Why floss?

I would say about 99.9% of my patients brush, I can't say as much about flossing, I would say it is about 60% floss on a regular basis. Which of the two do you think is more important?

Well both are very important to prevent cavities, periodontal disease, bad breath and an assortment of other oral ailments. I must say though that flossing reigns supreme in below the gumline plaque (bacterial mixed with food) removal.

What forms under the gumline with a lack of flossing is what is called biofilms (layers of different types of bacteria/food debris and byproducts). Now everybody has biofilm, even those who floss, but that biofilm in someone who flosses on a regular basis and in someone who doesn't can be quite different. For someone who flosses a few times a week to daily will have a biofilm that is not so diverse (different types of bacteria and food) because they are using the floss to regularly remove this stuff so it doesn't accumulate. For those of us who floss only occasionally or not at all the biofilm will be very diverse (different types of bacteria/food/byproducts) all mixed together. As well, after this plaque has sat for awhile under the gums it can harden into what is called calculus, ie. tartar.

Biofilm can be anywhere from harmless (benign, non-destructive bacteria) that does not cause disease (ie.gingivitis/periodontal disease) to very harmful and destructive causing the body to start an inflammatory response in order to prevent disease progression. One sign of destructive biofilm/bacteria that may be intiating or causing a disease process to start is bleeding/redness of the gums. If you see one or both this means inflammation is starting. In this circumstance I would recommend flossing the area even more not less. I have come across a few people who have becomed frightened when their gums bleed and for good reason, the body is actually giving you a blatant signal that something is wrong. Gums should not bleed when you floss them, not a lot and not a little. Even a little blood shows us something is up, it is not normal to bleed from your gums, just as it is not normal to bleed from your leg. Unless you physically cut yourself with the floss (please don`t, be gentle!) the gums should not be bleeding.

Flossing technique is very important as well. When flossing the floss itself should be gently glided below the gums and gently polished along the side of the tooth it is cleaning. If you just go above the gumline with the floss it is defeating the purpose of flossing. That biofilm we talked about earlier that has the potential to be harmful lives well below the gumline in the dark, warm area that is called the sulcus. This area is perfect for anaerobic bacteria (bacteria that lives well in the presence of no oxygen). Many anaerobic bacteria have the potential to be destructive so these little guys need to be cleaned up and out with the floss.

Once you get good with flossing it should take you no less than a minute to complete your whole mouth. Remember when going between two teeth you need to clean each tooth and area below the gumline individually. Optimally you only need to floss 1x day, if you do more that is a bonus. As well, it doesn`t matter what time of the day you floss, as long as you do it.

So just remember, floss the teeth you want to keep! I won`t say anymore :)

Have a great night!
Nathan