Dr. Saumitra Saravana
To Floss or Not to Floss
We all know how annoying it is to have something stuck in between our teeth and since ancient times, we have used some aids to clean in between our teeth. Around 1815 or so, Levi Spear Palmer, a Dentist started to recommend using silk threads to clean in between the teeth. This idea caught on and was patented by Johnson and Johnson who started to market what we now know as Dental floss. Although, we are not sure why they called it “Floss”. Over the years, dental floss changed from being made out of silk thread to nylon and then to material more resistant to shredding like Goretex. Nowadays, floss like Oral B "Glide" floss have made it really easy for the floss to "glide" in between the teeth. However truth be told, flossing is not very popular among people. Daily flossing in a NHANES survey over a span of 3 years showed only 31% of adults flossing. In reality this number is much lower and its is probably only 20 % of people who floss every day.(J Clinical Perio 33, 612-619, 2006) In another study, where subjects were told that they would be monitoring their Oral Hygiene routine, less than 50% of the subjects actually flossed and only a few of those actually flossed the right way! (Winterfeld, T Et al 2015).
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So flossing is not one of our favorite things to do. In the ‘Today’ show segment on flossing, the news anchors report lying to their Oral health providers about flossing! Then there is this article that flossing done wrong can cause more damage to teeth than not flossing!
It's all very confusing and what does one do?
Firstly, is flossing done the right way the best way to clean in between our teeth? The strict answer is no but there is a lot of nuance to it. In a major article Salzer et al (J Clin Perio 2015) researchers found interdental brushes to be more effective. They found Wooden sticks, Oral Irrigators and Interdental brushes more effective in cleaning the in between areas on your teeth. This research article might lead you to think that flossing should be abandoned in favor of other interdental aides.
This is our take on this whole controversy.
Gum disease starts off in the areas of your gums that are found in between the teeth. The gum tissue in these areas are generally thinner and can be easily infected by bacteria found in plaque. If your teeth are very close to each other then, floss is the only thing probably fitting in there and possibly the best way to clean this area.
If you can fit a Interdental aide like the ones made by the Tepe Company or "Soft Picks" made by the Gum Company this could be a great alternative to a traditional flossing method. If you have large gaps between your teeth then flossing possibly might not be the right way to clean your teeth but something like a "Proxabrush" made by the Gum Company be a good aide. In addition to these aids, the "Water Flosser" by the Water Pik company is also a great aide in helping keeping the interdental areas clean. In many studies it was found to be a good alternative to other interdental aides and a better approach than using medicated mouth rinses. This makes sense as the medication has no way to get in between our teeth when we are simply rinsing with the mouth rinse.
Finally, there are newer aides called the "Air Floss" by Sonicare. In my opinion, it might be a good tool for patients who do not have sensitive teeth or gums, however I would recommend using the water flossing aides as a better alternative.
So over the past few decades, Oral Health providers have been saying, "Brush, Floss, Rinse", it is probably more important to think about cleaning the in between areas of your teeth first.
Possibly with floss or one of the other aides that may work better than a floss in your case. So, come in for a check and we can go over your customized oral hygiene routine for you!