Oral not as a substitute.[12] Toothbrushes with dentifrice are

Oral health is integral to general health and has often been referred
as a mirror to general health.1,2} A perfect general health is
incomplete without perfect oral health. According to the World Health
Organization, oral health is “a state of being free from mouth and facial pain,
oral and throat cancer, oral infection and sores, periodontal (gum) disease,
tooth decay, tooth loss, and other diseases and disorders that limit an
individual’s capacity in biting, chewing, smiling, speaking, and psychosocial
wellbeing”.3 Dental caries and periodontal disease are most common
oral diseases and are prevalent universally.4 People are
vulnerable to dental caries and periodontal disease all through their lifetime.

Although, multifactorial etiology of dental caries and periodontal
disease is known they are primarily initiated by dental plaque.5 It
is calculated that about 1 cubic millimeter of dental plaque contains
approximately 200 million bacteria.6 Dental plaque might contain
cariogenic bacteria which can ferment dietary carbohydrate to produce acid
precipitate leading to demineralization of tooth structure and cavity
formation.7 The bacterial plaque on tooth surface adjacent to
gingiva or gingival crevice can irritate the soft tissue leading to gingivitis.8
The inflammation sometimes penetrates into deeper tissues resulting in
destruction of supporting connective tissues and alveolar bone called
periodontitis. Periodontitis may further progress in severity leading to pain,
discomfort, difficulty in chewing, tooth mobility and eventually tooth loss.9 

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Dental plaque control is viewed as the most effective method of
preventing periodontal diseases since it addresses the underlying etiology i.e.
pathogenic microflora on the tooth surfaces. Evidences suggest that meticulous
plaque control can prevent gingivitis and periodontitis in both children and
adults.10,11  Plaque control
methods can be classified as either mechanical or chemical methods which are
used as self-care, or procedures professionally done by dentists or dental
hygienists. Until now mechanical plaque control seems to the most dependable
form of plaque control method. Chemical plaque control has been used only as an
adjunct to mechanical means and not as a substitute.12  

Toothbrushes with dentifrice are the most widely used method of
self-performed mechanical plaque control. Recently, powered toothbrushes are
gaining popularity but there is no substantial evidence regarding superiority
of powered over mechanical tooth brushing. The effectiveness of toothbrush,
however, depends on the acquired dexterity skills of individual, frequency and
optimum time.13-16 Plaque removal exclusively by tooth brushing is
difficult in critical inter-dental areas. Interproximal areas are found to be
more vulnerable for gingival inflammation than other tooth surfaces.17
Several inter-dental cleaning aids have been developed and are available like dental
floss, toothpick, uni-tufted and proxa brush. These interdental cleaning aids
needs some amount of training and are not recommended for all patients. Irrigation
devices are other oral hygiene aids developed to further improve the effect of
tooth brushing on reducing interdental plaque.18 Chlorhexidine gluconate
at 0.2% has been considered as gold standard among chemical plaque control
agents.19 Some investigators have reported
promising results following the use of Chlorhexidine with oral irrigation

It is assumed that oral hygiene aids other than toothbrush are not
very popular among general public. The appropriate use of interdental aids is
directly related to prescription practices by the dentist. Limited prescription
of other oral hygiene aids could be due to trivializing maintenance phase of periodontal
treatment or lack of adequate knowledge among dental practitioners. Such
prescription practices can be assumed to be generally carried by dental
students to their future practice outside school. There is lack of information
on usage and awareness of interdental oral hygiene aids among dental students
in Saudi Arabia. The objective of this study was to assess the knowledge
regarding use of oral hygiene aids among dental students in Saudi Arabia.