Revolutionizing Oral Hygiene: The Power of Technology

AI powered toothbrushes, 3D printing, CAD/CAM, lasers, CBCT, and robotics are revolutionizing dentistry dramatically. Why has there been no appreciable decrease in dental disease over the last 20 years?^1,2,4 Why do periodontal and dental diseases persist? Why are there so many recurrent interproximal caries and implant failures?

Periodontal disease starts BETWEEN the teeth!

Over 65 cumulative years of teaching and practicing dentistry, the authors have learned that the interdental space remains the most vulnerable, most infected, yet the most neglected area of the mouth. This is where the most severe and destructive dental disease occurs, the area which is the most difficult to restore and seal, and the space that is the bacterial and toxin entry-point into the circulation (Fig. 1), directly affecting oral and systemic health.

Fig. 1

Gum Disease starts BETWEEN the teeth. It is also the point of entry of bacteria into the blood stream contributing to heart and systemic disease

The single easiest and best thing to improve oral and systemic health is to “CLEAN BETWEEN” the teeth – a process that may be difficult, complicated and inconvenient, often leading to non-compliance.⁷ This unfortunately predisposes patients to recurrent dental and periodontal diseases which highlight the collective failure of the patient, dentist and hygienist relationship.^8,9

Oral hygiene is a shared responsibility between patients, hygienists and dentists, and now, physicians. As ADA President George R. Shepley DDS said, “Oral health and overall health are connected, and evidence shows that greater collaboration across medical and dental providers could improve patient health outcomes”. https://www.ada.org/publications/ada-news/2022/october/medical-dental-integration-emphasizes-mouth-body-connection

The spaces BETWEEN the teeth are where the most pathogenic bacteria avoid dislodgement by toothbrushing and rinsing. (Fig. 2)

Fig. 2

Limited ability of floss, wire brushes and toothpicks to clean root indentations.

The challenging anatomy of the interdental space complicates dental restorations.⁹ Incipient interdental caries (with or without gingivitis) frequently leads to recurring interdental problems because the biofilm, the original cause of infection, is never adequately removed. (Fig. 3) This may be due to habitual non-compliance and/or the mechanical shortcomings of floss, wire brushes, picks and water flossers. The biofilm is left to propagate between the teeth. Restorations often fail interproximally due to limited clinical access and visibility, and the lack of enamel that can offer a long-lasting gingival seal. Failed restorations lead to ever larger restorations, all due to an initial failure to “CLEAN BETWEEN”. (Fig. 4)

Fig. 3

Com-plexity of interdental anatomy causing plaque retention and accumulation

Fig. 4

The valley-like depression in the interdental gingival where the biofilm hides and accumulates.

Why the interdental space is important

Periodontal problems start interdentally where toothbrushes and mouthwashes cannot reach to clean.
Interdental caries are more difficult and expensive to restore and to maintain.
Interdental spaces are the most common areas for re-decay and restorative failure.
Interdental areas are where bacteria enter inflamed, non-keratinized gingiva into the bloodstream, spreading into the general circulation leading to systemic diseases.

The Anatomy of the interdental space

Col gingiva between the teeth is non keratinized; it is more vulnerable to infection, inflammation and pathogen infiltration into the blood stream.
Contact-caries begin gingival to the contact area.
Root indentations and furcations make surfaces difficult to clean with floss.
Interdental areas are relatively inaccessible. They are difficult to clean, restore, and maintain.
Interdental anatomy changes with age. The triangular space gets larger as gingiva recede. (Figs. 4,5)

Fig. 5

. Interproximal decay starts BELOW the contact point and above the col.

Why won’t people Floss or “CLEAN BETWEEN” their teeth?

Current oral hygiene devices can be complicated.⁹ Floss was invented 200 years ago, but is technique sensitive and requires two clean hands. It does not cleanse root indentations or furcations. Wire brushes require multiple sizes for differently sized interdental spaces but cannot address indentations; the wire can break and scratch sensitive roots and titanium implants. Many picks are difficult to grasp, break easily and are disposable, contributing to landfill.³ Water flossers can be messy and require a sink and water. (Fig. 6) None are designed to medicate.

Fig. 6

Floss, wire brushes, existing picks, water flossers are difficult and complicated, leading to non-compliance. PerioTwist make oral hygiene easy and convenient.

Better education, motivation, and facilitation

The dental team must make it so EASY that more people will readily “Clean Between”. Innovative interdental cleaners, such as the PerioTwist (Montreal QU), with unique features that overcome the deficiencies and shortcomings of existing devices make it easier and more convenient for people to “CLEAN BETWEEN”. Any improvement that makes a process easier and more efficient encourages its incorporation into daily routines, benefiting oral and systemic health. (Fig. 7)

Fig. 7

Dip it -Twist it! PerioTwist is the only interdental cleaner that will clean and medicate and not withdraw the medication as the device is withdrawn in a clockwise manner.

The PerioTwist technology empowers patients with an EASY solution to complex problems, raising awareness about “CLEANING BETWEEN”.

The PerioTwist is a re-usable “one-size-fits-almost-all” twist flosser that is equally useful at home, on the go, or in the dental office. PerioTwist is the only interdental cleaner that cleans and medicates the interdental space, not removing the medication as the device is withdrawn. Designed to clean implants and teeth, the PerioTwist has a large ergonomic handle; the cover inserts into the handle to double its length, and facilitates single-handed cleaning. This is a major advantage to the manually challenged, arthritis sufferers and care givers. The PerioTwist Prevention & Oral Care Program educates, motivates and facilitates people to “CLEAN BETWEEN” to prevent dental and systemic disease. (Fig. 8)

Fig. 8

PerioTwist Cleans and medicates and snaps onto a contra angle for in office prophylaxis and medication.

Using PerioTwist in the Dental Office:

Interdentally prophylaxis
Application of topical anesthetic between teeth prior to scaling and root planing
Application of antibacterials, disinfectants, varnishes, bleaching gels, re-mineralization pastes interdentally
Cleaning cements following cementation of crowns, veneers and implants.

A patient-centered practice is lucrative and rewarding for the entire dental team. (Fig. 9) Dental disease is one of the most prevalent diseases. It causes pain, misery and expense. Yet, 95% of all dental disease is completely preventable with good oral hygiene.^1,2 Improving oral and systemic health is an attainable goal. Restorations must be long-lasting so that dentists and hygienists can focus on the prevention of recurrent disease. And patients would much rather receive praise for good oral health than to be scolded for not using floss.

Fig. 9

Patients would much rather receive praise for good oral health than to be scolded for not using floss.

“CLEANING BETWEEN” benefits patient, dentist and hygienist

The oral hygiene department of the dental office is the most consistent source of higher revenue, patient education, marketing, patient and staff satisfaction, retention, and last but not least, referrals. Referrals account for more than 70% of all new business growing the practice, and 72% of dentists consider generating referrals to be the most effective way to attract more patients.⁵

PerioTwist is an effective marketing and referral tool. It takes less than one minute for the hygienist or dentist to demonstrate PerioTwist and its ease of use. Social media platforms can readily promote the practice’s patient-centered approach and its benefits.

The WHO Global oral health status report’s conclusion is that the status of global oral health is alarming and requires urgent action.^1,2,4 It is important to focus efforts on PREVENTION. The dental profession must begin to shift from the existing treatment paradigm to one that emphasizes disease prevention and health promotion.
It is better, easier and more beneficial for patient, dentist and hygienist to focus on the CAUSE, preventing disease, rather than the CURE, after the disease is already established.

Oral Health welcomes this original article.

Authors’ Disclaimer: Dr. Allan Cooper and Natalie Fiset are the developers and owner of PerioTwist.

References

https://www.who.int/team/noncommunicable-diseases/global-status-report-on-oral-health-2022
https://www.dental-tribune.com/news/new-who-report-unveils-alarming-state-of-global-oral-health/?utm_source=iContact&utm_medium=email&utm_campaign=dental-tribune-international&utm_content=International+%E2%80%93+1.12.2022
https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13727
2019 Jul 20;394(10194):261-272. doi: 10.1016/S0140-6736(19)31133-X. Ending the neglect of global oral health: time for radical action. https://pubmed.ncbi.nlm.nih.gov/31327370.
Source: Aegis Dental Network.
Efficacy, Safety and Patient Preference of Knotted Floss Technique in Type II Gingival Embrasures. Aaron F. Gomes, Amit Rekhi, S Meru and Pal Divakar. American Dental Hygienists’ Association February 2022, 96 (1) 64-75; https://jdh.adha.org/content/96/1/64.
Oral Health in America: Advances and Challenges 2021 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental and Craniofacial Research Bethesda, MD WHO.
Interdental cleaning and gingival injury potential of interdental toothbrushes. Marc Vogel 1, Beatrice Sener, M Roos, Thomas Attin, Patrick R Schmidlin. Affiliations expand PMID: 25503477; https://pubmed.ncbi.nlm.nih.gov/25503477/
Efficacy of inter-dental mechanical plaque control in managing gingivitis – a meta-review. Sonja Sälzer,Dagmar E. Slot,Fridus A. Van der Weijden,Christof E. Dörfer, First published: 08 January 2015 https://doi.org/10.1111/jcpe.12363Citations: 94.
Burger, D. Medical-dental integration emphasizes mouth-body connection: Dental providers look at improving overall health outcomes through increased collaboration with physicians ADA News, October 21, 2022.

About the Author

Dr. Allan Coopersmith graduated McGill University with the Thornton Gold Medal for highest standing and completed a General Practice Residency at the Albert Einstein Medical Centre. He has been teaching and practicing dentistry in Montral for 45 years, currently in Westmount, Quebec.

Nathalie Fiset is a registered hygienist practicing patient-centered Oral Hygiene for 26 years in Montreal Canada. She graduated first in her class with honors at College de Maisonneuve. She has dedicated herself to educating, motivating and facilitating her patients in the prevention of oral disease.