Flossing

Flossing

Summary

Flossing is a process that helps remove dental plaque from areas that a toothbrush cannot reach, such as between teeth and under the gums. This helps prevent tooth decay and gum disease. The American Dental Association (ADA) recommends that people floss their teeth at least once daily in addition to brushing twice daily.

In addition to removing plaque, flossing helps to remove food debris from between teeth and gums, polish tooth surfaces and control bad breath (halitosis). Experts recommend establishing a regular time for flossing and following a consistent pattern. There are two major techniques used to floss – the spool method and the loop method.

The spool method involves wrapping one end of the dental floss around each middle finger and using the index fingers and thumb to hold the floss tightly as it is guided between the teeth in an up-and-down fashion. The loop method involves tying the ends of the floss into a circle and placing all the fingers (but not the thumb) inside the loop. The index fingers guide the floss through the lower teeth, and the thumbs guide the floss through the upper teeth.

With both methods, the purpose is to remove plaque by scraping the tooth surface while also guiding the floss between the tooth and gum to clean below the gumline. This should be done with care because snapping the floss into the gums can injure them.

Dental floss is available in either unwaxed or waxed form. In addition, it is available in flavored or unflavored and wide and regular varieties. Studies have found that all types of floss are about equally effective in removing plaque.

About flossing

Flossing is an essential part of removing the dental plaque between teeth that can lead to tooth decay and gum disease. It helps clean areas of the teeth that a toothbrush cannot reach, and also cleans debris from below the gumline. Flossing can be performed either before or after brushing the teeth. Everyone should floss at least once a day in addition to brushing twice daily, according to the American Dental Association (ADA). Some studies suggest that flossing twice per day may be more beneficial than flossing only once daily. A child’s teeth need to be flossed once the child develops teeth that touch.

Many people think flossing is intended to remove the debris from between a person’s teeth. However, the main purpose of flossing is to remove plaque by scraping the tooth surface. Plaque is the substance formed when bacteria occurring naturally in the mouth combine with food debris, saliva and acid. In addition to removing plaque, flossing helps remove food debris from teeth and gums, polish tooth surfaces and control bad breath (halitosis).

During flossing, it is important to clean below the gumline. However, this should be done with care. Never snap the dental floss into the gums because this can cause injury. People who are flossing for the first time or after a prolonged period of not flossing often bleed from the gums and may experience soreness for a few days. This is normal, and it usually stops after flossing removes all the accumulated bacteria. If soreness continues for more than six days, the patient should consult a dentist.

Dental floss is available in either unwaxed or waxed form. Studies have found that all types of floss are about equally effective at removing plaque, and that patient preference should dictate which form of floss is used. Unwaxed dental floss provides more friction for cleaning, and because the floss is thinner it tends to slip between the teeth more easily. Waxed floss tends to resist tearing and shredding better, especially when flossing through restorations or tight spaces between teeth.  

Other types of floss include polytetrafluoroethylene-type floss, dental tape or ribbon and braided nylon floss. In addition, dental floss is available in flavored or unflavored varieties and wide and regular types. Special floss threaders and types of floss are available for people with braces, who need to use particular types for thorough flossing. Interdental picks are also available to remove plaque between teeth, but may not provide as thorough cleansing.

People are urged to choose the floss that is most appropriate for them. For example, the wider floss, also called dental tape, is often used by people with bridges or people who have especially wide spaces (diastema) between their teeth. In some cases, patients may need to experiment with different types of flosses before finding the type that is appropriate for them. Some people with severe periodontal disease experience significant pain during flossing, and a dentist may recommend that certain patients use an irrigating device (water pick) instead of floss. Patients with braces may want to supplement flossing with water irrigation to ensure that all debris in tiny tooth recesses is thoroughly removed.

Most experts agree that manual flossing is the most effective method of removing plaque between teeth. Electric flossers are generally recommended only for people who have a disability or another factor that prevents them from flossing manually. Irrigating devices such as water picks do not remove plaque, although they may help clear the teeth of some food debris. In addition, the ADA continues to recommend daily flossing despite recent claims that some mouth rinses may be as effective as flossing at removing plaque.

It can take time to get used to flossing. However, people quickly become more proficient as they gain more experience. Children typically are able to floss without assistance by the time they reach the age of 10.

Flossing methods

Experts recommend establishing a regular time for flossing and following a consistent pattern. Scheduling a regular flossing time helps remind the patient to floss. In addition, using the same pattern will help keep the patient from forgetting to floss certain teeth.

There are two major techniques used to floss – the spool method and the loop method. In both methods, the goal is to scrape the side of the tooth and to gently slide the dental floss into the space between the gum and the tooth without cutting into the gum. It is also important to remember to scrape the back side of the rear teeth.

The major flossing techniques include:

  • Spool method (finger-wrap method). Cut a piece of floss that is between 18 and 20 inches (45 and 51 centimeters) long. Wrap one end of the floss around each middle finger and use the index fingers and thumb to hold the floss tightly as it is guided between the teeth in an up-and-down fashion. The floss should be brought below the gumline gently in a manner that forms a “C” on the side of each tooth. Stop when pressure against the tooth is felt and gently scrape the side of the tooth. This method should be repeated on every tooth, and a new area of floss should be used after one or two teeth.

  • Loop method (circle method). Cut a piece of floss that is 18 inches (45 centimeters) long and tie the ends to form a circle. Place all the fingers (but not the thumb) inside the loop. The index fingers guide the floss through the lower teeth, and the thumbs guide the floss through the upper teeth. As with the spool method, the floss should be brought below the gumline in a manner that forms a “C” on the side of each tooth. This flossing method may be easier for children than the spool technique.

People who are uncomfortable with these techniques can use tools such as a floss holder (double-pronged devices into which floss is threaded and held), floss threaders (a blunt-ended device that helps floss move through tight gaps or under orthodontic wires), or various brushes, picks or sticks. These tools also may be helpful to people just learning to floss, people who have limited dexterity in their hands or arms, and people who floss the teeth of others, such as children, the elderly and the disabled.

However, some of these tools can injure the gums if not used correctly. As a result, patients are urged to consult with a dentist about how to use them properly.

In some cases, a person may have to floss the teeth of other individuals, such as children, the elderly or the physically or mentally disabled. Before flossing the teeth of such individuals, try to reassure them that flossing is painless and explain each step of the process before performing it. Anxieties typically dissipate quickly as flossing becomes a predictable routine.

Questions for your doctor regarding flossing

Preparing questions in advance can help patients to have more meaningful discussions regarding their conditions. Patients or parents may wish to ask their dentist the following flossing-related questions:

  1. How often should I floss? More than once daily?
  2. What type of floss should I use? What are the pros and cons of the various types?
  3. What flossing method do you suggest?
  4. How will I know if I’m flossing correctly? Can you demonstrate for me?
  5. How will I know if bleeding gums require a visit to the dentist?
  6. Are there certain areas of my teeth that may be trouble spots and require extra flossing?
  7. How can I tell if I’ve gone too far under the gumline when flossing?
  8. Do you recommend using a tool such as a flossing holder or a prethreaded flosser?
  9. When should my child start flossing for himself/herself?
  10. Should I use a water pick in addition to flossing?
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