Periodontology: The value of tooth and cocktail picks

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Sir, as a registered specialist in periodontology I concur that toothbrushing is probably the most important and common oral hygiene practice; however, it does not provide adequate interdental hygiene. Originally, dental woodsticks were advocated by the dental profession as 'gum massagers' to be used to massage inflamed gingival tissue in the interdental areas to reduce inflammation and encourage keratinisation of the gingival tissue.1

It has been shown that a triangular, pointed woodstick inserted interdentally can maintain a plaque-free region 2-3 mm subgingivally.2 For open interdental spaces, common among adults, woodsticks seem most appropriate.3 In periodontitis patients, the woodstick will depress the papilla which may help in recontouring the interdental tissues and consequently preclude the need for periodontal surgery.4 Woodsticks have the advantage of being easy to use and can be used anywhere.1

Round, pointed-end toothpicks or cocktail sticks are an undervalued resource in daily plaque control in the 45% of the population that are susceptible to chronic periodontitis. In the past ten years, I have found them to be effective during the treatment stages and in the maintenance phase in patients diagnosed with moderate/advanced periodontal disease, especially recalcitrant cases. The tip is ideally shaped for access to all root morphologies and most furcations. I have also found them to have the ideal profile for use around the circular emergence profile of dental abutments and dental implants.

In most cases patients have described to me that this was mento-physically less demanding than the other available interdental aids they had previously used. Having seen the success that these toothpicks achieved, I introduced their use in a YouTube video entitled 'Oral hygiene instructions with gum specialist Dr Hafeez Ahmed'. It frees up clinical time and offers the patient a resource for ongoing reminders and training.

So far, there are no high quality prospective studies on the round pointed end tooth pick or the cocktail stick to confirm that they are an effective interdental device in reducing the clinical parameters of plaque and gingival inflammation but I am hopeful that this letter might encourage this.


  1. 1

    Galgut P N . The need for interdental cleaning. Dent Health 1991; 30: 8–11.

  2. 2

    Morch T, Waerhaug J . Quantitative evaluation of the effect of toothbrushing and toothpicking. J Periodontol 1956; 27: 183–190.

  3. 3

    Axelsson P . Mechanical plaque control. In Lang N P, Karring T. Proceedings of the 1st European Workshop on Periodontology, Thurgau Switzerland. p 225. Quintessence, 1994.

  4. 4

    Bear P N, Morris M L . Textbook of periodontics. p 159. Philadelphia, USA: JB Lippincott Company, 1977.

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Ahmed, H. Periodontology: The value of tooth and cocktail picks. Br Dent J 220, 280 (2016) doi:10.1038/sj.bdj.2016.209

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