Interdental Brushes

Interdental brushes remove more biofilm interproximally when compared to floss and have demonstrated similar reductions in interproximal probing depths and gingival bleeding in numerous studies.^96-98 Interdental brushes may be especially advantageous at root concavities, such as the mesial of the maxillary first premolars, diastema, and areas of incomplete papillary fill. In patients who have received previous periodontal care interdental brushes have been shown to be more effective than floss overall.^{6,7,83,99,100} This may be due to a higher likelihood of open embrasure spaces which allows for improved access for interdental brushes or the increased penetrance of the bristles of interdental brushes subgingivally. A systematic review found that in adult patients with adequate interdental space to utilize interdental brushes, biofilm removal was superior with toothbrushing and interdental brush use when compared to other oral hygiene regimens including: 1) toothbrushing alone, 2) toothbrushing and flossing, or 3) toothbrushing and interdental wood sticks use.¹⁰¹ Furthermore, patient preference for the use of interdental brushes over flossing is evident.^99-101 It is sensible, therefore, to recommend interdental brush use in patients with a history of periodontitis and/or in other anatomic areas where their use may be beneficial. Nevertheless, their use may be contraindicated at some sites and in periodontally healthy individuals because their comfortable use requires decreased papillary fill and more interdental space when compared to floss.⁹⁵