The role of interdental cleaning for oral health, general health and quality of life
Recent research shows that oral health is an essential prerequisite for people’s well-being and quality of life. In order to reach the global goals for oral health, the dental profession has a great responsibility to work with a preventive and health-promoting approach.
Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort or disease of the craniofacial complex, according to the definition of FDI World Dental Federation. With this definition in mind, oral health is an undeniable part of general health and well-being.
The broad consequences of oral disease
Periodontal disease is common worldwide. It affects approximately 50 per cent of the adult population, and severe periodontitis prevalence varies from 10 to 15 per cent; prevalence figures are positively associated with increasing age.[2–4] Given the massive effects of the disease, it becomes clear that it should be a matter of global concern.
First, there is growing scientific support for a link between periodontal disease and several general diseases, including cardiovascular disease, diabetes and obesity. Thus, oral diseases are no longer considered local problems affecting the oral cavity but rather diseases with consequences for overall health.
Research has also shown a significant association between periodontal disease and oral health-related quality of life, independent of factors such as age, sex and other dental problems. The disease can contribute to anxiety, low self-esteem, and feelings of shame and vulnerability.
Oral disease has a vast impact from a financial perspective too. In 2015, the total global cost of oral disease was shown to be US$544.41 billion. The direct cost, measured as dental expenditure, accounted for US$356.80 billion, and the indirect cost, measured as productivity loss, was US$187.61 billion. Among oral diseases, periodontitis was the second greatest contributor to global productivity loss. Severe periodontitis accounts for US$54 billion yearly in indirect costs.
Causes and prevention
Dental professionals have a central role in preventing disease through a health-promoting approach based on science and proven clinical experience. Evaluating individual needs and conditions and weighing them together with scientific support should form the basis for instructions and recommendations, thus creating the best possible foundation for patient compliance and long-lasting oral health.
There are several risk factors for the development of periodontitis. Most important is the accumulation of plaque along and below the gingival margin. Control and removal of this biofilm are of utmost importance to maintain oral health. The significance of good oral hygiene in order to prevent oral disease is, therefore, indisputable.
Toothbrushing and interdental cleaning are cornerstones of high-quality oral hygiene. Interdental cleaning is associated with lower levels of periodontal disease, and periodontal health increases with a higher frequency of use of interdental cleaning devices. The recommendation of an interdental cleaning device needs to be tailored, but for the majority of the adult population, an interdental brush is preferred.
A meta-review concluded that there is consistent evidence for interdental brushes being the most effective devices for interdental plaque removal. This is also stated in the report of the 11th European Workshop on Periodontology on primary prevention of periodontitis. According to the working group, interdental brushes are the preferred choice for interdental cleaning, while floss is an alternative only when sites are too narrow for an interdental brush and show gingival and periodontal health. These results were confirmed in a network meta-analysis in which interdental brushes achieved the best result regarding gingival inflammation, plaque reduction and pocket reduction.
From the presented articles, it appears that interdental brushes, when compared with other manual cleaning devices, have the highest efficacy in terms of plaque removal and periodontal parameters. Every recommendation regarding interdental cleaning devices must be tailored; the sizes and shapes of the interdental spaces must be considered. In addition, an individual who is recommended to use interdental brushes needs to be instructed regarding the appropriate size or sizes and on an appropriate technique.
Current research emphasises the importance of good oral hygiene in maintaining oral health and its consequences for general health and quality of life. Because the most common oral diseases are predominantly interdental diseases, preventive efforts must include interdental cleaning as an adjunct to toothbrushing in daily home care. In achieving optimal plaque control, the interdental brush is the preferred device for most of the adult population globally.
A preventive approach is well in line with FDI’s 2020 global goals for oral health, one of the targets of which is to increase the population of people of all ages with a healthy periodontium. FDI also has a vision for 2020 of ensuring that oral health is recognised and accepted as a core element of general health and well-being. In light of financial reports, a preventive approach will most likely be beneficial also from an economic perspective, since it will limit the need for other dental treatments.
Editorial note: A list of references is available from the publisher. This article was published in prevention―international magazine of oral health, Vol. 4, issue 1/2020.