**4.4 Interdental cleaning aids**

Interdental cleaning aids are usually dental floss, toothpick or small interdental brush and Uni-tufted brushes. The use of interdental cleaning aid depends upon the spacing between the teeth and gingival tissue in the interdental spaces. Interdental cleaning of teeth is best achieved by using interdental brushes and these brushes should therefore be the first choice in patients with open interdental spaces [29].

Several interdental cleaning aids are available for cleaning of interdental areas. The use interdental cleaning device and method can vary depending upon the type of interdental embrasure (**Table 2**).

Dental floss: Dental floss is most useful in cleaning the interdental areas where the contacts between the teeth are tight and no space is present between the teeth and there is no recession of interdental papilla. Dental floss can be used by rotating around the fingers or they also can be used with a floss holder.


#### **Table 2.**

*Interdental space present and interdental aid to be used.*

Toothpicks: toothpicks are used in the tight interdental areas and it can be used as normal cleaning instrument anywhere required. Toothpicks have been used to clean teeth since ages; they come in different designs and varieties.

Interproximal brushes: Miniature interproximal brushes are available and they can be used in the interdental areas with slight papillary recession. Interproximal brushes are designed like a miniature bottle cleaning brushes are used in to and fro direction in the interdental areas.

Uni-tufted brush: Uni-tufted brushes are used in wide interdental areas with open embrasure and adjacent teeth with no contact. They help in cleaning of the open contact and make them plaque free.

Water jet/piks: water jets are the instruments which spray water with pulsations and pressure. Water jets have shown to be effective in removing debris from the interdental areas in patients who avoid the use of dental floss. Mouthwashes can also be used instead of the water; this increases its action due to the anti-plaque nature of the mouthwash.

#### **4.5 Tongue cleaners and mouthwashes**

Tongue cleaners are used to clean the dorsal surface of the tongue, which harbors maximum number of microorganisms. Tongue cleaners are usually flat surfaced made up of wood or plastic to scrape the surface of the tongue.

An oral rinse help in promotion of good oral hygiene, reduce oral discomfort, provide moisture to oral tissues and reduce bad breath [1, 15]. Mouthwashes are essential to completely rid of microorganisms from all the parts of oral cavity. ADA advocates use of mouthwash for regular maintenance of oral hygiene. Many mouthwashes with different chemical formulations are available in the market. Chlorhexidine containing mouth washes are considered gold standard. Other chemicals used are Bisguanides, Hydrogen Peroxide, Sodium Hypochlorite, Salt and Herbal mouthwashes.

Rationale for the use of mouthwashes:

Antiseptics present in mouthwashes are effective against the bacteria found within dental plaque, when they are in a planktonic form; they show both bacteriostatic and bactericidal activity.

Mouthwashes have a number of advantages**:**


*Short and Long Term Oral Hygiene Maintenance Protocols for Traumatic Dental Injuries DOI: http://dx.doi.org/10.5772/intechopen.96043*

Mouth rinses serve a variety of purposes

	- 1.Therapeutic Antiseptics
		- Phenol products: Listerine, Chloraseptic
		- Chlorhexidine products: Peridex, Corsodyl
		- Sanguinaria products: Viadent
	- 2.Cosmetic antiplaque rinses: Plax, Close-Up Anti-Plaque
	- a.Topical antibiotic rinses
	- b.Enzyme rinses
	- c.Artificial saliva rinses
	- d.Rinses that control tartar
	- Capable of reducing plaque scores by 20–50%.
	- Overall plaque reduction by 70–90% and exhibit slow release properties.
	- Exhibit better retentive properties over second generation agents.

Triclosan and Chlorhexidine mouthwashes have been widely used in recent times. Triclosan delays plaque maturation and inhibits formation of prostaglandin leukotrines which is a key controller of inflammation. Chlorhexidine acts against plaque and bacteria.

#### **5. Oral hygiene maintenance in deciduous dentition**

The primary dentition is fragile compared to the permanent dentition. The parent or the caregiver has to be delicate and gentle while brushing of teeth. It is advised to use a soft bristle brush in circular motion to clean the teeth. In the area of trauma and teeth with trauma, extra care should be given not to hurt and cause more pain and complications to the child.

In the area of injury during the healing phase, a cotton swab dipped in 0.12% chlorhexidine or antiseptic mouthwash can be used to clean the teeth and soft tissues. The cleaning of teeth and soft tissues should be carried out twice daily morning and night.

Use of mouthwashes in children is not advised as they may swallow the mouthwash instead of rinsing. In the area, where sutures are placed toothbrush usage should be avoided and gentle cleaning with a cotton swab is advised, so that the sutures do not get disturbed. After traumatic injuries of the primary dentition, most complications are associated to infection due to caries [30]. Post trauma after complete healing of the soft tissues radiographic assessment should be carried out to see any damage to the tooth buds of permanent teeth. Decidious teeth are not usually splinted to avoid disturbance to the permanent tooth buds. If splinting of deciduous teeth is carried out than the interdental areas below the splint fiber or wire should be kept clean by the use of interdental brushes in to and fro motion.
