Along with the quantitative reduction in supragingival plaque expressed by lower plaque indices and seen with both manual and powered toothbrushes,there is a marked reduction in total viable bacteria counts.There is a concomitant decrease in the percentage and anaerobic bacteria,while percentages of aerobe flora are elevated.While toothbrushing may reduce the levels of periodontopathogenic bateria such as Actinobacillus actinomycetemcomitans(Aa) in supragingival plaque,it does not significantly reduce the percentage of subgingival sites infected with these pathogens even when toothbrushing is combined with surpragingival scaling.

    Oral hygiene measures in the interdental or interproximal areas have been of major interest since the publication of reports that these surfaces cannot be cleaned by toothbrushing alone.It is therefore necessary to carry out interdental cleaning on a regular basis,such as by using dental floss,interdental brushes,wooden sticks or powered interdental cleaning devices.Among the many factors with a potential influence on the effectiveness of interdental hygiene are type of cleaning device used and the interdental anatomy.Both waxed and unwaxed dental floss may be effective in narrow interdental spaces or the interproximal area,while dental tape,wooden stickes or interdental brushes have been shown to be ore effective in wider interdental spaces.Interdental cleaning with interdental brushes was shown to extend 2.5mm below the gingival margin,while interdental floss may penetrate to a depth of up to 3.5mm.

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