconia, the new way to produce full zirconia restorations in a
single visit, is characterized by its
safe, quick workflow. In this edition
of VISION, power-user Dr. Michael
Skramstad shows how the process
can be implemented in the practice
and the patient-friendly results that
can be achieved.
In addition to user reports, the international customer magazine VISION
offers the dentists, practice teams
and dental technicians in its readership numerous suggestions and tips
for day-to-day practice life, while offering an entertaining read. VISION
is published in German and English,
and can be requested free of charge
from http://www.sirona.com/topics/vision/en/ as a print or e-paper
edition.
[7] =>
[8] =>
See the latest from
Gold Sponsor
at 8DFCIC in Dubai
04-05 November 2016
www.cappmea.com/aesthetic2016
)
[page_count] => 8
[pdf_ping_data] => Array
(
[page_count] => 8
[format] => PDF
[width] => 808
[height] => 1191
[colorspace] => COLORSPACE_UNDEFINED
)
[linked_companies] => Array
(
[ids] => Array
(
)
)
[cover_url] =>
[cover_three] =>
[cover] => ![Hygiene Tribune Middle East & Africa No. 5, 2016]()
[toc] => Array
(
[0] => Array
(
[title] => To floss or to brush—that is the (interdental) question
[page] => 01
)
[1] => Array
(
[title] => Subgingival air polishing: A new method
[page] => 02
)
)
[toc_html] =>
Table of contents
[toc_titles] => To floss or to brush—that is the (interdental) question
/ Subgingival air polishing: A new method
[cached] => true
)