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Dentists often advise flossing regularly. But isn’t brushing your teeth twice a day enough? There are several misconceptions and queries that prevent people from flossing. Here we will discuss definitions of flossing, flossing technique, and the benefits of flossing.

Previous studies have revealed that about 20% of Americans never floss and only about 26% of men and 37% of women floss daily. Meanwhile the American Academy of Periodontology (AAP) recommends flossing daily. These low flossing rates are a concern as flossing promotes oral hygiene.

Flossing, also known as interdental cleaning, is an effective approach to improving dental and oral hygiene. Interdental cleaning can be done by other methods such as rubber tip stimulators, irrigating devices, or single-tufted brushes. Flossing is a recommended method to remove plaque on the teeth and prevent its build-up. It can remove up to 80% of interdental plaque when done regularly.

Biofilms produced from bacteria can trigger dental plaque. Flossing helps in removing these biofilms. Dental plaque can lead to serious damage such as bone loss around the tooth and subsequent loss of the tooth. In more severe conditions, plaque attached to the tooth structure can trigger periodontitis and chronic gingivitis. Gingival inflammation in the tissue around the tooth will cause severe pain. It is, therefore, crucial to use waxed or unwaxed dental floss on a regular basis. It is considered to be an effective effort to prevent caries, cavities, and other periodontal diseases.

A study assessed the association between flossing and the incidence of periodontitis in adults. The results show that flossing can reduce the prevalence of periodontitis in adults. The frequency of flossing 2 to 4 days a week is considered useful and effective for preventing dental and oral diseases.

However, when compared to brushing your teeth and gargling with mouthwash, flossing is less popular. Difficulty with flossing and lack of motivation are considered the main factors for flossing infrequently. Some individuals may not be aware of the right technique to floss.

Flossing is recommended in children too, and children may need help with flossing. Typically, children above the age of 10 years can floss by themselves.

Dental hygienists usually educate patients about flossing during preventative dental care visits. Done with the right method flossing can maximize its benefits.

Contact points and narrow gaps are difficult to reach and clean with a flossing thread. This may result in a low level of effectiveness in reducing gingival inflammation. However, flossing is still considered to have advantages for dental and oral health and has no harmful effects other than causing a trauma reaction to the soft tissues of the teeth.

Due to the difficulty of performing the correct flossing technique, a new, more ergonomic flossing yarn design was devised. Tying the ends of a conventional thread to form a loop is an innovation that is considered to increase effectiveness and compliance in flossing.

Some of the advantages of loop floss include simpler handling, more effective cleaning of dental gaps, and increased efficacy in eliminating plaque on the teeth.

A study compared the flossing technique using dental floss in a loop against using conventional dental floss. These two techniques are assessed against the periodontitis severity index. Compared to flossing using conventional floss, loop floss can reduce friction with the skin of the fingers, optimum over tension, rotate more flexibly, wider reach in the tooth gaps, and provide complete control when used to clean teeth.

The flossing technique using thread loops can be done as follows:

The flossing kit can be customized based on the preferences and habits of the patient to give adequate reach between the teeth.

The US Government's Dietary Guidelines for Americans released in 2010 had recommendations for various dietary practices to maintain oral health. One successful approach is a combination of several recommendations including brushing teeth, using dental floss, using products containing fluoride and reducing sugar or starch in your mouth.

Flossing requires an adequate level of dexterity. Therefore, not everyone can do it right. If flossing is done aggressively and excessively, it can cause abrasion, subgingival tooth fracture, and exposure to the dental pulp. A case study reported that inappropriate flossing techniques can lead to interproximal cervical lesions. This damage requires professional dental treatment including the extraction of the maxillary molars. Therefore, it is necessary to provide adequate education to patients in performing flossing techniques to maintain oral and dental hygiene.

The initial side effects of flossing such as mild gingival bleeding should also be monitored closely.

Visit your dentist for appropriate recommendations and information on dental flossing to optimize dental hygiene and prevent plaque and caries. Also, your dental hygienist can educate you further about the benefits of flossing and help you to master the right technique.

Flossing is an important additional part of dental and oral hygiene, yet not enough people do it on a daily basis.

Flossing can be done to clean food debris between the teeth that are difficult to reach by a toothbrush, and to optimize the elimination of plaque adhering to the interdental structures.

Using dental floss tied in a loop is an easier technique.

Speak to your dentist or oral hygienist about customized flossing kit.

Cepeda, M.S., Weinstein, R., Blacketer C., and Lynch, M.C. (2017). Association of Flossing/Inter-Dental Cleaning and Periodontitis in Adults. Journal of Clinical Periodontology.

Fleming, E.B., Nguyen, D., Afful, J., Carroll, M.D. and Woods, P.D. (2018). Prevalence of Daily Flossing among Adults by Selected Risk Factors for Periodontal Disease-United States, 2011-2014. Journal of Periodontology.

Hunt, I. and Ryatt, S. (2013). Aggressive Flossing. British Dental Journal.

Rutkowski, J.L. (2016). The Truth About Flossing. Journal of Oral Implantology.

Salas, M., McClellan, A.C., MacNeill, S.R., Satheesh, K.M., and Cobb, C.M. (2012). Interproximal Cervical Lesions Caused by Incorrect Flossing Technique. Int Journal Dental Hygiene.

Worthington, H.V., MacDonald, L., Poklepovic Pericic, T., Sambunjak, D., Johnson, T.M., Imai, P., and Clarkson, J.E. (2019). Home Use of Interdental Cleaning Devices, in Addition to Toothbrushing, for Preventing and Controlling Periodontal Diseases and Dental Caries. Cochrane Database Syst Review.

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