Patients' Perception and Acceptance of Innovative Interdental Cleansing Devices: A Survey-Based Study

1. INTRODUCTION

Oral hygiene is crucial for maintaining overall health, and its importance is increasingly recognized as a key component of general health [1]. Various factors, including personal knowledge, attitudes, behaviors, and individual perceptions of health, influence both oral health and overall health. Research shows that individuals who are informed about oral health tend to maintain better oral hygiene [2]. Poor oral hygiene can lead to several serious health issues, such as carcinomas, infective endocarditis, and aspiration pneumonia. Oral squamous cell carcinomas are among the most prevalent cancers in the Southeast Asian subcontinent, and studies indicate that factors contributing to these cancers are often linked to inadequate oral hygiene [3]. Additionally, the normal bacteria found in the mouth can cause infective endocarditis. Lockhart et al. [4] noted that this condition is particularly common among individuals who experience gingival bleeding after brushing their teeth. Oral health is frequently neglected in elderly individuals. However, maintaining good oral hygiene is particularly important for this demographic. Khadka et al. [5] explored the connection between aspiration pneumonia and oral health in older adults, revealing that bacterial colonization in the mouths of those who do not receive professional oral care is often associated with prolonged respiratory infections. Traditional methods, such as dental floss, have been used for a long time to maintain oral hygiene [6]. However, there has been a shift toward new interdental cleansing devices that are gaining popularity due to their enhanced hygiene levels and increased user compliance. These innovative devices have shown significant effectiveness in reducing plaque and improving gingival health [7]. Despite their advantages, interdental cleansing devices have limitations. Many of them require a certain level of hand dexterity for effective use. Studies have shown that individuals with physical impairments often struggle to utilize devices like dental floss and interdental brushes effectively [8].

Using interdental cleansing devices regularly poses a significant challenge for many individuals, as these tools can be difficult to incorporate into daily routines [9]. Furthermore, certain interdental cleansing devices, such as traditional floss and some interdental brushes, may struggle to reach deep interproximal spaces adequately. Holtfreter [10] highlighted that while flossing is more effective than interdental brushes for plaque removal in patients with very tight contacts, it has its limits. Moreover, some interdental devices can lead to gingival trauma and discomfort; a study by Chipre and Shah [11] indicates that enhancing awareness of proper dental device usage can foster better oral hygiene practices. However, improper use of these tools can result in gum recession and injuries, ultimately discouraging daily use. The study conducted by Patil et al. [12] demonstrated a significant lack of knowledge among dental undergraduate students regarding the use of interdental aids. This underscores the importance of understanding patient perceptions and acceptance when transitioning from traditional cleansing tools to more advanced oral hygiene technologies. Such advancements often emphasize personalization, adapting to the user's specific dental anatomy for a more tailored and effective cleaning experience. For instance, many modern devices allow customization based on individual dental structures, ensuring a precise fit. Additionally, features such as adjustable cleaning intensity, duration, and patterns can often be controlled via a connected app, providing a truly personalized oral hygiene experience.

Recent research has demonstrated that the effective use of interdental brushes and water flossers offers superior cleaning capabilities compared to traditional dental floss, significantly improving plaque removal and reducing gingival inflammation [7, 13]. This increasing body of evidence underscores the importance of educating patients about the benefits of using interdental cleansing devices. Innovations in this field are rapidly advancing, enhancing overall oral health. For instance, the introduction of adjustable sizes and sonic vibrations has improved both the accessibility and effectiveness of these devices [14]. Additionally, electric brushes equipped with rotary features are more effective at removing plaque than manual brushes and traditional options, highlighting the vital role of technology and innovation in daily oral hygiene routines. Despite the evident advantages, the availability and acceptance of interdental cleansing devices remain barriers to their widespread adoption. Several studies suggest that a lack of awareness about these innovative tools significantly impacts individuals' willingness to incorporate them into their oral hygiene practices [15].

Several factors significantly influence patients' perceptions regarding oral hygiene practices, including familiarity with traditional methods, the cost-effectiveness of devices, recommendations from dental professionals, and the perceived complexity of using new tools. Understanding these perceptions is crucial for developing targeted educational strategies that promote effective oral hygiene practices. This survey-based study primarily aims to provide valuable insights into how diverse populations perceive and incorporate interdental cleansing devices into their daily oral health routines.

The findings of this study will enhance understanding of patient behaviors, which can assist manufacturers in refining their products and assessing the viability of such devices. Furthermore, dental professionals play a crucial role in shaping patients' perceptions of innovative interdental cleansing devices. By discussing and integrating these tools into routine dental visits, practitioners can significantly influence patients' acceptance and utilization of these devices. Dental professionals can effectively educate patients about the benefits and proper techniques for using these tools.

This research investigates the perspectives and acceptance of interdental cleansing devices through a survey-based methodology, providing a fresh and unique insight into patients' attitudes and behaviors toward adopting these essential oral hygiene tools. The study specifically aims to evaluate the effectiveness and user adaptability of the patented Interdental Cleansing Device (US 11,179,230 B1) in comparison with traditional techniques.

Additionally, the research will provide valuable knowledge for public health initiatives aimed at improving oral hygiene practices within the community. The results may guide the design and implementation of interventions to address prevalent misconceptions or concerns surrounding interdental cleansing. By empowering dental professionals to encourage the use of these devices, public health campaigns can become more persuasive and effective.

This study also identifies key barriers to the acceptance of interdental cleansing devices, including cost, accessibility, perceived difficulty of use, and a lack of awareness about the importance of interdental cleansing. Gaining insights into these factors will be crucial for developing targeted strategies in oral hygiene campaigns that focus on specific populations, thereby enhancing overall oral health.

2. MATERIALS AND METHODS

3. RESULTS

3.2. Personal Preferences for Oral Hygiene

The personal preferences of the study participants for maintaining oral hygiene are presented in Table 2 and Figs. (1 and 2). Of the 377 participants, nearly half reported that they do not consider maintaining oral health necessary (188, 49.9%), 126 (33.4%) were unsure of their oral health condition, and 134 (35.5%) reported poor oral health. In contrast, 117 (31.0%) reported good oral health. Additionally, 187 (49.6%) participants had tooth discoloration, 129 (34.2%) reported experiencing bad breath, and 121 (32.1%) were unsure whether they had bad breath. Fig. (1) illustrates the distribution of brushing habits, showing that brushing frequency was nearly evenly distributed: 96 (25.5%) participants reported not brushing their teeth. At the same time, similar numbers reported brushing once or twice a day. The duration of brushing was also comparable across groups, with 126 (33.4%) brushing for less than 1 minute, 128 (34.0%) for 1 to 2 minutes, and 123 (32.6%) for more than 2 minutes. Most participants used horizontal strokes (112, 29.7%), followed by those using all types of brushing techniques (103, 27.3%), and most preferred medium bristle brushes (107, 28.4%). Additionally, most participants changed their brushes every three months (109, 28.9%). Fig. (2) shows survey responses on interdental cleansing devices, indicating that the participants did not clean their tongue while brushing (196, 52.0%), but 205 (54.4%) found interdental cleansing necessary. Furthermore, 194 (51.5%) had a flossing habit, with 106 (28.1%) flossing three times a day, and 103 (27.3%) using unwaxed floss. A total of 192 (50.9%) participants reported interdental brushing, and 196 (52.0%) experienced gum bleeding when using an interdental cleansing device. Awareness of tooth decay causes was reported by 171 (45.4%) participants, 189 (50.1%) cleaned their teeth after eating sweets, and 198 (52.5%) did not follow their dentist’s advice, with 189 (50.1%) not having learned brushing techniques from a dentist.

Table 2.

Variable	Response	n (%)
Health of Teeth and Gums	Bad	134 (35.5)
	Good	117 (31.0)
	Not sure	126 (33.4)
Necessary to Maintain Oral Health	No	188 (49.9)
	Yes	189 (50.1)
Bad Breath	No	127 (33.7)
	Not sure	121 (32.1)
	Yes	129 (34.2)
Teeth Discoloration	No	190 (50.4)
	Yes	187 (49.6)
Aware of Tooth Decay Causes	No	206 (54.6)
	Yes	171 (45.4)
Follows the dentist's Advice	No	198 (52.5)
	Yes	179 (47.5)

4. DISCUSSION

This investigation gives insights from 377 patients at King Abdulaziz University Dental Hospital who were assessed and received the proposed interdental cleansing

device (US 11,179,230 B1). This study demonstrates that utilizing an advanced dental tool can aid in maintaining good oral hygiene. However, it is essential to acknowledge that the findings are based on individuals' personal experiences, rather than clinical tests of the device's performance. Although participants' feedback suggests that the products were very effective, these results should be confirmed by clinical trials that measure plaque levels, gum health, and the reduction in the risk of tooth decay. As a result of this drawback, we see that user experiences tell us about adoption, but we should rely on clinical research to demonstrate a product’s efficacy.

Participants reported that the interdental cleaning device was effective in helping to maintain their oral health. Studies have shown that interdental brushes and water flossers are more effective than regular floss in removing plaque and improving gum health. A review of studies by Kotsakis et al. [17] showed that using interdental brushes was much more successful at removing plaque between teeth than floss, mainly because of their ability to sweep away plaque in people with broader gaps in the back of their mouth. In addition, a review by Worthington et al. [18] concluded that liquid flossers worked better than string floss to control gingival bleeding, probably because liquid flosses are simpler to use and can go deeper between the teeth, aligning with these findings our results indicated that participants experienced significant ease of use and comfort with the prototype, suggesting that it may offer ergonomic benefits comparable to those observed with alternative tools. The fact that many people prefer this device represents an important insight that user-friendly design tactics, such as adjustable trays and the integration of upper and lower flossing, may resolve the primary issues with interdental cleaning. Since flossing can depend on good hand movement and requires a lot of time, it is often skipped by individuals who find it too difficult. The way the device is made, according to the patent [16], helps overcome these problems by automating flossing and fitting it to each person’s unique teeth and gums. This aligns with the findings of Ng and Lim [14], who suggest that using high-quality interdental tools helps individuals maintain good oral hygiene. Many people in the current study agreed that the interdental cleaning device was faster and more pleasant than regular dental floss, suggesting it could encourage them to maintain the habit long term, a key factor in preserving oral health. A similar study reported that an interdental brush was easier to use than daily flossing [19]. The study revealed an unexpected finding: age, gender, and education levels were not correlated with acceptance of the device. However, the high acceptance rate indicates that many people appreciated its design. This is significant because it contrasts with many other studies, which suggest that increased knowledge and information facilitate the adoption of new oral care methods for certain individuals [12]. This study suggests that improving understanding and educating individuals can encourage them to engage in and promote interdental cleaning. The knowledge gaps regarding tooth decay and inconsistent adherence to oral health advice indicate that participants lacked sufficient knowledge about dental hygiene. These findings align with those of Chipre and Shah [11] and Vandana et al. [20], who noted that a lack of knowledge about interdental aids often prevents their use and leads to poorer oral hygiene. Dental experts can help bridge this gap by explaining the purpose of interdental cleaning and demonstrating the correct techniques for practicing it. According to a study by Worthington et al. [18], guidance from dental professionals significantly increased the number of patients with periodontal disease who began using interdental brushes. Adding the interdental cleansing device to routine dental visits may also increase patient willingness and compliance. Furthermore, the study results clarify the broader impact of interdental cleaning on oral health. Proper care of interdental spaces may reduce the chances of developing cavities, periodontal disease, and potential tooth loss. According to Nakao et al. [21], a five-year follow-up study demonstrated that the use of interdental brushes significantly helped reduce tooth loss rates. Similarly, Marchesan et al. [22] found, using data from the National Health and Nutrition Examination Survey, that the use of interdental cleaning tools decreased the risk of caries and gum disease. The study's limitations restrict its ability to provide clinical outcomes, underscoring the need for future studies to evaluate the device's impact on plaque indices, gingival inflammation, and caries incidence. Traditional brushing cannot effectively clean the areas between teeth, unlike the device discussed here, which offers significant advantages. Barbe et al. [23] and Weik et al. [24] reported that brushing alone cannot completely remove the plaque between the teeth in patients with poor hygiene. It is important because plaque builds up most frequently between teeth, leading to gingivitis, periodontitis, and caries. According to the current studies, respondents reported that the device removed interproximal plaque, which agrees with findings highlighting the advantages of using interdental tools. A study, conducted by Slot et al. [25], showed that interdental brushes were twice as effective as brushing alone in reducing interproximal plaque

The findings indicate significant concerns that may impact public health intervention initiatives. While the interdental cleansing device has gained widespread acceptance, its market potential remains promising. However, challenges related to high costs, limited purchasing options, and low consumer awareness must be addressed to facilitate broader adoption. Graziani et al. [26] demonstrated that advanced oral cleaning tools are often prohibitively expensive for most consumers in low-income groups. This problem can be resolved through public health initiatives that raise awareness of more affordable devices or help support the development of new ones like this. Community oral health programs may be strengthened by adopting these new tools.

This study provides knowledge about the perceptions and acceptance of the innovative interdental cleansing device. However, several limitations must be taken into account. Since participants recorded their oral hygiene habits, opinions, and experiences of the tool via self-reported information using an online questionnaire, there is a greater likelihood of self-reporting bias, which can result from both overreporting and underreporting. This may affect the reported validity of acceptance and efficacy. Additionally, non-response bias may have occurred because the survey was voluntary and conducted among patients visiting King Abdulaziz University Dental Hospital. The results may have been skewed toward more positive perceptions, as individuals who declined to respond may have systematically differed from those who did in terms of their degree of interest in oral hygiene or familiarity with interdental devices.

Furthermore, since participants’ excitement about the new device may have inflated these results, it is not possible to definitively link the observed benefits to the device without a control group of people who cleaned their interdental spaces solely with conventional dental floss or interdental brushes. The single-site design in Jeddah, Saudi Arabia, also limits generalizability, as the participant group may not accurately represent larger populations with varying geographic, cultural, or sociological contexts, despite diversity in terms of age, gender, and education. In turn, this may negatively impact device usage in other locations. The sampling technique and sample size may also have introduced selection bias, as these patients are likely more engaged in oral health practices than the general population. Moreover, the cross-sectional design only assessed opinions from brief interactions with the device under a dentist's supervision. Thus, the reported opinions primarily reflect initial impressions of adoption while excluding subsequent effects on sustained effectiveness, long-term use, and adherence. These outcomes may ultimately affect adoption rates due to factors such as cost, ease of integration into daily routines, and durability. Previous studies [8] reported that device customization based on dental impressions, as described in US 11,179,230 B1, may raise accessibility problems in terms of cost and availability, particularly for individuals with physical limitations or limited dexterity. This study did not address these issues. These limitations suggest that further research should incorporate control groups, longitudinal designs, multiple population groups, and strategies for addressing self-reporting and non-response biases, such as the use of objective measures and participation incentives. Such studies are necessary to validate and demonstrate these findings.

CONCLUSION

In conclusion, this study demonstrates that a substantial number of individuals appreciate the unique interdental cleansing device, underscoring its potential to improve the comfort, efficiency, and effectiveness of dental care. The findings underscore the importance of user-centered design and the necessity of professional guidance in advancing interdental cleaning practices. However, it is important to approach these results with caution, as the study relies on self-reported data. Further clinical research is needed to comprehensively evaluate the device's performance. The insights gained from this investigation can inform dental practices, drive product development, and support public health initiatives aimed at promoting the adoption of modern oral hygiene products.

REFERENCES