What Are the Advantages of Rubber Interdental Brush？

Brushing teeth has been a central staple of oral care for thousands of years, and patients generally understand why it matters. Interdental cleaning, meanwhile, is a relatively new concept in this light.

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With emerging technology and advancements such as interdental brushes making the practice easier and more effective than ever, it's all about emphasizing the value to your patients in a compelling way, and instilling good habits and a daily ritual.

Spelling out the risks of inadequate interdental cleaning helps. Research [1] indeed suggests that if you want to change patients’ oral hygiene behavior, success largely depends on whether they understand the repercussions of poor oral hygiene, how they perceive their susceptibility to periodontitis, and if they realize how a change in habits could work in their advantage. You can read more about this in one of our previous blog posts. However, according to the same study, effective strategies to facilitate these behavioral changes revolve around goal-setting and planning: together with the patient, decide on the what, how, and when. This includes equipping them with the knowledge and tools that allow them to easily adapt their routine.

That's why many oral care professionals are introducing their patients to interdental brushes or rubber picks, as they’re easier to use [2] (if the interdental space allows) than floss. Clearly explaining what they are, and why they’re beneficial, holds the key to improving home care routines in a big way. According to state-of-the-art guidelines [3] – recently published by the European Federation of Periodontology – providing the right tools, and teaching patients how to use them, is the very first step of therapy.

1. Introducing patients to interdental cleaners

Introducing patients to an interdental brush or a rubber pick is a big step toward building better practices around cleaning between the teeth. A publication in the International Journal of Dental Hygiene highlights the importance of educating patients on interdental cleaning products [4] in helping manage interdental plaque at home.

But familiarity with the product is only half the battle in embedding the habit. According to the article, access to an interdental brush doesn’t suddenly lead to a prioritization of interdental care. The next step is motivating patients to regularly incorporate interdental cleaning into their routine.

2. Explaining the differences between toothbrushes, flossing and interdental brushes

Explain to patients where interdental cleaning fits into their oral care toolbox. How does it complement a toothbrush's function? Why can interdental brushes and picks be preferable to classic dental floss in some instances? Every implement has its purpose.

• Toothbrushes clean the three exposed surfaces of teeth - buccal, lingual and occlusal. This is easily explained.
• Flossing cleans between the teeth, on the mesial and distal sides, enabling patients to clean around the tooth below the gumline and reach the sulcus. It is especially helpful in between tight teeth, where the bristles of a brush can’t penetrate. Floss dislodges debris and plaque to prevent the development of periodontal pockets.
• Interdental brushes or picks clean the spaces between teeth and dental appliances, where food becomes lodged and plaque can accumulate. They also massage gums to stimulate blood flow, reaching where brushes can’t and where floss wouldn’t be efficient. As for differentiating between these two interdental cleaning options:
  - Interdental brushes are small brushes made of filaments attached to a coated wire with a rounded tip for more comfort and to protect the gums. There are many different sizes available (GUM offers nine).
  - Interdental picks are made of rubber, and are known for being more gentle with gums and teeth. They come in three different sizes.

3. What to look for when shopping for interdental brushes 

Help patients recognize what to look for in a product: coated wires, antibacterial filaments,  and convenience with adaptable handles are easy to use. These are all key factors to ensure hygiene and patient compliance.

As any dentist knows, technique is everything. Good interdental cleaning technique yields great results for oral health; poor technique leaves teeth and gums at risk. Convey the quality of interdental brushing over quickness.

Instructing patients on proper technique during a visit is the simple part, of course. What makes a difference is embedding the habit and making it stick. Conventional wisdom suggests that it takes 21 days to turn a behavior into a habit, although research suggests it might take three times as long [6]. Try pointing them toward creative tips for making habits stick [7].

If you’d like a simplified set of interdental brushing instructions to share with your patients, feel free to print and provide them with this paragraph:

Ensure patients know they might need different brushes or picks for differently-sized interdental spaces. This is often the case for cleaning between teeth or cleaning around permanent retainers or braces.

4. Sharing key benefits of interdental brushes

The benefits associated with interdental cleaning are relevant to any patient, but they’re worth explaining in the context of each unique individual. For example, if their gums bleed during the hygienist’s cleaning, recommend interdental brushes to help them avoid that issue in the future. Or, if a patient complains of debris stuck in their braces or implants, show them exactly how an interdental brush can help. Frame the benefits of interdental brushing [8] from a patient’s perspective:

• Can be easier and more comfortable than traditional string flossing when there is space.
• Cleans space toothbrushes just can’t reach, where floss may not be as effective.
• Helps reduce irritation and inflammation of interdental gums.
• Can reduce bleeding from gums, when combined with an overall oral hygiene regimen.
• Flexible material makes it easier to reach in between back molars.
• Reduces the prevalence of gingivitis and periodontitis.

5. Recommending interdental brushes or picks to patients

The last step in inspiring action is to provide the means. Recommend interdental brushes or picks to those patients susceptible to periodontal disease. Moreover, patients with orthodontic appliances benefit from these brushes' thorough cleaning. Give your patients an interdental brush or trial set of picks. Or, at the very least, recommend a specific variety to them.

It’s best to start with a demonstration, and then offer a sample or two, so patients can experiment with interdental brush products before investing in them on their own. This conversation also provides a great opportunity to talk about sizes, firmness, and the difference between interdental brushes and picks. Since some patients are averse to a metallic feeling in their mouth, you might opt to start by recommending  GUM SOFT-PICKS, which tend to have a higher rate of adoption and compliance. Once they start to get familiar with interdental cleaning, you can revisit brushes and their benefits.

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Woodsticks and rubber picks are also popular interdental cleaning devices, especially for people who are on the go, or want to dislodge detritus.

Dental professionals frequently receive questions about these tools, their safety, and their efficacy. 

In this post, we will review modern research around wooden toothpicks and rubber interdental picks specifically to help inform your perspective.

Dental Woodsticks and Rubber Picks: An Overview

Toothpicks are among the oldest oral care tools in history, with evidence showing they were used by ancient humans nearly 2 million years ago. Wooden toothpicks have been a prevalent tool for interdental cleaning throughout much of history, and they remain widespread in their use today. Dental woodsticks are not to be confused with today’s standard wooden toothpicks, even though they are similar. Wooden toothpicks are round and often pointed on both ends, and they have a variety of uses beyond oral care. Woodsticks, as described by Sälzer et al. (), “have a trapezoidal profile and are slightly curved along their length. They are manufactured from long fiber, shatterproof wood, and are available in different sizes. Their application is similar to interdental brushes.” 

Rubber interdental picks, or rubber toothpicks, are a relatively new interdental cleaning device, developed through advancements in material and technology. Typically made of rubber or silicone, these picks are small and flexible with small bristles or protrusions at the tip to maximise the removal of plaque and food debris. They are designed for gentleness and ease of use, and to help people reach tricky areas or between closely spaced teeth.

The SOFT-PICKS® from GUM® was the first rubber interdental pick product introduced to market, featuring a plastic core with soft elastomeric bristle designed to massage the gingiva while also delivering a strong clean.

Woodsticks and rubber picks: efficacy as interdental cleaning devices

To date, there has not been a direct comparison between the efficacy of woodsticks versus rubber interdental picks published in a scientific journal. However, there have been several independent studies focusing on these tools, from which we can draw useful insights to inform patient guidance and product recommendations.

Dental Woodsticks

A systematic review of triangular woodsticks and their efficacy against plaque and gingival inflammation was conducted in by Hoenderdos et al. The researchers concluded: “Evidence from controlled trials, most of which were also randomized, shows that woodsticks do not have an additional effect on visible interdental plaque or gingival index, but do, however, provide an improvement in interdental gingival inflammation by reducing the bleeding tendency.” The reduction in gingival bleeding is potentially attributable to physical stimulation of swollen papilla, providing greater defence against inflammation than toothbrushing alone. Regarding the relative efficacy of triangular woodsticks versus round wooden toothpicks for interproximal dental plaque, a study by Zanatta et al. () revealed no significant statistical differences.

Rubber interdental picks

Several studies have demonstrated the efficacy of rubber interdental picks. Here are some key takeaways from the research:

• Recently, two in vitro experiments in and demonstrated good cleaning efficacy, measured as removal of artificial plaque in interdental spaces modelled in several shapes.
• One of the first clinical studies was performed by Yost et al. (). In the group using SOFT-PICKS (n=30), plaque levels decreased from 2.34 at baseline to 1.95 at the final visit after 6 weeks (mean change: 0.39, p< 0.001, % change: 17%). During that visit, after the initial plaque measurement, participants were asked to use the SOFT-PICKS once more, which immediately reduced mean plaque levels further to 1.44 (mean change: 0.51, p< 0., % change: 26%). Further clinical trials in the several past years have confirmed those findings.
• Abouassi et al. () demonstrated that usage of rubber interdental picks such as SOFT-PICKS resulted in immediate significant plaque reduction (before=2.02, after=1.58, mean difference: −0.44 ± 0.03, p<0.).
• Two studies published in provided further evidence. Graziani et al. () showed that using SOFT-PICKS adjunctive to manual toothbrushing reduced full mouth plaque scores and interdental full mouth plaque scores with 71% and 65%, respectively, after four weeks. Also, after 28 days, interdental full mouth plaque scores were significantly lower in Group 4 (toothbrushing + SOFT-PICKS) compared to Group 1 (only toothbrushing) (difference: 21.8%, p=0.05). Similarly, Hennequin-Hoenderdos et al. () demonstrated that in approximal sites found to be accessible for SOFT-PICKS, the Plaque Index significantly decreased from 3.34 to 2.55.
• Most recently, a systematic review by van der Weijden et al. came to the conclusion that rubber picks are indicated for gingivitis and plaque reduction. There is mounting strong evidence for rubber interdental picks as a highly effective tool for reducing plaque levels and gingivitis. But of course, as any dental professional knows, effectiveness is only a part of the consideration for oral care devices. Ensuring that patients comply and actually use the tool is essential. So next we will explore the safety and user experience implications for both woodsticks and rubber picks.

Woodsticks vs. rubber picks: safety and user experience

The aforementioned systematic review of rubber picks by van der Weijden et al. also concluded that, “The evidence supports user safety and participants’ preferences.” This points to a key advantage of these devices: user appreciation. Studies by Smith et al. () and Moretti et al. () demonstrated superior ease-of-use for the SOFT-PICKS, compared to, for example, floss. In a clinical trial from Abouassi et al. (), rubber interdental brushes bristles were rated significantly higher by participants than conventional interdental brushes in terms of overall patient acceptance and specifically in these areas:

• Less pain during usage
• Comfort of brushing
• Willingness to buy the product

Hennequin-Hoenderdos et al. () found that SOFT-PICKS were favoured over interdental brushes by patients and yielded significantly lower gingival abrasion (GA) scores by comparison.

Most recently, a study performed in Germany by researchers from Kiel University investigated user-friendliness of rubber interdental picks compared to that of woodsticks. A total of 11 criteria were surveyed, including ease of insertion, cleaning capacity, stability, etc. The rubber interdental picks demonstrated superiority in 10 out of 11 criteria compared to woodsticks, whereas the only criteria not showing a significant difference was the item “taste”.

Meanwhile, there are a range of concerns surrounding the safety and user-friendliness of woodsticks. If used too aggressively or with too much force, these tools can still shatter, leaving splinters or pieces of wood behind. They can also damage the gums and tooth enamel, especially if the user is rushing or employing poor technique, thus leading to gum recession and tooth sensitivity.

Furthermore, woodsticks may not be suitable for individuals with tight contacts between teeth, as they may not fit between the teeth.

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Rubber interdental picks vs wooden toothpicks – which ones are more user friendly and why?