The ‘Flossophy’ of interdental cleaning

Everybody knows the importance of a good routine when cleaning teeth; however, toothbrushing alone isn’t sufficient enough to maintain healthy teeth and gums.

This article aims at the education of the significance of interdental cleaning, giving you the tools, and an understanding of the correct method.

Don’t forget to learn about how to brush your teeth correctly!

What is interdental cleaning

Simply put, it is cleaning between your teeth. 

Why interdental cleaning is important

If you imagine your tooth, it has 5 surfaces: the inside, the outside, the biting surface and the two side surfaces. Even with using the correct toothbrushing method you can only achieve the effective cleaning of the first three surfaces listed above. 

That leaves the two side surfaces of the teeth unattended, which provides ideal circumstances for the plaque to sit there all the time. Just to recap, plaque is a major causative factor for gum disease (which if left untreated could lead to tooth loss) and contributes to the development of caries (tooth decay). (1)

When the plaque sits on the teeth, the bacteria (and their by-products) trigger an inflammatory response in the gums (gingivitis and/or periodontal disease develops) As a result they swell and ‘pockets’ appear. This means that the gum detaches itself from the tooth and it gives way to the bacteria to travel further down on the side of the tooth. 

The bacteria and the by-products (toxins) and the body trying to fight off those are causing damage not just to the gums but the bone around the tooth as well. This destruction of the supporting tissues will lead to mobile teeth and eventually tooth loss. (2)

If this wouldn’t be motivational enough, maybe it is worth considering the effect gum disease can have on your overall health (please read one of my previous articles to recap: Links between general and oral health). 

The purpose of interdental cleaning is to prevent that by removing the plaque from between the teeth. Ideally, interdental cleaning needs to be done once a day (or more, if it is advised by your dental care professional).

Read this if you’ve got sensitive teeth!

Interdental cleaning aids

Floss is a soft, thin cord. 

It comes in various types (waxed, unwaxed, tape, super floss). Floss is available as a roll of string, but you can buy disposable floss picks/flossers (the floss is stretched out on a plastic holder) as well. (3)

Tips for flossing

String floss

• Take about 18 inches/45cm of floss from the roll. (4)
• Wrap it around both your middle fingers in a way that when you hold the floss with your index finger and thumb there will be about 2 inches/5cm of floss in-between. (4)
• Your index finger and thumb will manoeuvre the floss between your teeth (wrapping it around the middle finger will stop the floss from sliding, as it isn’t easy to have a firm grip on it). 
• Slide the floss with a gentle seesaw like motions through the contact point of the teeth (don’t rush it, as you can hurt your gums if you push it down with too much force).
• Once it is between the teeth create a C-shape against the wall of the tooth on one side and move the floss up and down (make sure you go under the gumline, but just until you hit the natural resistance of your gums; forcing it further down can cause damage). 
• Do the same on the other side of the gap.
• Use a new, clean section of the floss when you move to the next two teeth (to make sure you are not redistributing plaque/bacteria from one tooth on to another). (4)

Effective flossing could be difficult to master as it is quite a technique sensitive. Floss picks are easier to use, however, the disadvantage is that you will use the same piece of floss between all your teeth (it would be very expensive to use multiple floss picks for one session, furthermore very bad for the environment due to the plastic waste they create).

Interdental brushes

are little brushes attached to a plastic holder (they look like miniature bottle brushes). They come in different sizes and with a different type of holders. They are easier to use than the string floss.

Tips for use

• Choose the right size of brush for the different gaps (there are various sizes of gaps between the teeth in a mouth). Ideally, the brush should fit snugly without having to force it in, but also effectively cleaning the walls of the teeth both sides of the gap.
• Insert the brush gently and move it back and forth a few times.
• Make sure you clean between every gap in your mouth.
• Ensure that you wash the brush before inserting it into the next gap (you don’t want to transfer the plaque from one place to another) and when you finished. It is ideal to leave them to dry, before putting them away. (5)

Electric flossers

Simply put these are devices, which are operated by pumping either air or water through a flosser tip. The cleaning between the teeth is achieved by the power of air jet or water flow. Some makes need to be recharged before use; others have to be plugged in while using them. Electric flossers are easier to use than floss, and as they have a fairly big handle, they can be helpful for people with limited manual dexterity (e.g. people suffering from arthritis in the hand). The disadvantage is that they are costly. Also, some dental professionals are doubtful whether they are as efficient as other interdental cleaning aids.

These are just the most commonly used interdental cleaning aids. Some people may only need to use one type of interdental cleaning aid; others (who have more complex dental needs, e.g. having crowns, bridges, implants or orthodontic appliance fitted) may have to use a wider variety of products.

The market is full of different types of interdental cleaning aids and it can be very confusing, which one to choose. The condition of people’s oral health differs widely, hence their oral health care needs will vary individually. It is advisable (before spending money and finding the product doesn’t have the right effect) to consult your dentist/hygienist. They will provide the best advice based on the condition of the teeth/gums on what interdental aids to purchase and how to use them.

At present, the only way to achieve good oral health is to put the time and effort in (i.e. there is no easy way around it) by using the correct toothbrushing and interdental cleaning technique, visiting the dentist regularly and the hygienist (if instructed by the dentist). However, if you look at the benefits, it is worth it.

Finally, to quote one of my dental colleague’s: ‘Clean daily between the teeth, you want to keep!’

Written by Hajnalka Takacs – qualified dental nurse and oral health educator

References

1. Felton, A., Chapman, A. and Felton, S. (2014) Basic Guide to Oral Health Education and Promotion. 2nd edn. Chichester: John Wiley and Sons Ltd.
2. Sharma, N. C., Lyle, D. M., Schuller, R. and Qaqish, J. G. (2012) ‘Comparison of two power interdental cleaning devices on plaque removal’, The Journal of Clinical Dentistry, 23(1), pp. 17-21.
3. Oral-B (2020) Dental Floss Types – The Pros and Cons
4. National Health Service (2019) Why should I use dental floss?
5. National Health Service (2018) Why should I use interdental brushes?

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