The Importance of Flossing

“Do I actually have to floss every day?”

“Does it really matter if I floss before or after brushing?”

These are examples of things I hear in my practice fairly often, and things many of us have probably heard or said at some point. I hope to be able to give you a no-nonsense explanation of the merits of flossing. Let’s break this down, but first, I’m going to offer an understanding about the difference between modern-day research and the largely evolutionary act of flossing.

It has been claimed that flossing lacks adequate evidence to prove its beneficial effects. Part of this is true, in that there is a lack of formal research, however there is not a lack of physical results. In this void of data, an otherwise automatic practice for oral hygiene can receive skepticism.

The technique of flossing has traditionally been self-explanatory, and practiced as a biological urge, not unlike scratching an itch or removing a thorn from the skin. Food stuck between teeth is irritating. It is possible that dentists and researchers never felt the need to publish data on a behavior that is similar to a natural reflex.

Interestingly, the validity of flossing may have been verified in a secondhand manner. Medically, every person has a different oral environment. Cavities can be influenced somewhat by genetics (in a very small amount, likely too small to cause an effect), such as through the composition of one’s saliva. This is because saliva has varying components that can offset the effects of plaque. Cavity-causing bacteria release by-products that cause saliva to become more acidic, leaching minerals from the teeth. This leaching of minerals eventually leads to the tooth surface becoming soft, weak, and breaking into an open cavity—a dental cavity. Compound salivary quality with added challenges such as food with sugar or carbohydrates, deep grooves on teeth, or any other challenge that makes it harder for teeth to stay clean, and problems ensue. The majority of people will not need to worry about genetics so long as correct daily oral hygiene is practiced.

A toothbrush is not capable of removing all plaque. Specifically, It is not typically able to remove the plaque from areas in between teeth, or on the back surface of a tooth in the very back of the mouth. Brushing without flossing is like using hand sanitizer without rubbing your fingers between each other. You don’t want your hands or teeth to be half-sanitized. And using mouthwash isn’t going to cut it because neither mouthwash or toothpaste penetrates through plaque layers. The plaque must be physically removed first.

It should be emphasized that flossing before brushing is essential, or toothpaste and mouthwash will also not penetrate through any food wedged between the teeth. What more, flossing up and down once and then moving to the next area is not enough. Think of the floss as a literal way to brush the surfaces of your teeth where the bristles of a toothbrush can’t go. These surfaces need to be brushed as much as one would with a regular toothbrush. Several times per surface is much more desirable to fully remove plaque layers.

Something to also consider when choosing to floss is the effect flossing has on gum health. Built-up plaque will migrate into the gums and allow bacteria to flourish if not removed. This bacteria once again releases acid, which affects the gums by causing them to detach from the tooth over time, and the bone around the affected teeth to recede. This results in the formation of calculus and deep periodontal pockets, which can’t be cleaned with normal home care or regular hygiene appointments. Continued bone loss around the teeth will eventually cause the teeth to be lost. Without flossing, periodontal disease can manifest, and a person will be dependent on continuous advanced professional cleanings to keep their teeth and gums stable for the rest of their life.

A common option today is to use flossing appliances that serve as an alternative to traditional manual flossing. If a person cannot be brought to use dental floss to clean their teeth, these are acceptable options. In my experience, they serve best for debilitated people who are unable to floss their teeth on their own. The water removes the gross debris from between the teeth, and some plaque, but some layers will remain.  Between traditional manual floss, and specialized brush piks that exist to go between teeth, nothing in my experience equates to the result traditional flossing has on a person’s gum health.

For diabetics, gum disease can progress much faster, and flossing is even more essential. For people with dental restorations, especially bonded (non-metal) restorations, optimal oral health is incredibly important, and failure to consistently floss can lead to the premature failure of the dental work.

Ultimately, damage in some form will occur if floss is not used. In my opinion, flossing is the other 50% of brushing. Therefore, if a person relies on brushing alone, they are only doing about 50% of the work. By flossing and brushing in a diligent manner, oral health can have its best chance of being maintained, and a person can enjoy the many benefits that come from healthy teeth and a happy smile.