Dental floss: why it’s so important
Uh-oh… Time for your dental cleaning and bi-yearly scolding from your dentist for not flossing enough (or at all). If you’re like most people, you probably floss very irregularly. Definitely not every day… Once or twice a week? Actually, probably mostly in the days or hours leading up to your 6-month cleaning at the dentist… And as usual, your dentist always knows.
Good news -- if you’re the person I’m describing above, you have a lot of room for improvement on your oral hygiene habits. You can improve your overall oral health like you’ve never done before. No more bleeding gums, less sensitivity when you go get your cleaning, and no more getting shamed by your hygienist. How, you ask? FLOSSING!
Before we start, we’ll be the first to admit that clinical studies conducted on flossing have shown modest benefits (at best) from flossing AND brushing versus the benefits of brushing alone. Does that mean flossing isn’t important or doesn’t work? No. The problem with drawing conclusions from those studies:
Many of those studies haven’t followed patients for a long enough period of time
Many of those studies don’t include enough people in their population sample
Many studies take the patient at their word that they’re flossing correctly and as often as they are supposed to
If you let yourself believe that flossing doesn’t do anything, then let’s put it to the test: next time you see your dentist, see if they can tell you whether or not you floss regularly. If flossing really makes no difference, they would have a 50/50 chance at guessing whether or not you do it regularly. We can almost guarantee, though, that they’ll be able to tell you without hesitation if you floss regularly, irregularly, or never. Yes, it’s that obvious.
Now, without further ado…
This article has a few main objectives:
Explain why flossing is important
Explain the difference between plaque and calculus
Show you some examples of what happens when you don’t floss (and how your dentist knows you don’t do it enough…)
Show you how to floss the right way
Why is flossing important?
The purpose of flossing is to assist your toothbrushing to thoroughly clean all the surfaces of your teeth. We want all the surfaces clean – the outsides, insides, and in-betweens – to prevent the buildup of plaque and calculus. This keeps breath fresh, reduces unhealthy inflammation, and reduces our risk of developing cavities and gum disease.
One of the best examples we’ve come across: imagine brushing your teeth as brushing corn-on-the-cob. Visualize all the spaces in-between the individual kernels. Those are the spaced between your teeth.
No matter how well you brush — whether a manual toothbrush or electric — you’ll never be able to sufficiently clean those in-between crevices and spaces unless you can get something in between them.
Imagine all that gunk in-between the kernels is plaque and calculus… Can you visualize how floss might help?
What is plaque?
Dental plaque is a thin, sticky film that usually builds up along the gumline of your teeth. It’s usually either whitish or transparent, and is made up of sugars and bacteria. If you’ve ever skipped brushing at night, you will have noticed this thin, sticky substance on your teeth in the morning.
Gingivitis (or gum inflammation), presents as red, puffy, swollen gums. These gums most likely bleed when brushing or flossing. Notice the plaque along the gumline.
Once plaque attaches to your teeth, unless it’s removed by brushing and flossing, it begins to grow and mature. As more bacteria accumulate, acids begin to be produced as the bacteria break down and consume sugars. These acids cause:
Inflammation of the gums, causing them to get red and swollen/puffy; this is known as gingivitis. Inflamed gums may be tender to touch, bleed when brushing or flossing, or be overly sensitive at your dental cleaning appointment.
Erosion of the outer enamel layer of your tooth, which is how cavities start.
Acid erosion on the outside surfaces of teeth. This is from the buildup of plaque on the outside, or “facial”, surfaces that are able to be brushed. Now imagine what is happening in between the teeth if that plaque is not removed…
What is calculus (tartar)?
Notice the hard, yellowish calculus along the gumline and in-between the teeth.
The longer plaque sticks around without being removed, the more likely that it will begin to calcify into calculus (aka “tartar”). Essentially, the soft plaque picks up minerals in the saliva and begins to harden. That new hardened substance, calculus, can no longer be easily removed with a toothbrush or floss. This requires removal with professional instruments at a dental office.
The problem with calculus:
This rough, hardened substance becomes a magnet for additional sugars, bacteria, and debris, building up faster and faster over time
As more bacteria is trapped in the growing calculus, the more likely they release bad odors…
The acids released by calculus damage the gums and their attachment to your teeth, leading to more inflammation, subsequent “pockets”, and eventual bone loss, which will then trap even more bacteria and debris – a snowball effect…
This illustration shows the sequence of events leading to periodontitis (gingival inflammation PLUS bone loss). When pockets form and are allowed to persist, periodontal disease progresses quickly.
Comparison of what a healthy tooth and surrounding gums look like versus a tooth surrounded by unhealthy gums looks like. Notice the reddish gums on the unhealthy side (compared to healthy pink) accompanied by a deep pocket.
When the condition of the gums progresses from inflammation only, usually caused by plaque, to inflammation PLUS bone loss, it changes from gingivitis to periodontitis (periodontal disease). This is usually the stage where your dentist or dental hygienist may begin to talk to you about a deep cleaning (more on this in a separate article).
Why brushing alone is not enough
Now that we’ve established what we are attempting to prevent with flossing (the accumulation of plaque, which leads to calculus), lets show you why brushing alone is not enough.
The areas in the picture are called “interproximal contacts”, or just “contacts”. The bristles of your toothbrush, whether it’s manual or electric, and even for the very best brushers, will not reach these areas. Remember the picture of the corn-on-the-cob (above)? Cleaning in-between those kernels would be the equivalent of cleaning in-between those interproximal contacts of teeth.
When you leave plaque in the “in-between” areas, the acids produced there form smooth surface cavities and gum disease, as seen in the pictures above, as well as interproximal calculus. The simple act of passing floss through these areas and scraping/scrubbing those contacts will prevent plaque from persisting there. This will prevent two things:
Prevent the plaque from releasing acids there and subsequently forming cavities and causing gum disease
Prevent the plaque from hardening and turning into calculus there, subsequently creating pockets and bone loss (periodontal disease)
How your dentist knows you don’t floss
There are several signs of improper cleaning between teeth, some of which are detectable during a routine oral exam, even without x-rays, and others that are diagnosed easily with the help of x-rays.
Signs of no flossing that can be seen without x-rays:
Bleeding, puffy gums
Deep pockets in your gums (periodontal pocket)
Large, obvious cavities in-between teeth
Signs of no flossing that are detectable on x-rays:
Calculus formation between teeth
Cavities between teeth that aren’t large or obvious to the naked eye
Bone loss in the presence of deep pockets (your dentist will probably notice the deep pockets first, then confirm the finding with x-rays, or vice versa)
See the images below for examples of what your dentist might see on an x-ray if you don’t floss regularly.
The little white triangles in-between teeth are calculus accumulations. This causes chronic inflammation and bone loss over time.
The arrows are pointing at inter-proximal cavities, which present as small, dark triangles between teeth. When they are on two teeth that are touching together, they’re called “kissing lesions”.
How to floss (the right way)
Below are links to videos explaining how to floss using different methods. While most dentists will recommend traditional string floss for most patients, some of the other tools you will see below, such as floss picks or water flossers (oral irrigators), might be beneficial to use as a replacement or additional tool. As your dentist for more information.
Thanks for reading! To review any questions you might have, feel free to send us a message! You can expect a response within 24-48 hours.
