I have something stuck in my teeth again. What should I use to get the leaf out?

Although dentists have always regarded brushing teeth as the most important method of dental care, brushing teeth alone cannot completely and thoroughly clean teeth. This is because under normal circumstances, all teeth in the same dental arch are arranged together in a way that they are close to each other, so the adjacent surfaces of most teeth are hidden, making it difficult to clean them with a toothbrush.

Therefore, in order to better clean the adjacent surfaces of teeth, people have come up with many ways and made many kinds of tools, such as dental floss, water floss, interdental brushes and toothpicks. As the saying goes, "no choice is bad, but too many choices are also bad." With so many tools for cleaning the adjacent surfaces of teeth, which one is better? And how should we choose?

01 The complex anatomical and physiological environment of the interdental space

We already know that the crown part of each tooth is a polyhedron, usually composed of 4-5 tooth surfaces, and these tooth surfaces are all curved and irregular in shape.

When the gaps between teeth are normal, adjacent teeth rely on each other, so the adjacent surfaces of the teeth have both areas that can contact each other and areas that are separated from each other, which leads to a more complex anatomical and physiological environment of the gaps between teeth.

The separation areas of the adjacent surfaces of teeth can form gaps in four directions: upper, lower, inside and outside: the upper one is the incisal/incisal wedge-shaped gap, the lower one is the interproximal space (the part of the interdental papilla filled with the gums, which is also the part where plaque and tartar are easily accumulated, and it is also the key target area for cleaning the adjacent surfaces of teeth), the inner one is the lingual wedge-shaped gap, and the outer one is the labial/buccal wedge-shaped gap.

Image source: Reference [1]

In short, tooth interproximal cleaning tools are designed to clean the contact areas and the above-mentioned gaps.

02 Dental floss, water floss, interdental brush, toothpick

What is the difference between them?

1. Dental floss

Dental floss is the most recommended tool for cleaning the interproximal surfaces of teeth by dentists. It can be used regardless of whether the gaps between teeth are normal or not. When the gaps between teeth are normal, only dental floss can fully and thoroughly clean the interproximal surfaces of teeth - the contact area and the wedge-shaped space. This feature is closely related to its slender and light body. Based on this, dental floss can be used as the most effective tool to prevent and detect interproximal caries (one of the common types of tooth decay).

Except dental floss, toothbrushes and other tooth adjacent surface cleaning tools do not have this function.

The bristles of the toothbrush can only enter the wedge-shaped gap, but cannot penetrate into the contact area. Image source: Fu Rao

The mechanism of dental floss cleaning power is that the dental floss that "tightens" the tooth surface will exert pressure on the tooth surface, thus generating friction on the tooth surface during the sliding process. The closer the dental floss is to the tooth surface, the greater the friction and the better the cleaning effect.

2. Water floss

Water flosser, also known as water flosser, can only clean the wedge-shaped gaps outside the interproximal contact area of ​​teeth when the gaps between teeth are normal. This feature makes it inferior to dental floss. Of course, interdental brushes and toothpicks also have this ability defect.

However, water floss also has three very excellent characteristics:

Regardless of whether the gaps between teeth are normal or not, it can clean the gingival sulcus or periodontal pockets located at the junction of teeth and gums . This feature makes water flossing superior to other tooth adjacent surface cleaning tools such as dental floss.

The working principle of water flossing is to use water with a certain pressure to flush dental plaque, food residues, etc. Because the water flow can more easily enter the places that toothbrushes or dental floss cannot clean, the cleaning process of water flossing is more delicate than other tooth adjacent cleaning tools . Water flossing is very suitable for people who are undergoing orthodontic treatment, need periodontal health maintenance or have dental implants;

Water floss can also massage the gums , which is its unique skill.

Image source: Reference [2]

3. Interdental brush

Interdental brushes are interdental brushes. Interdental brushes can only be used to clean large gaps between teeth, such as areas with receding gums and exposed root surfaces. The working principle of interdental brushes is the same as that of ordinary toothbrushes, using multiple bundles of bristles to clean the surface of teeth. Compared with dental floss and water floss, interdental brushes have a larger contact area with the adjacent surfaces of teeth, so they have a stronger cleaning ability for the adjacent surfaces of teeth. Different types of interdental brushes have different shapes and sizes of brush heads. When choosing an interdental brush, you should consider the width of the interdental gaps and choose one that fits the interdental gaps tightly.

Image source: Reference [3]

4. Toothpicks

Toothpicks are a long-standing and widely accepted tool for cleaning adjacent surfaces of teeth. However, from the perspective of dental care, toothpicks do have some shortcomings:

When the gaps between teeth are normal, the interproximal contact area of ​​the teeth cannot be cleaned ;

Toothpicks are more suitable for cleaning large gaps between teeth caused by gum recession and exposed root surfaces. However, unlike interdental brushes, toothpicks are usually round in cross-section and can only make point contact with the tooth surface, so they cannot thoroughly clean the tooth surface .

Toothpicks are sharp in shape and hard in texture, and can easily damage the gums .

In general, toothpicks are better used as a makeshift tool for removing larger pieces of food debris .

03 Classification and selection of dental floss and water floss

Dental floss can be classified according to its form and texture. According to the form, dental floss can be divided into dental coils (spindle dental floss) or dental floss sticks. The use of dental coils requires more professional methods, while the use of dental floss sticks is easier to master, so dental floss sticks are more suitable for general use; according to the texture, dental floss can be divided into waxed dental floss or unwaxed dental floss. Waxed dental floss can generate less friction, so it is suitable for tight teeth or removing food residues, while unwaxed dental floss can generate greater friction and is more suitable for removing dental plaque.

Water flossers can be classified according to whether the water flow pressure is constant, and can be divided into constant pressure water flossers and pulse pressure water flossers. From the perspective of cleaning ability, pulse pressure water flossers are better.

Now everyone must be clear, let's summarize it at the end:

Dental floss is the most versatile tool for cleaning interproximal surfaces and the only tool that can clean the contact areas of teeth;

Water floss is more suitable for cleaning gingival sulcus and periodontal pockets, and is suitable for a certain group of people;

Interdental brushes are mainly used to clean large gaps between teeth;

Toothpicks are only suitable for temporary use.

In short, these tools all have their own uses. Don’t think that you can stop flossing and brushing your teeth just because you have a water flosser.

References:

[1] Pi Xin, ed. Oral Anatomy and Physiology (5th Edition) [M]. Beijing: People's Medical Publishing House, 2003.

[2] Lyle DM. Relevance of the waterflosser: 50 years of data[J]. Compend Contin Educ Dent, 2012, 33(4): 278-280,282.

[3] Meng Huanxin, ed. Periodontology (4th edition) [M]. Beijing: People's Medical Publishing House, 2012.

[4] Hu Deyu, ed. Oral Preventive Medicine (6th Edition) [M]. Beijing: People's Medical Publishing House, 2012.

[5] Ng E, Lim LP. An overview of different interdental cleaning aids and their effectiveness[J]. Dent J (Basel), 2019, 7(2): 56.

Author: Fu Rao

Review | Rong Wensheng, Chief Physician, Department of Prevention, Peking University Hospital of Stomatology

Source: Science Popularization China-Creation Cultivation Program