Why Floss?

Q:

Via email Tuesday January 12, 2010.
I brush my teeth numerous times a day with an electric toothbrush and I use Listerine mouthwash 2 times a day but I do not floss at all, I find it a hassle and I don’t like doing it. Everytime I see the dental hygienist she informs me I need to floss because my gums are bleeding, but I don’t see bleeding when I brush, only when I go to the dentist. Isn’t brushing and rinsing enough?

A:

Thank you for the question, we get this question a lot from many of our patients. The reason your dental hygienist is informing you to floss because it is really one of the most important things you can do to reduce bleeding and inflammation of your gums. When you brush and rinse with a mouthwash you clean all of the tooth structure above the gumline, but you are missing most of the area below the gumline. Below the gumline is where the really harmful bacteria that can cause gingivitis (inflammation of the gums) and periodontitis (inflammation and destruction of the bone around your teeth) thrive-it is dark, warm, moist and food is present, a perfect breeding ground for bacteria. Then imagine this bacteria sitting there for months because you are not flossing, basically you will have layers upon layers of a variety of bacteria.

When certain types of bacteria exist in the mouth that cause soft tissue disease, they can cause ulcerations within the gum tissue. These ulcerations are basically open sores (basically like an irritative response to them sitting against the gum tissue). This is why if you do floss and you don’t do it regularly you will see bleeding and when the dental hygienist sees you and she probes to check below the gumline she detects bleeding. Many times if you brush and rinse, but don’t floss the ulcerations are underneath the gums and not visible to the naked eye, this why regular visits are important as gingivitis and periodontitis (in early stages) can be painless and the patient unaware of what is going on underneath the surface.
So yes, flossing is VERY important to remove bacterial plaque below the gumline, but proper technique is vital. With flossing going below the gumline and cleaning the tooth structure is the key to optimal bacteria plaque removal. When going between two teeth, the main thing to remember is to go below the gumline on both teeth, not just in between the teeth. If you are questioning your flossing technique, ask your dental hygienist to review it with you.

Optimally flossing should occur one time a day, when you do it doesn’t matter, as long as you do it. Personally, I like to floss, brush and rinse in the evening but that is just because it is convenient for me and I like to have a perfectly clean mouth to go to bed with. Like Nike says, “Just Do It!” I recommend that same and remember, Floss The Teeth You Want to Keep!

A simple (and I mean simple ;) diagram below of where floss reaches. Notice the red areas are where bacteria builds up and can cause inflammation below the gumline.