You should floss at least once a day.
Despite headlines in recent years that suggest the benefits of flossing are unproven, the National Health Service (NHS), Canadian Dental Association (CDA), American Dental Association (ADA) and the American Academy of Periodontology all recommend flossing at least once a day.
Why do I need to floss?
When you brush your teeth with a manual or electric toothbrush, you are only cleaning 3 of the 5 sides of your teeth. Whilst the bristles of the toothbrush do reach into the gaps between teeth, their reach and cleaning effectiveness is limited.
In fact, by brushing your teeth alone you are only cleaning 60% of the tooth surface. 40% goes uncleaned unless you clean those interdental spaces.
Your mouth contains hundreds of different bacteria, and this is completely normal. However, some of these bacteria feed on the debris left behind by food and drink we consume.
This creates something called plaque.
Removing plaque is one of the main reasons we brush our teeth.
Plaque is a sticky substance on the teeth that contains bacteria. Plaque builds up over the course of the day. Whilst some bacteria in plaque are harmless, but some are harmful to your gum health, causing gum disease.
The bacteria in plaque can also produce acids which cause decay in your teeth.
Over time, if the teeth and gums are not properly cleaned, the plaque is not removed. The plaque builds up and the bacteria in it produce acids which irritate your gums. This can lead to redness with bleeding, swelling and tenderness -- which we call gingivitis (early stages of gum disease)
Failing to remove plaque will also result in the plaque hardening into something referred to as tartar or calculus. Calculus is more sticky than your teeth and more plaque will stick to this tartar/calculus than your teeth. This will lead to even more bleeding. Long term, if gingivitis is not treated it will most likely progress into periodontitis.
If left untreated gum disease can be painful and eventually lead to tooth loss. Gum disease is primarily caused by poor oral hygiene.
Using interdental cleaning tools such as dental floss disrupts the plaque formation as it passes over the tooth surface, helping to prevent damage to the teeth.
Regular flossing helps achieve a good level of oral hygiene and assists in preventing gum disease and associated oral health issues.
For more advice on the basics of keeping your mouth healthy, see our teeth brushing guide.
Arguments for and against flossing
For a long time flossing daily has been the recommendation of dental professionals and organisations across the globe.
Dental reviews by the Cochrane Library found that flossing and toothbrushing removes more plaque than brushing alone. Their recommendation was that
“despite the uncertain or low quality of most of the studies, and given the importance of avoiding plaque deposition, plus the absence of any major disadvantages, these results support the use of regular flossing with toothbrushing.”
More recently, the media picked up on the fact that the U.S Dietary Guidelines issues in 2015 omitted flossing as a recommendation where it has previously advised to do so daily.
The Associated Press looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings were that the evidence for flossing is “weak, very unreliable,” of “very low” quality, and carries “a moderate to large potential for bias.”
“The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal.”
The US government acknowledged the effectiveness of flossing had never been researched, as required, but the ADA was quick to issue a statement surrounding the media controversy.
“The bottom line for dentists and patients is that a lack of strong evidence doesn’t equate to a lack of effectiveness”.
It is worth noting further research by Cochrane Library which states that interdental brushes are more effective than flossing in some cases.
Given dental health is such a big issue it would be fair to assume that more would have been done to date to really investigate the health benefits and prove or not the benefits of flossing.
However, as with some things in life whilst we could probably get away with not doing it, there is a degree of common sense and logic to why the act of interdental cleaning and flossing is necessary.
If a regular toothbrush can’t get to the area to clean it, then floss or interdental brushes are the answer.
Interdental cleaning tools -- dental floss, interdental brushes & water flossers
There are a variety of ways you can achieve plaque removal between your teeth. This type of cleaning is called interdental cleaning. Interdental cleaning may also be referred to as interproximal cleaning, although they mean the same thing.
The tools that can be used for interdental cleaning include floss, brushes and water flossers. Each has a slightly different approach to achieve a similar end result.
Flossing is perhaps the most widely used term to explain and refer to the cleaning of gaps between our teeth.
Floss is the most commonly used and advised tool, primarily due to the cost and simplicity of the product.
However, the likes of interdental brushes and water flossers are becoming more common and more regularly recommended as these can be beneficial in assisting with the cleaning of interdental spaces.
Products like water flossers, although more expensive to buy can be more convenient and more enjoyable to use. Many dentists would prefer you use a tool that you would prefer to use regularly than the one you struggle with or simply won’t use.
Interdental brushes are primarily designed for use in the interdental area, which is the gap that exists between teeth and that is occupied by the gums.
Interdental brushes come in different sizes to help you clean these different sized gaps between the teeth.
Floss is generally one of the thinner products and glides easily in the tightest of spots between teeth and can reach and fit in areas that the brushes cannot. You might be advised to use floss in conjunction with interdental brushes.
Check out our detailed comparison post, Interdental Cleaning – Floss vs Interdental Brushes to learn more about how they differ and what you should use when.
If the idea of a water flosser sounds interesting, check out our post on the best electric dental flossers.
Whatever your feeling, don’t let the challenge of deciding on the correct product stop you doing interdental cleaning. The most important thing is that you clean and for most people, the easiest thing to do is opt for a regular reel of floss.
Speak to your dentist or hygienist for advice. They can often recommend products specifically suited to you based on your mouth, teeth and preferences.
Which floss should I use?
As if the different types of tools were not complicated enough already, there are actually different types of dental floss available too.
You can read about them and their differences here.
How do you floss?
The technique required does depend on whether you are using regular dental floss, interdental brushes or indeed a water flosser.
See our instructions on how to floss with regular string or tape floss.
Or see our instructions on how to use interdental brushes.
When is the best time to floss?
Most dental professionals will advise flossing last thing at night, but this is not necessarily the time that you have to floss.
The ADA’s mouth healthy website sums up the general feeling and recommendations well:
The most important thing about cleaning between your teeth is to do it. As long as you do a thorough job, it doesn’t matter when. Pick a time of day when you can devote an extra couple of minutes to your dental care. People who are too tired at the end of the day may benefit from cleaning between their teeth first thing in the morning or after lunch. Others might like to go to bed with a clean mouth.
This is further backed up by the Canadian Dental Association.
Getting into the habit of daily flossing is easier when you floss while doing something else like watching TV or listening to music, for example.
When you do floss, do it before you brush your teeth. This way, the plaque and debris from the interdental spaces are removed prior to brushing. When you brush, the protective toothpaste reaches in between the teeth and is not removed by flossing, as you have already done this.
What the dental professionals say
So what do other dental professionals say about how often you should floss.
Firstly, we reached out to Abigail Pearson, a hygienist at Purity Clinic:
If you have particularly crowded or tight gaps and can not fit the interdental brushes through, then flossing is your only real alternative. Like with any tooth cleaning, you should ideally be doing it two times a day, morning and night. If you brush your teeth twice a day why would you not clean in-between them too?
Abigail Pearson --www.purityclinic.co.uk -- GDC 259413
And we’ve also roundup up opinions from other dental professionals:
“Once a day” is the recommendation from Jenni Seaney, a dental hygienist who is featured in the video below.
Further to the above, Assure a Smile say:
You should floss at least once daily. It doesn’t particularly matter when you do it during the course of the day or whether it is before or after you brush your teeth just as long as you do it. Flossing earlier in the day reduces the chances that you’ll forget about doing it later, while flossing before bedtime or even during the middle of the day may fit better into your lifestyle. Whatever works for you will work for your teeth and gums.
Ruggless Dental say:
We recommend flossing at least once a day.
According to Smiles of Elgin:
Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.
And finally, Greeley Dental Care:
It is imperative to floss at least 1 x day. Some patients prefer to floss in the morning or afternoon, while other prefer to floss at night.
With all things considered you should be flossing once a day.
Whether you floss in the morning, afternoon or evening, it is up to you.
Whether you want to use floss, interdental brushes, a water flosser or a combination, the most important thing is that you actually clean between your teeth once a day in addition to cleaning the teeth twice a day for 2 minutes.