Most dentists will tell you it's like pulling teeth trying to get our patients to floss on a consistent basis. It's an awkward activity, it can be hard to maneuver around the molars and sometimes the floss shreds or breaks in the process. So frustrating!
When we brush our teeth, we are able to clean about 75% of the tooth surface area. If we are not using dental floss, we are missing the other 25% of where bacteria like to congregate. These bacteria are like the teenager having a party at home because mom and dad are out of town. We all know what a house party hosted by teenagers can look like!! The mess left behind when we don’t clean between our teeth can lead to inflamed and bleeding gums.
It is critical to practice proper cleaning between our teeth and because most adults DO NOT, nearly 94% of Americans suffer from a condition known as gingivitis. Gingivitis is an inflammatory process that causes bleeding of the tissues. Fortunately it is reversible if proper oral hygiene habits are adopted and a healthy diet is maintained. More serious concerns lie in the fact that these infectious and inflammatory components of gum disease can invade the soft tissues, entering the bloodstream and elevating the risk of systemic disease. Diseases with a known link to oral bacteria are:
And the list is growing.
The oral cavity is the gateway to the rest of the body! Good health starts here!
About six months ago, I listened to an interview with a UK dentist who is ‘anti-flossing’. This would be a heretical conversation amongst 99% of American dentists but my scientific curiosity had me eager to learn the logic of her position. Her argument was that most patients don't know how to floss properly and were doing more damage than good by traumatizing their gum tissues. The harm stems from bacteria that congregate the areas in between our teeth being forced into the tissues and the bloodstream if we don't floss with care and intention. There are studies that support her claims and need to be considered on a patient to patient basis. If your gum tissues bleed when you are flossing you could be doing more harm than good and this is where water flossing has demonstrated strong efficacy.
Recent research on the benefits of water flossing have been conducted and demonstrate evidence that this practice far surpasses sonic/oscillating electric toothbrushes at removing biofilm and improving gingival health. Water flossing also outperformed string flossing with a 33% biofilm reduction and it was twice as effective at reducing gingival inflammation.
As a provider, I want to arm you with knowledge that will help you to have optimal oral hygiene and to promote excellent dental health.
Great health always begins with a healthy diet. I cannot stress this enough!! Our overly processed and manipulated/manufactured food products are not only the source of our obesity epidemic and other poor health outcomes but also a key component to poor dental health. Recognizing that most patients hate flossing, I have long advocated for an alternative to string flossing and that is water flossing. The results observed when patients adopt this as part of their daily routine are both impressive and encouraging. This was my anecdotal experience, now proven by the studies mentioned above. An additional problem with string flossing is that most commonly used dental flosses are so smooth and slippery, they're essentially ineffective at actually removing the plaque. In a future newsletter I will cover the concerns recently observed with popular brands of floss being made from 'forever chemicals'.
Before you run off, convinced this dentist has lost her mind….she questions the safety of fluoride and now she’s telling you floss is ineffective. Let me clarify that I am NOT advocating that you toss the floss out the window. In a perfect world, the water flosser would be an adjunct to your toothbrush, your dental floss, your tongue scraper and the saline rinses I have promoted recently. BUT, if you refuse to string floss, I think excellent oral hygiene can be achieved with the water flosser and your toothbrush.
TIPS FOR EFFECTIVE WATER FLOSSER USE
Always practice using the appliance first. Before you turn it on and start spraying water all over, familiarize yourself with the concept of using a hose to dispense water for cleaning purposes.
You cannot look at yourself in the mirror like you do while you brush. Water will go EVERYWHERE. You are best to hold your head parallel to the sink and stare at the drain.
Fill the reservoir with warm water.
Start at a low setting to find your comfort force of water spray. Healthy tissues should easily tolerate the higher pressure settings. If your gums bleed easily, start low and use daily. If you have a chronic area that continues to bleed after repeatedly using the water flosser, please bring it to the attention of your dentist at your next visit so he/she can investigate what may be wrong.
Your goal with the water flosser is to clean the area along the tissue surface of the tooth. I describe this as scalloping along the gumline of each tooth. Pause for a second as you come to the area in between your teeth. Scallop and pause, scallop and pause as you move around the dental arch.
Be sure to use your water flosser on both the cheek and tongue side of your teeth. This will entail rotating the tip of your flosser to angle towards the inside of your mouth.
HOW NOT TO USE A WATER FLOSSER!!
HOW NOT TO WATER FLOSS!! If you do this at home both you and your phone will be soaked. It’s OK to put your phone down for a minute to exercise mindfulness while cleaning your teeth 🙄
Which Brand??
For the better part of my career, I have recommended the WaterPik brand water flosser because its price point is reasonable and it is highly effective. I have heard many complaints about how loud the appliance is and that it takes up too much room on the countertop. In my quest to find a solution to these complaints, I believe the Sonicare brand is the answer. It has an extremely quiet hum when activated, it has a sleek compact design with sufficient power to clean as well as the bulkier countertop models and it has an attachment that reduces the collateral water spray while cleaning a broader area of the tooth.
Patients who start using a water flosser consistently become strong advocates for this oral hygiene practice. The most obvious evidence of its benefit is the food debris you see removed as you irrigate. Even after brushing and flossing, you will be astonished at what is left behind. Good luck and NEVER hesitate to ask questions when you visit your favorite hygienist.
My dentist once told me that if he were stranded on a desert island and (for some inexplicable reason) could only have one oral hygiene tool with him, he would choose floss over a toothbrush. I took him seriously and have flossed every night since then!
Thanks Jessica.
I'm a regular string flosser - and dentists have always commented on this ("your gums don't bleed!"). My teeth don't feel clean unless I've flossed. I hear how water flossing is more effective, but it sounds awkward and messy.
In terms of picking up new dental hygiene habits, I might try the tongue scraping first. Off to find your writings on that!