Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

From Trisha's Desk Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director

Start Discussion More by this author (282)
Toothbrushing gets all the attention. It's the first thing patients are taught when visiting the dentist or hygienist. People all have toothbrushes and know they should brush their teeth every day. But what about between the teeth?

Bacterial biofilm accumulates in areas that are well protected and out of reach by the toothbrush. According to Dr. Per Axelsson (2000), both caries and periodontal disease are more prevalent between the teeth than on facial or lingual surfaces. You might think occlusal surfaces are the prime target for caries, but there are only 20 occlusal surfaces in the permanent dentition, compared to 64 proximal surfaces. In the deciduous dentition there are only eight occlusal surfaces compared to 40 proximal surfaces.

Proximal surfaces are not reached with a toothbrush. The proximal tooth surfaces, just below the contact point, are where carious lesions begin. Periodontal tissue under the contact, called the col area, is less keratinized than facial and lingual tissue and thus more susceptible to the toxic waste products released by the bacterial biofilm. Proximal surfaces are more susceptible to disease than facial and lingual surfaces. Despite being the biggest target for caries and periodontal disease, oral hygiene instructions still emphasise toothbrushing first, rather than cleaning between the teeth.



To accurately target where disease starts, the oral hygiene message should be to skip brushing and start cleaning in between. Tell a patient to skip brushing and they will definitely listen to the next thing you say! Skipping toothbrushing is not a message patients expect to hear from their dental professional.

How successful is the current brushing and flossing message? According to the Proceedings of the European Workshop on Mechanical Plaque Control in 1998, people only reduce their plaque scores by an average of 50 percent with toothbrushing. Despite feeling clean from the toothpaste, toothbrushing with toothpaste is not removing the bacterial plaque biofilm. The concept of flossing is good, but compliance is very poor. In the United States, only 13 percent of adults and six percent of children reported daily flossing, this according to research published in the Journal of Periodontology by Carter-Hanson, in 1996. If patients do floss, their technique is so poor, they can actually floss between the teeth without removing any plaque biofilm!

Many alternatives to dental floss are available in the form of triangular wooden sticks, soft plastic picks and oral irrigation. Without scientific merit, dental floss still holds the top spot for interdental cleaners. We know that people don't floss and if they do, they aren't very effective at it, so it's time for alternatives. Cleaning between the teeth on a daily basis is more important than toothbrushing. Don't look for research that actually tells subjects to skip brushing and clean between their teeth. We are so emotionally tied to toothbrushing, just the idea of shifting the emphasis to interproximal surfaces rather than brushing surfaces makes many in the profession uncomfortable.

If disease prevention is the goal, it should start between the teeth, not with toothbrushing. Don't worry, people will still brush their teeth, but they will start with the surfaces at greatest risk of disease, the interproximal surfaces.
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450