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The Guideline for Selecting Proper Auxiliary Oral Hygiene Devices
Int J Clin Prev Dent 2021;17(1):1-5
Published online March 31, 2021;  https://doi.org/10.15236/ijcpd.2021.17.1.1
© 2021 International Journal of Clinical Preventive Dentistry.

Su-Min Yoo

Department of Dental Hygiene, Kyungdong University, Wonju, Korea
Received March 8, 2021; Revised March 20, 2021; Accepted March 27, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
There are several kinds of oral hygiene devices produced and sold; however, consumers, dental patients, and even dental officers sometimes have problems in selecting proper devices. Several kinds of oral hygiene devices that are widely used were chosen according to the dental patient’s oral and systemic states for clinical recommendation or use. It was classified with the oral state as normal divided by age group, caries-active, periodontal problem, orthodontic appliance, bridge or implant, and denture wearer group. Different oral hygiene devices should be recommended for them. Toothbrushes should be selected by head size according to the age groups, and dentifrices should be selected with the consideration of caries prevention for children and adolescents; otherwise, anti-inflammatory action for adults and aged persons. The concave type of bristle-plane toothbrush should be selected for orthodontic appliances in patients with interdental brushes and 2 lanes soft bristle toothbrush for patients with periodontal problems. And patients with dental implants should use floss silk, interdental brush, rubber tip, gingival massager, or waterpik. For patients with hypersensitive dentin, it would be recommended to use a toothpaste containing a desensitization agent with a soft brush. A denture brush should be selected for denture wearers.
Keywords : auxiliary oral hygiene device, oral hygiene, interdental brush, floss silk
Introduction

There are many kinds of oral hygiene devices produced by various companies and distributed in the market; therefore, the dental patients face difficulty in selecting a proper device. Even the dental workforces sometimes have problems recommending the proper oral hygiene device to their patients with different oral states [1]. So, a guide book or simple table for easy selection of the proper oral hygiene devices is needed.

The main oral hygiene devices are toothbrushes and dentifrices that remove dental plaques through toothbrushing [2]. Many guidelines have already been suggested for the selection of proper toothbrush and dentifrice according to the patient’s age group [3]. Therefore, at present, special cases such as patients with fixed type of orthodontic appliance, those with gingival problems, or those with prosthodontic appliances/dental implants should be described for effective use or recommendation.

As it is known, auxiliary oral hygiene devices should be recommended for use in special cases and not in general oral states like wearing a certain appliance or severe gingivitis. So, a proper type of toothbrush and dentifrice as well as an adequate type of auxiliary oral hygiene device should be selected according to the systemic body state and oral state of the dental patient [4].

Recommendation of Proper Oral Hygiene Devices for Individual Patients

The systemic body condition and oral state should be considered when selecting a proper device for oral hygiene. An important point of the systemic condition is age group, such as preschool age group, children, adolescents, young adults, middle-aged adults, and elderly, as suggested by the Korean Ministry of Health and Welfare. The oral state should be divided into caries, periodontal problems, presence of prosthodontic or orthodontic appliances, presence of dental implants, and denture wearers.

The oral state should be classified into dental caries, periodontal problems, presence of fixed-type prosthodontic appliances, orthodontic appliances, dental implants, partial denture, or full denture. Oral hygiene devices such as toothbrush, dentifrice, interdental brush, dental floss silk, rubber tip, gingival massager, and gargle solution should be selected.

Systemic condition, oral state, and proper oral hygiene device are shown in Table 1 and it is important to connect the proper items with each other.

Table 1 . Systemic condition and oral state for selection of proper devices

AgeOral stateOral hygiene device
PreschoolSevere cariesToothbrush (soft/orthodontic brush)
ChildrenPeriodontal diseaseDentifrice (fluoride, anti-inflammatory)
AdolescentHypersensitive dentinInterdental brush
Young adultFixed prosthodontic applianceDental floss silk
Middle-aged adultFixed orthodontic applianceRubber tip
ElderlyDental implantGingival massager
DisabledPartial denture
Full denture
Gargle solution


The head size of the toothbrush should differ with the patient’s age, which is classified as preschool age group, children, adolescents, and adults, considering the tooth size and oral cavity. It was recommended for the toothbrush head size to cover 2 or 3 posterior teeth, as shown in Figure 1 [5]. How-ever, for special cases, such as orthodontic appliance wearers, it would be recommended to use the concave-type head form of toothbrush, as shown in Figure 2, and zigzag type for bridge-applied patients. For patients with dental implants, it should be recommended to use the two-pane soft brush for the waterpik method of toothbrushing, as shown in Figure 3 [6].

Figure 1. Toothbrushes by age group.

Figure 2. Toothbrush for orthodontic patient.

Figure 3. Toothbrush for implant patient.

Dentifrice could be selected considering the fact that fluoride is contained for caries-sensitive age group and caries-active group; otherwise, anti-inflammatory agents or salt or Al-lantoin deliveries that contained dentifrice could be recommended for patients with periodontal disease, as shown in Figure 4. Moreover, in the case of hypersensitive dentin, desensitization-agent containing dentifrice would be recommended, as shown in Figure 5, and no Sodium Lauryl Sulfate (SLS) contained in dentifrice would be recommended for patients with oral malodor, as shown in Figure 6. In the case of hypersensitive dentin, such desensitization agents as fluoride, KCl, or ZnCl2 contained in dentifrice would be recommended for use with the soft bristle of the toothbrush, and the rolling method of toothbrushing instructions.

Figure 4. Dentifrice for hypersensitive dentin.

Figure 5. Electric toothbrush.

Figure 6. Denture brush.

For aged people, an adult-sized soft toothbrush would be recommended since most of them have periodontal problems. Moreover, for aged persons with implanted teeth, care should be taken to prevent inflammation around the dental implant through the waterpik method of toothbrushing with soft and two-lane toothbrushes, as shown in Figure 3. The use of proper denture brushes should be required, such as the denture brush shown in Figure 7. An electric toothbrush was recommended for disabled persons, as shown in Figure 8.

Figure 7. Dentifrice for periodontal disease.

Figure 8. Dentifrice for malodor control.

As you know, there are many kinds of auxiliary oral hygiene devices produced and sold in the market, as shown in Figure 9
-12. It is very important to match them for proper selection of each dental patient, as shown in Table 2.

Table 2 . Simple guideline table for recommendation of oral hygiene devices

AgeClassificationRecommended toothbrush and dentifriceRecommended auxiliary oral hygiene device
PreschoolGeneralSmall size toothbrush, fluoride dentifriceDental floss for incisor
ChildrenGeneralSmall size toothbrush, fluoride dentifrice
AdolescentGeneralToothbrush for youth, fluoride dentifriceGargle for necessary
OrthodonticOrthodontic toothbrush, fluoride dentifriceInterdental-brush, rubber tip
Young adultGeneralToothbrush for adults, fluoride/anti-inflammatory dentifriceDental floss, gargle for necessary
OrthodonticOrthodontic toothbrush, fluoride/anti-inflammatory dentifriceInterdental-brush, rubber tip/gingival massager
Middle-aged adultGeneralToothbrush for adults, anti-inflammatory dentifriceInterdental brush/dental floss
Gingivitis2 lane soft/vibratory electric toothbrush, anti-inflammatory dentifriceInterdental brush, rubber tip, gingival massager, gargle for necessary
ProsthodonticZig-zag typed toothbrush, anti-inflammatory dentifriceInterdental brush, super-floss/dental thread and floss silk, gingival massager
Sensitive dentinSoft toothbrush, SnF2, ZnCl2, KCl contained dentifriceFluoride mouth-rinse
MalodorAdult toothbrush, no Sodium Lauryl Sulfate dentifriceGargle for necessary, tongue cleaner
ElderlyGeneralToothbrush for adults, anti-inflammatory dentifriceInterdental brush, gargle for necessary
Implant2 lane soft toothbrush, anti-inflammatory dentifriceInterdental brush, waterpik, gargle for necessary
DentureDenture brush (full/partial)Denture cleaner, tissue conditioner
DisabledHandicappedElectric toothbrush, anti-inflammatory dentifriceGargle for necessary


Figure 9. Dental floss silk.

Figure 10. Interdental brushes.

Figure 11. Rubber tip.

Figure 12. Waterpik.
Discussion

It was concluded that toothbrushes would be selected by size according to the patient age group, and dentifrice would be selected as caries prevention for children and youth; otherwise, periodontal health for middle-aged or elderly in general.

For adolescents or young adults undergoing orthodontic treatment, the concave-shaped bristle-plane toothbrush was recommended for use in cleaning the upper and lower portions of the bracket wire that includes the gingival sulcus by short vibration, and the interdental brush should be selected for proximal area cleansing for them.

In the case of adults with periodontal problems, it would be recommended to use the two-lane soft bristle toothbrush to ease the Bass method of toothbrushing. It would also be suggested to use dental floss silk or the interdental brush to eliminate dental plaques at the proximal surface and to use the rubber tip or gingival massager for subsiding gingivitis.

For hypersensitive dental patients, it was recommended to use desensitization ingredients such as SnF2, ZnCl2, or KCl2 contained dentifrice with weak and fine abrasives; otherwise, non-SLS-containing dentifrice was recommended for patients with oral malodor.

For patients with dental implants, the two-lane toothbrush was recommended to perform the waterpik method around the gingiva of the dental implant to prevent peri-implantitis.

Denture brushes should be used for patients with denture and different types for partial denture and full denture, and electric toothbrushes with short-lived vibrations would be recommended for disabled persons or patients with gingival pro-blems.

Conclusion

Proper selection of oral hygiene devices is recommended for individuals for effective dental care and successful promotion of oral heal health.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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March 2021, 17 (1)