How Often Should You Floss

How to Floss Your Teeth (Step-by-Step Instructions)

Many people understand that brushing their teeth is essential for preventing tooth decay. But while daily brushing is critical, flossing is just as necessary. 

Dental floss can remove leftover food particles stuck between your teeth. Flossing also helps remove a sticky film called dental plaque, which can cause tooth decay and gum disease. 

Despite the benefits, the majority of people in the U.S. neglect daily flossing. According to the American Dental Association (ADA), only 40% of Americans floss every day.8  People often fail to floss because they don’t see an immediate benefit. Others floss on occasion, but not enough to make a difference to their oral health.

Dental health experts agree that flossing is an essential part of good oral health. The ADA recommends flossing at least once per day. And in 2016, the U.S. Department of Health and Human Services reaffirmed flossing as an “important oral hygiene practice.”4

If you have trouble flossing correctly, here are step-by-step instructions:

  1. Choose the right dental floss. There are six main types:
  • Waxed floss — This is the most common type of dental floss preferred by dentists and hygienists. 
  • Unwaxed floss — This is another common type of dental floss. This is easier to get between teeth pressed snugly together than waxed floss. However, unwaxed floss is more prone to shredding. Both waxed and unwaxed floss are typically made of nylon.
  • Floss holder — Also known as picks or pre-threaded flossers, these are Y or E-shaped tools that hold a small segment of floss between two prongs on the end. Floss holders are easier to use than traditional floss, which requires more manual dexterity.
  • Dental tape — An interdental cleaner like floss, but wider and flatter, this is used for people with wider gaps between their teeth. It comes in both waxed and unwaxed forms.
  • Super floss — This is more like regular floss than tape but has a thick section in the middle. This makes it another good choice for those with teeth more spaced apart.
  • Polytetrafluorethylene floss (PTE) — Also known as Teflon, PTE is the same material used in Gore-Tex fabric and non-stick cooking ware. It slides between teeth easily and is less likely to shred than waxed floss. It is the most popular brand of floss on the market today. However, there are concerns about possible health risks, including cancer, thyroid disease, and ulcerative colitis.6
  1. Pull off an 18-inch-long piece of floss (disregard if you are using a floss holder). 
  2. Wrap the end of the floss around your middle finger. This will make it easier to hold. Do the same with your other hand. Pull the floss taut. 
  3. Gently push the floss between your teeth.
  4. Once the floss touches your gums, wrap it against the side of one tooth. 
  5. While holding the floss against the tooth, gently move it back and forth and up and down. Discard the floss.
  6. Get a new section of floss. This prevents germs from one set of teeth being transferred somewhere else. Repeat the process above for the rest of your teeth. 

String Floss vs. Water Flossers: Which is More Effective?

Water flossers are an alternative to traditional string dental floss. They apply water pressure to the teeth to wash away plaque. Although they can help those who can’t or won’t use string floss, water flossers don’t remove as much plaque.9 

However, many people cannot use string floss. For those people, water flossers may be a great alternative. Water flossers are a gentle alternative for sensitive gums and can reduce gum inflammation.7 

Those with braces may also benefit from using water flossers.2 They also require less manual dexterity than traditional flossing tools. This makes it easier to remove food debris from hard-to-reach-places in the back of the mouth.

Supplementing your oral care routine with water flossing is significantly more effective at removing plaque than just brushing alone.3

How Often Should You Floss Your Teeth?

The ADA advises flossing at least once per day.1

Is it Bad to Floss Twice a Day?

There's nothing wrong with flossing twice a day, but it's not necessary. You might floss a second time to remove food stuck between your teeth. The most important thing is to be gentle (too much pressure will irritate your gums) and do a thorough job.

Should You Floss in the Morning or at Night?

The ADA does not have any specific advice on when you should floss, just that you should do it correctly and every day. 

Many like to fit flossing into their morning routines; others do so before bed. It's up to personal preference. Just do it daily when it's convenient for you, and before long, you'll have adopted a new healthy habit.  

Should You Floss Before or After Brushing? 

There is scientific evidence that shows that flossing before you brush may be better. This is because flossing prior to brushing helps dislodge any food or plaque debris that the toothbrush can then remove. It is also a good technique to lower the risk of gum disease and bad breath.

A 2018 study from the American Journal of Periodontology found flossing first was better at reducing plaque.5 In addition, the study found brushing after flossing led to more fluoride remaining in the mouth.5

What Happens if You Don’t Floss Your Teeth Daily? 

Proper dental health for your teeth requires daily flossing. Failure to do so can raise your risk for tooth decay and gum disease. 

Brushing alone is not sufficient for removing plaque between teeth. Plaque between teeth is known as interproximal dental plaque. It contains bacteria that attack the teeth and gums.

If left long enough, plaque can eventually harden into a rough substance called tartar. Tartar collects along your gums and can lead to cavities and gum disease. Once tartar forms, only your dentist will be able to remove it. If you want to avoid unpleasant and costly dental work, floss daily.

Plaque bacteria also causes irritation and inflammation of the gums, which can pull away from teeth, forming pockets that collect more bacteria. These bacteria attack the tissues that hold the teeth in place. In severe cases, they can damage the bone that anchors the teeth in place, resulting in tooth loss.

In the early stages, gum disease is known as gingivitis. The more advanced stage is known as periodontitis or periodontal disease. 

Symptoms of gum disease include: 

  • Sore, swollen gums
  • Gums that bleed when you brush your teeth
  • Continual bad breath
  • Receding gum line
  • Loose teeth

Flossing daily is not only key to a clean mouth but may also serve as good preventive care for complications elsewhere in the body. For example, evidence suggests poor oral health is linked to diabetes, cardiovascular illnesses, and even Alzheimer's Disease.10 

Bacteria from periodontitis can enter the bloodstream and cause arteries to harden. 10 This can increase the risk of heart attack and strokes. Though more research is required, kidney damage, arthritis, and even dementia are also potential complications.10 

Resources

American Dental Association. “American Dental Association Statement on Regular Brushing and Flossing to Help Prevent Oral Infections.www.ada.org, 2013.

Genovesi, AM, and Lyle C. Lorenzi. “Periodontal Maintenance Following Scaling and Root Planing, Comparing Minocycline Treatment to Daily Oral Irrigation with Water.Tuscan Stomatologic Institute, Department of Dentistry, 2013.

Lyle, Deborah M., et al. “Comparison of Water Flosser and Interdental Brush on Plaque Removal: A Single-Use Pilot Study.The Journal of clinical dentistry, vol. 27, no. 1, 2016, pp. 23-26. www.waterpik.com.

Manchir, Michelle. “Government, ADA recognize importance of flossing.www.ada.org, 2016.

Mazhari, Fatemeh, et al. “The effect of toothbrushing and flossing sequence on interdental plaque reduction and fluoride retention: A randomized controlled clinical trial.Journal of Periodontology, vol. 89, no. 7, 2018, pp. 824-832. aap.onlinelibrary.wiley.com.

Miller, Ryan W. “Oral-B Glide floss tied to potentially toxic PFAS chemicals, study suggests.www.usatoday.com, 2019.

Ng, Ethan, and Lum Peng Lim. “An Overview of Different Interdental Cleaning Aids and Their Effectiveness.Dentistry journal vol. 7, no. 2, 2019, www.ncbi.nlm.nih.gov.

Rack, Jessie. “Are You Flossing Or Just Lying About Flossing? The Dentist Knows.www.npr.org, 2015.

Salinas, Thomas J. “Is it more effective to floss teeth with a water pick or standard dental floss?www.mayoclinic.org.

Winning, Lewis, and Gerard J. Linden. “Periodontitis and systemic disease.” BDJ Team, vol. 2, no. 10, 2015. www.nature.com.

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