|Year : 2019 | Volume
| Issue : 4 | Page : 283-287
Home remedies for interdental cleaning: A descriptive study
PT Kaviya, R Anusha, Parangimalai Diwakar Madan Kumar
Department of Public Health Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
|Date of Submission||24-Sep-2018|
|Date of Decision||26-Mar-2019|
|Date of Acceptance||25-Oct-2019|
|Date of Web Publication||12-Dec-2019|
Dr. R Anusha
Department of Public Health Dentistry, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: The ignorance toward oral hygiene practices in the Indian society remains a major reason for poor oral hygiene. This has led to food impaction in the interproximal regions of the tooth surface, one of the most commonly faced oral problems. Till date, no evidence exists to have assessed the use of these home-based alternative aids for removing impacted food in the interdental regions of oral cavity. Objective: The objective was to assess the attitudes and practices regarding the removal of impacted food between the teeth among adult population in Chennai city. Materials and Methods: A convenience sample of 183 individuals were assessed. This cross-sectional study was conducted with a self-constructed 10-item questionnaire on individuals reporting to the outpatient department of our dental institution during March and April 2018. The questionnaire included close-ended questions related to demographic details, type of diet, oral hygiene practice, use of interdental aids or any household materials that are available at home, duration of usage, and symptoms (if any). Data were compiled, and frequency distribution was obtained using SPSS software version 20 (IBM Corp.). As the study sample was very small and analysis was not the primary objective, simple description of the data obtained was considered sufficient. Results: Among the study participants, 69.9% (n = 128) reported that they use household material as an interdental aid. Among those 128 participants, 35.2% (n = 45) used combination of materials (including broomstick, toothpick, safety pin, and fingernail) and 32.8% (n = 42) used broomstick, whereas 7.8% (n = 10) used safety pin and 4.7% (n = 6) used fingernail alone to remove the impacted food. About 25% (n = 32) reported pain and 22.7% (n = 29) reported bleeding while using these objects. Nearly 73.4% (n = 94) of the participants reported that they use it for more than 3 years. Conclusion: Our study showed that there is reduced practice of recommended interdental aids compared to the household materials that are easily available at hand. This indicates the lack of basic knowledge about interdental aids and the method of using them. Thus, oral health promotion through health education should identify these illicit oral hygiene practices and provide targeted interventions to alleviate the same.
Keywords: Attitudes, mouth diseases, oral health, oral hygiene
|How to cite this article:|
Kaviya P T, Anusha R, Kumar PD. Home remedies for interdental cleaning: A descriptive study. J Indian Assoc Public Health Dent 2019;17:283-7
|How to cite this URL:|
Kaviya P T, Anusha R, Kumar PD. Home remedies for interdental cleaning: A descriptive study. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2020 Apr 8];17:283-7. Available from: http://www.jiaphd.org/text.asp?2019/17/4/283/272783
| Introduction|| |
Oral health is an inseparable part of general health, and there are numerous factors which influence the oral health of an individual such as diet, oral hygiene practices, socioeconomic status, geographic location, and literacy. According to the World Health Organization, promotion of oral health is the most cost-effective strategy to reduce the burden of oral disease and maintain oral health and quality of life. It has been noticed that proper oral hygiene practices in Indian population have mostly remained an ignored and unrealized major social problem. This negligence has, in turn, led to the slightest catch of food between the teeth, which would initiate glitches such as caries halitosis, periodontitis, gingival abscess, and alveolar bone resorption. Food impaction refers to the forceful wedging of food into the interproximal periodontal tissue. This can be classified as horizontal and vertical types. The former is usually due to lateral pressure from tongue whereas the later occurs as a result of step deformity between the marginal ridge of adjacent tooth or presence of plunger cusp., The use of readily available home-based alternatives in the oral cavity such as toothpicks, safety pins, broomsticks, writing pen, and metallic sewing needle  has been reported to injure the soft and hard tissues of the oral cavity. Thus, to overcome these issues, primary prevention – oral health promotion – is the key. Till date, no evidence exists to have assessed the use of these home-based alternative aids for removing impacted food in the interdental regions of the oral cavity. Hence, we undertook a pilot study to assess the attitudes and practices of individuals regarding the removal of impacted food in between the teeth among adult population visiting the outpatient department of peripheral centers of our institution in Chennai city.
| Materials and Methods|| |
A cross-sectional study was conducted among the adults attending the outpatient department of peripheral centers of our institution. These satellite units offer both medical and dental services as a part of their routine activity. A nonrandom sample of individuals above the age of 18 years who were present on the day of data collection and who gave consent to participate were only included in the study. Only dentate individuals with a minimum of twenty permanent teeth were included in the study. No specifications regarding the type of occlusion were considered as the study group belonged to varied age. The study was carried out from March 1 to May 30, 2018. Data were collected from an interviewer-administered questionnaire which contained ten major items which included demography, nature of diet, brushing habits, type of brushing, frequency, use of other oral hygiene aids, and awareness about interdental aids. The “question 9” was further divided into ten subquestions inquiring about the type of aid used to remove the impacted food, time of use, duration of usage, region of use, type of food, pain, bleeding history, direction of use, and habitual nature. The questionnaire was prepared in English and checked for content and face validity by giving it to two experts in the dental field. A total of 20 twenty adults were randomly chosen from the study population. Each expert independently rated the relevance of each item on the questionnaire to the conceptual framework using a 3-point Likert scale (1 = essential, 2 = essential, but not useful, and 3 = not useful). The Content Validity Index was used to estimate the validity of the individual items and scale. To determine the face validity of the questionnaire, an evaluation form with a 4-point Likert scale (strongly disagree = 1, disagree = 2, agree = 3, and strongly agree = 4) was developed to help respondents assess each question in terms of:
- The clarity of the wording
- The likelihood the target audience would be able to answer the questions
- The layout and style.
Once completed, the responses were entered in Microsoft Excel 2016 and analyzed statistically to obtain the frequency distribution of each item using SPSS software version 20 (IBM Corp., Chicago, IL, USA). Based on the data obtained, frequency and percentage distributions of the variables were assessed. As the study group was very small and analysis was not the primary objective, simple description of the data obtained was considered sufficient.
| Results|| |
As there was no restriction on the age limit of the participants to be included, all those participants who gave consent and fulfilled the eligibility criteria were included in the study. A total of 183 participants with age ranging from 18 to 82 years were studied. The mean age of the study group was 49.5 ± 14.7 years. Almost 97.8% of the participants use toothbrush and toothpaste as their principal mode of cleaning their teeth [Table 1].
Nearly 69.9% of the participants have experienced food lodgment after meal among whom, 35.2% used combination of objects (broomstick, toothpick, safety pin, and fingernail). [Figure 1] depicts the percentage distribution of the various alternative household aids used by the study population. For almost 91.4% of the respondents, it took <5 min to remove the food lodged between the teeth. Meat was the most common food type causing food lodgment (66.4%), and the most frequently occurring site was in the back tooth region [Table 2].
|Figure 1: Distribution of the various alternative household aids used by the study population|
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|Table 2: Frequency distribution of the main ten subitems of the question “9” representing the attitudes and practices of the respondents toward removing food impacted in the interproximal region**|
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Symptomatic experience of pain and gum bleeding were experienced by 25% and 22.7% of the participants, respectively.
[Figure 2] depicts the percentage distribution of the duration of usage of the alternative aids among the study population. On the whole, 58.6% of the participants were not aware of the consequences of the use of such household aids on the oral tissues.
|Figure 2: Distribution of the duration of usage of the alternative aids among the study population|
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| Discussion|| |
Food impaction is one of the most commonly encountered problems which could occur due to improper anatomy of the teeth or due to iatrogenic reasons. The frequently associated etiology for this includes presence of open contacts, irregular marginal ridges, plunger cusps, proximal caries, or even pericoronitis. Khairnar M in a similar study quoted that food impaction is frequently a source of extreme annoyance to both the dentist and the patient.
In our study, majority of the participants, i.e., 69.9% (n = 128), had the habit of using these household materials, either in combination or as a sole agent to dislodge the impacted food from the interdental regions.
The constant irritation of the food dregs or the sharp aids in the interdental region can result in infection and inflammation of the periodontium. Most of the periodontal infections begin in the col area, thereby insisting on the importance of plaque removal in this region. It can also occur otherwise, with the chronic periodontal inflammation leading to recession and loss of attachment, thereby opening the contact areas causing food lodgment. However, there is lack of substantial evidence reporting this two-way relationship. The other possible effects of food impaction include dental caries on the proximal surfaces of the teeth involved and alveolar bone loss.
Almost 97.8% (n = 179) of the participants used toothbrush and toothpaste as their principal mode of cleaning their teeth, which is similar to the studies by Oberoi SS et al., Gupta et al., Ali et al., and Johani  who reported a usage of 83.6%, 68.5%, 88%, and 95.4%, respectively. Toothpowder was used by 7.6% of our study participants, which is slightly higher compared to 5.76% reported by Ali et al.
Once daily brushing was seen among 73.8% (n = 135) of our participants, which was higher than 57%, 63.5%, and 23.5% found by Khami et al., Gupta et al., and Johani HA  respectively. However, this was relatively less compared to the 91% and 100% use reported by Rimondini et al. and Cortes et al., respectively  In addition, the percentage of participants reported to practice twice daily brushing was only 26.2% compared to 38.5% found by Johani  and 33% reported by Petersen et al. While a study among the Indian population by Jain et al. showed a lesser use of only 23%.
Among the respondents, 82.5% (n = 151) of them used the traditional horizontal method as their principal method of brushing, which is in accordance with the study conducted by Jain et al. and Zhu et al. with a use of 60% and 75%, respectively. Almost 25.1% (n = 46) of the participants used soft-bristled brushes, similar results were observed even in the study by Zhu et al. The frequency of changing the brush was found to be 1–3 months in 57.4% (n = 105) of participants, which was higher than the 30%–35% reported by Gupta et al. and Jain et al. In our study, 24.6% (n = 45) of the participants used other aids such as tongue cleaner, mouthwash, and dental floss, which was higher compared to 8.93% use of mouthwash alone as an adjunct as reported by Paul et al. and Mahtani and Lakshmanan.,
Even though only a small fraction of the participants reported gum bleeding (22.7%) and pain (25%) while brushing, which are lesser when compared to 40% found by Jain et al., Nagarsekar et al., and Vandana et al., this could be due to the refractive nature of the periodontium. In addition, this severity of the disease would depend on the type, nature, quantity of food that is stuck in the interdental region, duration of food impaction, and time taken for removal. The greater the time taken for removal, the severe might be the injury to the supporting tissues. However, the existing evidence assessing the influence of these factors is very limited.
Of all those 128 participants using those sharp household aids, 58.6% (n = 75) were not aware of the consequences of such aids and on the whole, only 44.8% (n = 82) are aware of the interdental aids available in the market. This is comparatively better than 71% of unawareness about interdental aids found by Mahtani and Lakshmanan et al., among a total of 100 randomly selected outpatients. Similar studies among health professionals by Nagarsekar et al., Vandana et al., and Bennadi et al. reported knowledge of 70%–80% among the study groups, with only 20% of them practicing the use of such aids.
Overall, our study showed a greater prevalence of use of the household alternatives that are easily available in the place of an interdental aid for dislodging impacted food between teeth. Till date, extensive literature exists only on the knowledge, attitude, and practice of interdental aids or on the secondary or tertiary care of the consequences of food impaction.,,, It is recommended to assess the long-term consequences of these aids on the oral tissues in order to substantially include them in oral hygiene promotion programs.
| Conclusion|| |
- Although being cross-sectional in design, our study gave an insight to the wide variety of home-based easily available alternatives that are being used in the place of an interdental aid for removal of impacted food
- These data can be taken as the basis for future studies to assess the long-term detrimental effects of such injurious objects on the periodontium
- As the study population belonged to only those patients reporting to satellite center, the results could inadvertently show a higher prevalence. The influence of socioeconomic status needs to be studied further with respect to the use of household aids for interdental cleaning
- Health education programs should emphasize on these issues also along with the right ways of using oral hygiene aids in order to achieve an acceptable level of oral health among large populations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Randhawa AK, Veeresha KL, Gambhir RS, Sohi RK, Bansal V, Dodamani A. Assessment of oral health status, treatment needs, coverage and access barriers of patients reporting to a rural dental college in Northern India. J Indian Assoc Public Health Dent 2011;18:89904.
Paul B, Basu M, Dutta S, Chattopadhyay S, Sinha D, Misra R. Awareness and practices of oral hygiene and its relation to sociodemographic factors among patients attending the general outpatient department in a tertiary care hospital of Kolkata, India. J Family Med Prim Care 2014;3:107-11.
] [Full text]
Khairnar M. Classification of food impaction-revisited and its management. Indian J Dent Adv 2013;5:1113-9.
Peng M, Zhu Z, Yang X. Investigation and treatment of food impaction. J Oral Sci Res 2005;21:462-4.
Newell DH, John V, Kim SJ. A technique of occlusal adjustment for food impaction in the presence of tight proximal contacts. Oper Dent 2002;27:95-100.
Subbaiah R, Thomas B, Maithreyi VP. Self-inflicted traumatic injuries of the gingiva-A case series. J Int Oral Health 2010;2:43-9.
Bennadi D, Halappa M, Kshetrimayum N. Self reported knowledge and practice of inter dental aids among group of dental students, Tumkur, India. J Interdiscip Dent 2013;3:159-62.
Lynn MR. Determination and quantification of content validity. Nurs Res 1986;35:382-5.
Oberoi SS, Mohanty V, Mahajan A, Oberoi A. Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis. J Indian Soc Periodontol 2014;18:369-74.
] [Full text]
Gupta V, Singh AK, Gupta B. Assessment of oral hygiene practices and awareness of periodontal-systemic health interrelationship amongst the local population of Kanpur region-a cross sectional study. J Oral Health Community Dent 2016;10:1-8.
Ali NS, Khan M, Butt M, Riaz S. Implications of practices and perception on oral hygiene in patients attending a tertiary care hospital. J Pak Dent Assoc 2012;1:203.
Johani HA. Oral hygiene practice among Saudi patients in Jeddah. Cairo Dent J 2008;24:395401.
Khami MR, Virtanen JI, Jafarian M, Murtomaa H. Oral health behaviour and its determinants amongst Iranian dental students. Eur J Dent Educ 2007;11:42-7.
Rimondini L, Zolfanelli B, Bernardi F, Bez C. Self-preventive oral behavior in an Italian university student population. J Clin Periodontol 2001;28:207-11.
Cortes FJ, Nevot C, Ramon JM, Cuenca E. The evolution of dental health in dental students at the University of Barcelona. J Dent Educ 2002;66:1203-8.
Petersen PE, Aleksejuniene J, Christensen LB, Eriksen HM, Kalo I. Oral health behavior and attitudes of adults in Lithuania. Acta Odontol Scand 2000;58:243-8.
Jain N, Mitra D, Ashok KP, Dundappa J, Soni S, Ahmed S. Oral hygiene-awareness and practice among patients attending OPD at Vyas dental college and hospital, Jodhpur. J Indian Soc Periodontol 2012;16:524-8.
] [Full text]
Zhu L, Petersen PE, Wang HY, Bian JY, Zhang BX. Oral health knowledge, attitudes and behaviour of adults in China. Int Dent J 2005;55:231-41.
Mahtani AA, Lakshmanan R. Awareness of interdental aids and their regular use in daily oral hygiene – A questionnaire based study. J Pharm Sci Res 2017;9:202-4.
Nagarsekar A, Gaunkar R, Aras M. Knowledge, attitude, and practice of dental professionals regarding the effect and management of food impaction associated with fixed partial denture prostheses: A survey. J Indian Prosthodont Soc 2016;16:372-9.
] [Full text]
Vandana KL, Mahajan N, Savitha B. Knowledge, attitude, and practices of interdental aids among medical professionals in Davangere district, Karnataka. J Int Clin Dent Res Organ 2015;7:39-43. [Full text]
Bidra AS. Nonsurgical management of inflammatory periimplant disease caused by food impaction: A clinical report. J Prosthet Dent 2014;111:96-100.
Jeong JS, Chang M. Food impaction and periodontal/peri-implant tissue conditions in relation to the embrasure dimensions between implant-supported fixed dental prostheses and adjacent teeth: A cross-sectional study. J Periodontol 2015;86:1314-20.
[Figure 1], [Figure 2]
[Table 1], [Table 2]