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By Dr. David Leader
Imagine a black and white checkerboard kitchen floor. Down on your knees, you carefully clean all of the white tiles. Standing back, the floor shines, the sun glinting off the pearly white tiles. Yet, you know the floor is not clean. When you brush carefully and do not floss, you know that the same is true of your teeth.
Flossing is the standard of care for cleaning between teeth. Manufacturers offer many devices and medicaments that clean between teeth. For example, some companies advertise toothbrushes with special bristles to clean better between teeth. Recently, Listerine produced a short-lived advertising campaign quoting in-house research that demonstrates that rinsing is as effective as flossing. While many products compare to the action and effect of flossing, not one matches the effect of floss.
The correct flossing technique involves wrapping a long piece of floss around the middle finger of each hand. Index fingers and thumbs guide the floss between the teeth and even behind the very last teeth. Scrape the floss up and down against the sides of the teeth and gently under the gum. That way, floss will remove plaque, the coating of bacteria that forms on the teeth and causes cavities and gum disease.
If flossing is not a habit, the gums will usually bleed the first several times. That is because plaque forms sores inside the gum pockets around the teeth. After a week or two, the bleeding will cease. If bleeding continues, speak with your dentist.
For the many kinds of people and teeth, there are many kinds of floss. Some people have trouble getting floss to slide easily between their teeth. This is a good thing. Tight contacts between teeth prevent food from becoming stuck. Dentists often recommend waxed dental floss; wax lubricates the floss to allow it to slide more easily between the teeth.
Another strategy is to make floss that is thinner and stronger. Proctor & Gamble manufactures Glide floss from Gore Tex fibers. Glide is very thin and slippery. Glide slides between teeth more easily than most other brands of floss. However, some find it to be uncomfortable to hold as it cuts tightly into the skin.
Some companies manufacture wider floss for use between teeth with wider spaces. The larger dental floss or dental tape cleans teeth more efficiently than regular or thin floss. For teeth even more widely spaced, dentists recommend using thin, acrylic yarn.
A new trend is to add abrasives or medicaments to floss such as tea tree oil to help treat gingivitis or silica to help whiten teeth. While this trend does not translate into more recommendations from the dental community, it does afford the floss manufacturers more shelf space in the dental aisle at the market.
Some patients are not able to hold floss due to arthritis, muscle, or skin ailments. Dental professionals introduce those patients to floss holders. A floss holder is a fork made of the same material as a toothbrush handle. The user wraps the floss around the fork and can clean between their teeth using this device. The J. Butler Company makes the Flossbrush that includes a supply of floss within its handle. Oral B makes a powered device that they call the Hummingbird that works the same way using preloaded, disposable floss holders in a vibrating handle. Both of these devices are easy to use and work well.
Bridgework and braces makes flossing between teeth more difficult. Dentists and dental hygienists recommend the use of floss threaders, plastic needle like devices, to pass floss between teeth that are connected together. Floss threaders are easy to find near the toothbrushes in pharmacies and grocery stores or online.
The proper use of floss threaders demands excellent fine muscle control. For that reason, some patients find flossing joined teeth to be difficult or impossible. There are devices that make this task easier. Small brushes clean between teeth very effectively. Proxabrush, by Butler, is the brand that most dentists think of; OralB makes a similar product that they call the Interdental Brush System.
Another kind of interdental cleaner for bridgework and braces is a mechanical pick that rotates or vibrates a brush or pick between the teeth. The OralB Hummingbird has optional picks. Waterpik makes the Power Flosser. These devices are not a replacement for floss, but are useful for people who cannot handle floss or take the time every day to floss around dental devices.
Toothpicks have been used to clean between teeth since prehistoric times. Some people are able to clean with toothpicks as well as others use floss. This is not easy to do. There is a particular way to clean bacterial plaque from teeth with a toothpick. Hold the toothpick perpendicular to the tooth and gently scrape the pocket in the gum around the tooth. Be very gentle.
The most important dental care your teeth get is the care you give them. Do not leave your teeth half clean. Speak with your dental team about the best way for you to clean between your teeth. Ask them to show you how. It will make their day.
Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.