There’s nothing more demotivating at the dentist than being told you need to floss more. We’ve all been there, you try it, because you’ve been told you should. You start off with good intentions, but after a few days, messing about with that fiddly bit of string, making your gums sore, maybe making them bleed, you can’t really be bothered and you’re left asking yourself, do I really need to floss every day?
Short answer: yes, but that fiddly bit of string isn’t the only way to “floss”. When I say flossing, I mean any technique for cleaning between every tooth every day.
WHY WHY WHY?
Why? is always the most important question and I think not understanding why, is why nobody ever sticks to flossing long term. We dentists are great at telling everyone to floss, we’re not very good at explaining why you should do it. Wh
y would anybody go out of their way to do anything without good reason?
Flossing isn’t just about getting that bit of apple skin out from between your teeth. In fact, it’s pretty much only about one thing, plaque.
Plaque is the soft mushy yellow-white stuff that’s growing on all surfaces of your teeth all the time. It feeds on sugar, which is why your teeth sometimes feel furry after a sugary drink, that plaque is having a field day and multiplying. When you brush twice a day it’s to remove the bull if this plaque. Unfortunately, even the most expensive electric toothbrush in the world with “floss heads” doesn’t clean effectively between your teeth so plaque continues to build up here.
When plaque is left on a tooth and you eat something containing sugar, not only are you feeding the plaque, but the plaque creates acid and this is what starts to rot your teeth. The images on the left show some decay that started in between the teeth (top) and then the same decay left untreated, the tooth now needs much more complicated treatment (root canal treatment) in order to save it.
When the plaque is left around the gums, it causes inflammation, leading to sore gums and the start of gum disease. These gums bleeding easily when touched by a toothbrush or other cleaning aid (like floss), food, or even sometimes just on their own. Remember it’s the plaque that’s building up causing the irritation.
Why do my gums only bleed when I floss?
If you notice your gums bleeding only after you floss and not after brushing, it’s because brushing alone isn’t removing the plaque from between your teeth. The plaque missed when brushing builds up between the teeth, irritates the gums weakening them and so they bleed when you floss. Your brush simply doesn’t reach far enough between the teeth to clean the plaque of or knock the inflamed gums, so you don’t see the bleeding.
So anywhere where plaque is left, you run the risk of tooth decay or gum disease.
The solution then is simple, keep the plaque off.
Of course a hygienist can remove this plaque for you, but they’ll only clean it out once every three, six or twelve months. Plaque will start to build up again within 24 hours and then it’ll be months again before it’s removed, if you’re not cleaning it off yourself.
But won’t floss pull out all my fillings?
No! You should never be able to pull out a healthy filling or a healthy crown with floss. The forces that your teeth are subject to when eating or chewing are immeasurably greater than those you’ll put them under when flossing. If something falls out when you’re flossing, it was broken anyway and it’s much better coming out so we can see what’s going on and fix the problem. The one thing we know will cause a problem is the plaque that’s left by not flossing.
How to floss
You don’t have to use that long string of floss, to floss. When we say floss, what we really mean is cleaning between the teeth, every gap, every day, and there are quite a few different ways to do this.
The cheapest way to clean between your teeth is with normal dental floss, the stuff you get on a 25m spool. I actually prefer dental tape myself, tape, unlike the traditional round floss, is flat in cross section so it’s much thinner and so passes between your teeth much easier. The trick is to wrap the floss around your middle fingers so you’ve got a tight band of floss (not so tight that you’re cutting off the blood supply) with both index fingers and thumbs free to get it into the awkward to reach places at the back of your mouth. Securing it round your middle fingers stops it from slipping all over the place and you can reach the back of your mouth using just your index fingers rather than trying to fit two full fists in there.
A word of caution, in my experience, some brands of floss feel quite coarse between your teeth, if you get one you don’t like the feel of, don’t give up, maybe try a different brand. I find the Oral B satin tape in the picture the most pleasant to use (I have no affiliation with Oral B other than receiving the occasional bit of free toothpaste or a toothbrush).
Flossettes (Floss Harps)
Flossettes, as I like to call them, are short pieces of floss, usually on a plastic frame. Most people find these much easier to use and you can re-use them if they’re clean and in good condition, but they do tend to break after a few uses and they cost a bit more than traditional floss.
Another word of caution, sometimes these can get stuck in some gaps if you’ve got crowns or fillings with rough edges. Don’t panic, it’s simple enough to take a small pair of scissors and cut the floss and pull it through the gap. This isn’t a problem when using normal floss as you can just let go of one side of the floss and pull it through.
There’s a lot of research that suggests that interdental brushes are actually the most effective way to clean between your teeth. In my opinion, they’re not ideal for younger people with really healthy teeth and gums and no recession, or those with crowding (commonly between the lower front teeth). We regularly recommend TePe brushes (again, no affiliation) at Smiles in Tandem and it’s usually best to have an appointment with a hygienist to establish which size is the best for you. You may need a couple of different sizes for different areas of your mouth.
Water flossers such as the Waterpik are really popular with patients. They look a bit like an electric toothbrush with the sole purpose of squirting a jet of water (or mouthwash) between the teeth. They’re easy to use, just try to make sure you’re pointing it straight between the teeth and use it from inside to out as well as outside to in to make sure you’re flushing as much plaque out as possible.
This isn’t an exhaustive list, but it covers the most common and most effective options. Nobody can force you to floss, but as I said to my good friend who was arguing with me against flossing, “if you saw what I saw every day, you’d floss too!” Or there’s my first mentor in dentistry, Dr Speechley, who used to tell his patients that “you only need to floss the teeth you want to keep”.
Flossing isn't supposed to be an onerous task that we dentists nag you about every time you see us. The cleaner you can keep your teeth at home, the less likely you are to need any treatment. That's what we're after really, we're just trying to make sure you know how to minimise the chance of you needing fillings or having gum disease in the first place. Prevention is always better than the cure, after all.
Finally, a confession. I didn’t always used to floss. I made the same excuses that I’ve heard my patients make time and time again, “I don’t have the time”, “I forget” or “it makes my gums sore”. It took until about a year after I qualified as a dentist to really get into the habit of doing it every day. My trick for remembering to do it every day; keep the floss in front of your toothbrush. If you have to move the floss to get to your brush, it serves as a little reminder to do it. Now, I can really tell if I’ve not flossed, like I can if I’ve not brushed my teeth. They just don’t feel clean.
So give it a go and do forget to give us a call if you're struggling and we can get one of our wonderful hygienists to give you a hand.