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All About Flossing

10th August 2016

Patients often ask me if flossing is really necessary, and do they have to floss every day? The answer to both is a definite YES! Our mouths are full of bacteria, which starts to form Dental Plaque as soon as we have brushed our teeth. Bacteria thrive in a warm, dark and moist environment, like the mouth, and the spaces in between the teeth are like little pockets where they can remain hidden. The gum naturally forms a crevice around the neck of the tooth which is why when we brush we should aim the bristles at 45 degrees into the gums in order for the bristles to penetrate this crevice.

In between the teeth there is the same crevice but the bristles of the toothbrush don’t quite reach. I once heard a Periodontist (Dentist further trained to treat severe Gum Disease) refer to this condition as Interdental Disease because it often starts in between the teeth. Gum Disease is the body’s reaction to specific pathogenic Bacteria, causing inflammation and destruction of the supporting tissues around the teeth. This can eventually lead to tooth mobility and eventual loss if not treated correctly. The main treatment for this condition is the Patient’s own Oral Hygiene regime and we as a profession can’t emphasise the need for good oral hygiene enough in the prevention of Dental Disease. A lack of flossing can also increase the risk of the other Dental Disease to affect the population, Dental Caries (Tooth Decay). The aim of interdental cleaning is to remove bacteria from under the gumline between the teeth.

When you floss it is important to slide the floss carefully down the tooth towards the gum and carefully bring the floss about halfway down the triangle of gum in between the teeth on either side. So you wrap the floss around one tooth and slide it into the gum and back out a few times then you repeat the process for the adjacent tooth and so on around the mouth. I tend to advise this is done before brushing and once a day, preferably in the evening. Once you have then brushed your teeth spit out the excess toothpaste and leave the residue in the mouth, this will help a little more in protecting the teeth.

Other options

Interdental brushes are very useful particularly when the gaps between the teeth at the gumline are larger than normal either due to previous gum disease, tooth loss, gum recession or just movement of the teeth. They are colour coded and come in different sizes depending on the gap. The brush should fit snugly in between the teeth touching both sides but sliding through with relative ease. They are also great for patients with fixed retainers after Orthodontic treatment and those patients whose manual dexterity is challenged. The aim of these brushes is to brush the gum between the teeth not to go up and down the side of the tooth. The brush is carefully pushed through between the teeth at the gumline.

Interdental sticks do much the same job but less efficiently depending on the product. The woodsticks do not remove the bacteria but do remove any food debris pretty well, although they can splinter and get stuck between the tooth and the gum which is why I do not recommend woodsticks. There are many softer sticks with fine bristles which are in some cases easier to manage and by far a better option.

Floss picks are great to teach the technique of flossing and for patients with difficult to access mouths as they are a piece of floss loaded in a carrier which fits into the mouth easily without patients trying to reach their fingers to the back of their mouth. Patients who have a sensitive gag reflex may find these better to use.

Water flossers have their place but in my opinion are last resorts as they seem to be less effective in plaque removal than physically disturbing the bacteria. I tend to recommend them to patients again whose manual dexterity is not very good and if we have tried other alternatives first. However, I have seen a few patients who use the water flosser and have immaculate Oral Hygiene and I would not recommend a change in these circumstances.

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