Piksters Interdental Brushes, 7 pack, 9 size

What are Piksters and how do I use them to reduce gum disease?

Piksters interdental brushes are small cylindrical brushes designed to slide into and clean the spaces between the teeth. Unlike floss, they have lateral bristles that spring out to engage  and remove the plaque in the small crevices in between the teeth. Dentists call these areas of furcations. As the picture shows floss tends to clean in a straight line across the two humps on either side of a furcation whereas an interdental brush can spring out and dig into these areas and disturb the plaque.

As they have a stiffened wire core you can clean the spaces between your teeth one-handed, unlike regular floss.This makes it easier for the average person to use. Whatever is easier to do you are more likely to do - so many dentists find that their patients like to use these in preference to floss.

In several dental schools in Europe the use of interdental brushes is now taught as the primary method of cleaning between the teeth, whereas in the past floss was mainly taught.

Piksters have plastic-coated wire, which many dentist and hygienists prefer, as they will not scratch any implants you may have.

Piksters ease of use tends to make people want to use them habitually - which is good because it is important to effectively remove the plaque and its bacteria at least once each day.

What is gum disease and why the emphasis on daily plaque removal?

The reason for this daily plaque removal is that the longer the bacteria remain undisturbed, the more they change into the aggressive, pathogenic, anaerobic type of bacteria that causes more gum disease and bone loss. These pathogenic bacteria excite the body's inflammatory response, and unfortunately the cells that are designed to kill the bacteria can also cause collateral damage to the bone - the result is a slow, painless and unnoticeable loss of bone that is usually irreversible. Many a patient has attended a dental office to be told that they have lost so much bone that the tooth is in danger of falling out. Sometimes this comes as a total shock, as there is no warning and often no symptoms that they notice. Therefore it is really important to nip this disease process in the bud and stop it before it irreversibly damages the bone, which is what holds the tooth in place - not the gum - and visit your dental professional to monitor your gum and bone health.

What are the warning signs of gum disease and what do I do about them?

The first warning sign of gum disease is bleeding of the gums when brushed. This is actually called "gingivitis" at this early stage and is reversible. In its early stages gum disease is called gingivitis but when it progresses deeper into the bone  it is called periodontal disease which is harder to stop. Some people become concerned that their gums bleed and assume that they must be brushing too hard. However, bleeding is usually a sign that plaque has been left behind for too long and the toxins are now causing the gums to become inflamed and prone to bleed. Inflamed blood vessels are large in diameter and very fragile, and when disturbed by brushing , they break, and as a result you get bleeding. With effective bacteria removal this propensity to bleed can be reversed in three to seven days, but for the healing to occur you need to keep removing the source of the problem - the plaque. This may mean using a more vigorous and effective cleaning action than you have used in the past, even though the gums may bleed a bit to start with. The same is true of floss. If you haven't used it before, or for a long time,  there is a good chance your gums will bleed when you start. Keep going and the bleeding will stop. Of course this is only true when you are using modest forces that would not normally traumatize healthy gums.

Why are there many different Pikster sizes?

There are small sizes which are made for teeth where the gaps are fine. There are large sizes which are useful for people with braces or gum shrinkage or the back teeth where the gaps are generally larger. There are 'huge' sizes for cleaning in large gaps where teeth have been removed, or where you have bridges or dentures that are held to your mouth by implants that have large spaces around them.

It is important that the brush moves against the teeth and the gum sufficiently firmly to remove the very sticky plaque, and also to stimulate the formation of protective keratin protein on the surface of the gum. Tissue that is 'keratinised' tends to be more resistant to bleeding and damage from normal tooth-brushing, whether that brushing comes from an interdental or normal toothbrush. The different sizes allow you or your dentist or hygienist to find the one that gives you optimal cleaning power and stimulation of the gum keratin.

How do I decide what size to use in which situation?

You can test different sizes for yourself, or ask your dentist or hygienist to advise you. You can buy a variety pack which has most of the common sizes (0-6) in one packet  that you can evaluate. Dental professionals often have our professional kit which has all the different size options (0-9), so they can also test to see which one(s) fits comfortably and easily between the relevant gaps in your mouth. Always choose a size that does not involve pain or too much pressure to push it in. If the wire buckles it probably means there is too much pressure, or maybe you are pushing it too fast. So, always twist the brush in slowly, as it goes in more easily, and even if you can't twist it, use a gentle wriggling action as this helps to ease it in with less likelihood of the brush buckling. Often people will use two sizes for different areas. Size 0 can be used with the lower front teeth, especially where they have very little space between them. But be careful to twist or wriggle this particular brush in very slowly as this size has very, very fine wire and is much more inclined to buckle. For general purpose cleaning sizes 1 to 4 can be used - these are typically used around the side of your mouth and towards the back of the mouth.

Around bridges and implants there is often an existing and substantial loss of gum and bone, and the hole to get the interdental brush into is already quite substantial, so in these cases you can use any size that you consider fits comfortably. Plaque is very sticky and can be quite difficult to remove, so don't be afraid to use a brush that feels somewhat firm as long as it doesn't cause trauma to your gum. Check with your dentist , oral health therapist or dental hygienist to see what they recommend, if in doubt. Also, please note that you should not be concerned if your gums bleed a little bit at the start. This is so important that we will restate and amplify it. Many people have inflamed gums due to the fact they haven't been using interdental brushes or floss. The inflammation causes a weakening and dilation of the blood vessels, therefore they tend to break more easily under gentle stimulation, which is seen as bleeding when it is cleaned properly. This bleeding is therefore a sign from nature that you actually need to clean more often, not less often, as is a common misconception when people notice bleeding. However the bleeding should stop within a few days, due to the fact that you have removed the cause of the problem and that nature has had time to heal the damage. As long as plaque is removed effectively each day the bleeding will not return. If it does return or doesn't go away, there is a reason. Visit your dentist, oral health therapist or hygienist to find out what that is. It could be a sharp ledge, or bits of calculus that need removing.

You will therefore find  that your gums will toughen up and bleed less as you use  devices such as Piksters, floss, SupaGRIPs Flosspicks  and X-Floss and this is the best indicator that what you are doing is making a difference, and allowing your gums to heal.

Handle Extenders for Piksters interdental brushes (IDB's) and floss-picks

You can extend your Pikster IDB handle in two ways:

(1) Using the cap that is on every brush, which can be flipped around and put on the end of the handle.

(2) Using the larger, longer, dedicated extension handle (v2 Pikster only - you will notice a slight taper on the end of this handle to fit into the extender). By using these extension handles you can get more gripping power and control of your Pikster. This is particularly useful when you are inserting it into the gap between the teeth from the tongue side of the lower molars (see Image). The extension handle saves you having to get your fingers right into the tongue space. It is also useful for those with arthritis or the elderly where there is less strength and dexterity in the fingers. The extension handle allows more hand control and less reliance on the strength or flexibility of the fingers. Note that Piksters extension handle will only properly fit the new version 2 of Piksters that is identifiable by the fine taper on the end of the handle and the word 'piksters' debossed on the middle of the handle.

Is it alright to bend the wire?

Yes - and to access some areas, such as the back teeth, it is necessary to bend the wire at approximately 80º to get the brush in. Obviously you cannot twist the brush in this situation, but you can gently 'wriggle' it in. Do not push the handle back and forth (ie. in and out of the mouth) after you have bent and inserted the brush wire section, as this will repeatedly bend the wire where it joins the handle. (See Pictures) Push the handle sideways to drive the brush in and out between the teeth. Use the cap to extend the handle to give you extra leverage, if needed, or use the extension handle described above.

The less you bend the wire back and forth the better. So when you use it, work the wire brush portion in and out of the tooth gap, and don't move the handle back and forth in a way that bends the wire excessively or repeatedly where it joins the handle. The wire is made to be as stiff as possible, but the downside of this is called 'work hardening', which means the more it bends the faster it breaks. It would be very easy to make a wire that never broke, but it would be soft and almost useless as an interdental brush.

How to use Piksters correctly.

1)  The front teeth do not require the brush head to be bent. Insert the brush head in line with the plastic handle (see Picture 6).

Choose a size that inserts without force. The correct size will fit easily.
2)  Insert the brush slowly with a gentle twist or wriggling action - this will ease the brush into the space so that the wire does not buckle as much. If the wire buckles, discard the brush. Once buckled, it cannot be straightened properly.

3) Try to minimise any bending of the wire at the joint with the handle (see Pictures 5-6). In and out movements are fine but not bending.

4)  When using the brush between the back teeth, access will generally be easier if the brush head is bent over. Use this technique to make the bend as smooth and round as possible and reduce stress concentration: use one finger to push the tip of the brush head (not the base) over to an angle of approximately 45º to 90º, preferably once only. Pushing the tip will avoid a sharp bend where the wire meets the plastic handle, and reduce the stress concentration and likelihood of breakage in the metal.

5)  Do not recap a bent brush more than 4 times as this will re-bend the wire and increase chances of breakage. Piksters are reusable and can last many days if they are not bent excessively. Simply rinse it out under water like a normal toothbrush. The cost per use of a proper quality brush can therefore be less than other disposable 'fake' brush look-a likes.
If you are a regular IDB user, you can expect an IDB to break at some point. Usually they break where the wire meets the handle and the brush portion can be left between your teeth. 

If a brush head should break you can push it out backwards using another Pikster or toothpick from the opposite side, or floss it out using floss with knots tied in it, or remove with tweezers.

• See also "What to do if a brush head breaks" below.

Cosmetic/ appearance issues- Please note:

All interdental brushes, toothpicks and wooden sticks can put pressure on the tip of the small spike of gum between the teeth, (called the papilla) especially if you force it in or use a brush that is too big for the space. This can cause a slight re-shaping of the gum tip over time so that the tip of the pink gum is not as pointy, it is more rounded. The gap between the teeth becomes visible as it is more open.  This can be a good thing for some as it gives them better access into the gap to clean properly, but for others, especially in the front teeth, it can be a slight cosmetic issue, so you should be aware of it. If you are concerned, use floss, or SupaGRIPs floss-picks, or smaller brush sizes with a gentle action for cosmetic areas such as the front teeth. The least wear back of this gum spike will be by using floss - either as a floss-pick (easier to hold) or held between your fingers.