Dental floss

Dental hygienist flossing a patient's teeth during a periodic tooth cleaning.Dental floss is either a bundle of thin nylon filaments or a plastic (teflon or polyethylene) ribbon used to remove food and dental plaque from teeth. The floss is gently inserted between the teeth and scraped along the teeth sides, especially close to the gums. Dental floss may be flavored or unflavored, and waxed or unwaxed.




History

Dental flossLevi Spear Parmly, a dentist from New Orleans, is credited with inventing the first form of dental floss. He recommended that people should clean their teeth with silk floss in 1815.

Dental floss was still unavailable to the consumer until the Codman and Shurtleft company started producing human-usable unwaxed silk floss in 1882. In 1898, the Johnson & Johnson Corporation received the first patent for dental floss. Other early brands included Red Cross, Salter Sill Co. and Brunswick.

A character is depicted using dental floss in James Joyce's famous novel Ulysses (serialised 1918-1920) - an early mention of the practice in literary fiction.

The adoption of floss was poor before World War II. It was around this time, however, that Dr. Charles C. Bass developed nylon floss. Nylon floss was found to be better than silk because of its greater abrasion resistance and elasticity. In response to environmental concerns, dental floss made from biodegradable materials is now available.

Dentists and dental hygienists urge the daily oral hygiene regimen of toothbrushing and flossing. Nearly all Americans brush their teeth. However, the ADA indicates that only about 12 percent of Americans floss daily, 39 percent floss less than daily, and 49 percent do not floss at all.


Use

Dental floss is commonly supplied in plastic dispensers that contain 10 to 50 meters of floss. After pulling out the desired amount, the floss is pulled against a small protected blade in the dispenser to sever it.

Dental floss is held between the fingers. The floss is guided between each tooth and under the gumline to remove particles of food stuck between teeth and dento-bacterial plaque and adhered to such dental surfaces. Ideally using a C-shape, the floss is curved around a tooth and placed under the gumline, and then moved away from the gumline, the floss scrapes the side of each tooth, and can also clean the front or back of the tooth. Gently moving the floss from below the gumline to away from the gumline removes dento-bacterial plaque attached to teeth surfaces above and below the gumline. A clean section of floss can be used to clean each tooth to avoid transmitting plaque bacteria from one tooth to another.

There are many different kinds of dental floss commonly available. The most important variable is thickness. If the floss is too thick for the space between a pair of teeth then it will be difficult or impossible to get the floss down between the teeth. On the other hand, if the floss is too thin, it may be too weak and break. Different floss will suit different mouths, and even different parts of one mouth. This is because some teeth have a smaller gap between them than others. It's possible that thicker floss does a better job of scraping bacterial plaque off teeth, given that there is space enough between the teeth to use it. When a piece of hard food is tightly wedged between the teeth, one may need to switch to thinner floss, because thick floss cannot get past the food. It is possible to split some kinds of dental floss lengthwise turning generating a pair of thinner pieces that are also weaker but sometimes useable. This is possible because some kinds of dental floss are made of many very thin strands that are not woven together but rather run more or less in parallel. This can be useful if the dental floss you have is too thick, and you do not have access to any other, for example when travelling in a foreign country.

If the urgent problem is discomfort or even pain that steadily increases for hours after the meal, due to pieces of food jammed tightly between the teeth, whether pressing on the gum tissue or not, then dental floss is safer and, more importantly, more effective than a toothpick. First work the floss down between the teeth where the pain is, until the floss has got past the food, then pull the floss back up, propelling some or all of the trapped food out from between the teeth. Repeat until you can feel that all or at least almost all of the food is out. Then rinse with water or mouthwash forcefully using the cheek muscles to drive the water or mouthwash in your mouth between the teeth repeatedly, in order to flush out any remaining fragments of food. You may wish to take this opportunity to floss between the rest of your teeth for hygiene reasons. Furthermore, you may wish to make it a habit to floss after every meal, combining the benefits of enhanced oral comfort and hygiene.


F-shaped and Y-shaped dental floss wandsSpecialized plastic wands, or floss picks, have been produced to hold the floss. These may be attached to or separate from a floss dispenser. While not pinching the finger, using a wand may be awkward and also make it difficult to floss at all the angles possible with a finger. At the same time, the enhanced reach can make flossing the back teeth easier. These types of flossers may be missing the area under the gum line that needs to be flossed.

Occasional flossing and/or improper flossing can typically lead to bleeding gums. The main cause of the bleeding is inflammation of the gingival tissue due to gingivitis.


Directions

The American Dental Association (ADA) advises to floss once or more per day before brushing your teeth; flossing prior to brushing allows for fluoride toothpaste to reach between the teeth . It should be noted that overly vigorous or incorrect flossing can result in gum tissue damage. For proper flossing, the Association advises to curve the floss against the side of the tooth in a 'C' shape, and then to wipe the tooth from under the gumline (very gently) to the tip two or three times, repeated on adjacent and subsequent teeth.

Dental floss does not clean the interproximal areas beneath the contact point, because the area is concave.


Vibration

Some power flossers utilize vibration which transfers through the floss, originating from the ends. This is likely inspired by the similar use of vibration of the bristles in modern electric toothbrushes. As the vibration causes subtle movement, the floss will find the path of least resistance when pressed down. The movement would also help in temporarily separating tooth and gum for floss to get through.

This allows easier penetration under the gumline, with less force applied to push into the gap between teeth. With less force applied, more control of flossing is possible. In normal flossing, pressure may be applied until the floss 'pops' through the teeth, and the momentum can carry on and painfully impact the gum tissue. With more control, this can be reduced or avoided totally.

Many consider vibrations to be soothing; it is a common technique in massage and orthopedic devices. Much like electric toothbrushes are soothing to the teeth and gums, vibrating floss can soothe and massage the gumline.

Cuts become less likely as the floss will not press against as isolated an area, and less pressure is applied. Any abrasions to the gum would be more evenly distributed, leading to more equal adaptation of the tissue.


Benefits

Flossing in combination with toothbrushing can prevent gum disease, halitosis, and dental caries.

Flossing is a better alternative to using a toothpick to remove food trapped between the teeth. A toothpick may be tried and not solve the problem leading to an incorrect conclusion that the problem was not due to trapped food. Pain caused by trapped food can sometimes not be recognized as being caused by trapped food. The pain may be hard to locate exactly, so it may seem to be coming from inside a tooth, leading to an unnecessary visit to a dentist, if flossing is not tried out first.

Dental insurance

Dental insurance is insurance designed to pay a portion of the costs associated with dental care.

The most common types of dental insurance plans are Preferred provider organizations (PPO) or dental health maintenance organizations (DHMO). Both types are considered managed care.

Basics to dental health

Basic dental care involves regular brushing and flossing of your teeths, consulting your dentist or dental hygienist for small problems and for regular checkups and cleaning. Eating mouth-healthy diet such as fruits, vegetables & dairy products is also essential. Its better for you to keep a personal dentist who keeps in touch with you.

Having good oral health gives us a sense of well-being, self esteem and also grants us freedom from dental problems such as tooth decay, gum diseases, bad breath and tooth ache.

Oral hygiene

Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems and bad breath.

A dental hygienist demonstrates dental flossing.

Teeth cleaning

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, and gum disease. Severe gum disease causes at least one-third of adult tooth loss.

Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing, and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment for children and adults.

Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.

Interdental brushing

Periodontologists nowadays prefer the use of interdental brushes to dental floss. Apart from being more gentle to the gums, it also carries less risk for hard dental tissue damage. There are different sizes of brushes that are recommended according to the size of the interdental space. It is desirable to clean between teeth before brushing to enable easy access for the saliva fluoride mix to remineralise any demineralised tooth often resulting from food left on teeth after every meal or snack.

Flossing

The use of dental floss is an important element of the oral hygiene, since it removes the plaque and the decaying food remaining stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acid forming foods left on teeth also demineralise tooth eventually causing cavities. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before bedtime, to help prevent receding gums, gum disease, and cavities between the teeth. Interdental cleaning is important before brushing to provide easy access of the saliva fluoride mix to remineralise any demineralised tooth to help prevent tooth decay.

Tongue cleaning

Cleaning the tongue as part of the daily oral hygiene is essential, since it removes the white/yellow bad breath generating coating of bacteria, decaying food particles, fungi (such as Candida), and dead cells from the dorsal area of tongue. Tongue cleaning also removes some of the bacteria species which generate tooth decay and gum problems.

Gum care

Massaging gums with toothbrush bristles is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bed, to help prevent receding gums, gum disease, and cavities between the teeth.

Oral irrigation

Dental professionals usually recommend oral irrigation as a great way to clean teeth and gums.

Oral irrigators can reach 3-4 mm under the gum line, farther than toothbrushes and floss. And, the jet stream is strong enough to remove all plaque and tartar. The procedure does leave a feeling of cleanliness and freshness, and does disrupt more plaque or bacteria as floss since it cleans deeper.

Food and drink

Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.(8) Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal. Some foods like fruit and sugar confection are acid forming. Chewing obviously forces food between teeth generally displacing previously trapped food so it is a good idea to chew tooth friendly foods before and after meals or snacks to reduce acid demineralisation and even remineralise demineralised tooth as when chewing celery that forces saliva into trapped food to dilute sugar, neutralise acid and remineralise demineralised tooth. However over 80% of cavities occur inside pits and fissures on chewing surfaces of back teeth. So it is clear that acid forming foods cause these cavities and if fissure sealants are places over these surfaces to block food being trapped inside pits and fissures, acid demineralisation and tooth decay cannot progress.

Beneficial foods

Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth.(8)

Detrimental foods

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first.

Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.

Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.

Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.

Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well. However gum cannot absorb and expell saliva so cannot force saliva inside pts and fissures or between teeth like chewing celery, so cannot easily dilute sugar, neutralise acid and remineralise demineralised tooth. It seems there is more in depth analysis is needed into the relationship between food, teeth and plaque bacteria.

Other

Smoking and chewing tobacco are both strongly linked with multiple dental diseases. Regular vomiting, as seen in bulimics, also causes significant damage.

Mouthwash or mouth rinse improve oral hygiene. Dental chewing gums claim to improve dental health.

Retainers can be cleaned in mouthwash or denture cleaning fluid. Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution.

Oral hygiene and systemic diseases

Several recent clinical studies show a direct link between poor oral hygiene (oral bacteria & oral infections) and serious systemic diseases, such as:

• Cardiovascular Disease (Heart attack and Stroke),

• Bacterial Pneumonia,

• Low Birth Weight,

• Diabetes complications,

• Osteoporosis.