How to use dental floss, interdental brush and water floss?

This is the 4647th article of Da Yi Xiao Hu

As a dentist, whenever I talk about dental floss during oral hygiene education, I may hear different opinions:

"I brush my teeth twice a day and don't floss. Will flossing make the gaps between my teeth bigger?"

"I floss when I have food stuck in my teeth, but not otherwise."

"I tried using dental floss, but found it difficult to get between the teeth, so I stopped using it."

“Can I use dental floss instead?”

Let’s take a look at what dental floss does, why we use it, and the use of related products - interdental brushes and water floss.

Why floss?

Our teeth are arranged one by one in the shape of dental arches to perform their functions in the oral cavity. The inner, outer and occlusal surfaces of the dental arches can be cleaned when we brush our teeth, but the adjacent surfaces of two teeth are not exposed to the inner and outer sides of the dental arches and cannot be cleaned when brushing our teeth. Even if there is no obvious food residue stuck between the two teeth, dental plaque will adhere to the adjacent surfaces of the teeth. The root cause of most diseases that endanger the health of our teeth is dental plaque. The adjacent plaque between two teeth cannot be cleaned, and long-term accumulation will lead to interproximal caries. Interproximal caries in one area often destroys two adjacent teeth at the same time; interproximal plaque will form dental calculus after mineralization, which stimulates gingival inflammation. Over time, it develops into periodontal disease, which manifests as red and swollen gums, bleeding, gingival recession, and even loose and falling teeth in severe cases. Our teeth gradually narrow from the crown to the root. There is a gap at the contact point between the two teeth towards the gums, which is called the "gingival gap". In a healthy state, it is filled with gums. This part of the gums is called the "gingival papilla". After the gingival papilla recedes, the gingival gap is exposed, showing a "black triangle". The "black triangle" in the front teeth area often attracts people's attention because it affects the appearance. In addition to affecting the appearance, the "black triangle" is also prone to food impaction. In order to prevent interproximal caries and interproximal calculus formation, we need to use dental floss for interproximal cleaning. Clinical studies have shown that brushing teeth with dental floss can better control dental plaque and prevent oral diseases than brushing teeth alone.

Figure 1. Caries on the interproximal surfaces of anterior teeth

Figure 2 Gingival recession and black triangle

How to floss?

Taking rolled dental floss as an example, take a 30cm long dental floss, wrap the two ends around the middle indexes of both hands, guide the middle part with the index fingers and thumbs of both hands, and saw through the tightest contact point of the adjacent surfaces of the teeth. Wrap the adjacent surface of a tooth in a "C" shape, slightly enter the subgingival, and pull along the tooth surface away from the gum for 6-8 times, then wrap the adjacent surface of another tooth in a "C" shape, pull up and down 6-8 times, and then saw through the contact point to complete the cleaning of one contact area and two adjacent surfaces. It should be noted that when passing through the contact point, it should be passed in a "sawing" manner, otherwise it will be difficult to pass sideways, or it will suddenly pass through the contact point and compress the gums, causing gum damage; in addition, the dental floss should not be too deep into the subgingival, and the gums should not be painful to avoid gum damage. Using dental floss correctly according to the above points will not only not make the gaps between teeth larger, but also help us better maintain oral health. In addition to rolled dental floss, dental floss sticks are also commonly seen on the market. Dental floss sticks do not need to be wrapped around the fingers when used, which is more convenient. However, since the dental floss on the dental floss stick is shorter and less elastic, it is difficult for it to pass through adjacent surfaces with tight contact points. In this case, it is recommended to use rolled dental floss.

Figure 3 Schematic diagram of using dental floss

When we use traditional fixed braces, that is, braces with wires for orthodontic treatment, the wires may affect the use of dental floss, but during correction, we need to maintain good oral hygiene to ensure healthy and smooth movement of teeth. As long as the method is appropriate, dental floss can also be used for interproximal cleaning when wearing fixed braces. At this time, it is recommended to use rolled dental floss. First, pass the dental floss under the wire. You can use a dental floss retractor to make the operation easier. Then, as with the normal method of using dental floss, use your fingers to guide the dental floss through the contact points in a sawing manner to clean the interproximal surfaces, as shown in Figure 4.

Figure 4 Dental flossing when wearing fixed braces

When should you use an interdental brush?

The use of interdental brushes can be summarized into the following situations: The first situation is shown in Figure 2, when the gums have obviously receded, a "black triangle" appears on the adjacent surfaces of the teeth, or there is really a gap between the two teeth. Selecting an interdental brush of appropriate size can pass through the gap between the adjacent surfaces of the two teeth. At this time, an interdental brush can be used instead of dental floss to clean the adjacent surfaces as shown in Figure 5. It should be noted that when there is no gap between our teeth and there is no "black triangle" due to gum recession, the use of an interdental brush may compress the adjacent gingival papilla and cause gum recession. It is recommended to use dental floss for adjacent surface cleaning. The second situation is when using a fixed appliance for tooth correction. Clean the tooth surface under the wire as shown in Figure 6. In addition, there is often a "black triangle" between dental implants and adjacent teeth, which needs to be cleaned with an interdental brush.

Figure 5 Interdental brush cleaning the interproximal space

Figure 6 Using interdental brushes during orthodontic treatment

Can water floss replace dental floss?

There are many types of water floss products on the market. Many clinical studies have shown that the plaque removal efficiency of water floss is not significantly different from that of traditional dental floss. Those who do not want to use traditional dental floss can use water floss. Compared with traditional dental floss, water floss is easier to operate. Just aim the water outlet at the contact area of ​​adjacent teeth near the gums and rinse. However, the size and weight of water floss are usually larger than traditional dental floss, and it needs to be charged. During the rinsing process, a large amount of water will flow into the mouth, which needs to be adapted.

Summarize

Brush your teeth correctly at least twice a day, and use appropriate tools to clean the adjacent surfaces of each tooth at least once. Good self-oral hygiene maintenance can help us stay away from oral diseases, reduce oral diagnosis and treatment costs, and make teeth function longer and healthier. Healthy oral cavity, happy life!

References:

1. Gao Xuejun, Yue Lin. Endodontics. 2nd edition[M]. Peking University Medical Press, 2013.

2. Meng Huanxin. Periodontology. 3rd edition[M]. People's Medical Publishing House, 2008.

3.Londero AB, Reiniger APP, Tavares RCR, et al. Efficacy of dental floss in the management of gingival health: a randomized controlled clinical trial[J]. Clinical Oral Investigations, 2022, 26(8): 5273-5280.

4.Abdellatif H, Alnaeimi N, Alruwais H, et al. Comparison between water flosser and regular floss in the efficacy of plaque removal in patients after single use[J]. The Saudi Dental Journal, 2021, 33(5): 256-259.

5.Behera RR, Jalaluddin M, Kalgeri SH, et al. Assessment of the Plaque Removal Ability of Two Different Dental Floss Devices: A Comparative Study[J]. World Journal of Dentistry, 2023, 14(10): 860-863.

Author: Feng Tingting, PhD, attending physician of the Department of Orthodontics, Tongji University Affiliated Stomatological Hospital, PhD in Stomatology, Peking University, young member of the Orthodontics Committee of the Shanghai Stomatological Association, member of the Orthodontics Committee of the Chinese Stomatological Association

Reviewer: Liao Chongshan