Dental floss grabs much attention among devices used to access and remove interdental plaque
Inadequate removal of pathogenic interproximal dental plaque may progress to gingivitis and approximal caries.(1,2) Since more than 50% of adults have gingivitis, and the interdental areas may be more susceptible to periodontal disease, it is essential for patients to adequately remove interproximal dental plaque to promote oral health.(2,3,4) Various devices are designed to access and remove interdental plaque, and dental floss receives the most attention of all the interproximal devices.(2,5)
Dental floss is intended to remove plaque and food debris from interproximal areas that a toothbrush may not be able to access. The ADA has reported that floss removes up to 80% of plaque from interdental areas and recommends to incorporate floss as part of a daily oral care routine(6,7) as does CDA, ADHA and CDHA. When the proper technique is utilized, floss has demonstrated clinical efficacy with removing interdental plaque and reducing gingivitis.(3,8) However, in-home studies reveal that only 2% to 10% of patients regularlypoint perform acceptable flossing and that most cannot or will not floss on a daily basis.(9) According to Warren et al, there is conflicting data regarding floss efficacy as some studies support significant plaque removal from flossing whereas other studies have demonstrated an unclear benefit of flossing as compared to toothbrushing alone.(2) In 2008, a systematic review conducted by Berchier et al regarding plaque removal and gingivitis reduction of dental floss concluded that there is insufficient data to support routine flossing as a beneficial adjunct for reducing gingivitis and that flossing does not provide a plaque removal and gingivitis reduction benefit beyond brushing alone.(10) Similarly, a review conducted on the benefits of flossing on interproximal caries demonstrated that the data on flossing and interproximal caries reduction is difficult to interpret due to inconsistency across study results and that there have been no studies assessing real-world conditions and the benefits on interproximal caries reductions in an adult population.(11) However, the authors of both reviews encourage dental professionals to assess the benefits of “professional-quality flossing” based on a patient’s needs and capabilities.(10,11)
1. Graves RC, Disney JA, Stamm JW. Comparative effectiveness of flossing and brushing in reducing interproximal bleeding. J Periodontol. 1989; 60(3): 243-247.2. Warren PR, Chater BV. An overview of established interdental cleaning methods. The Journal of Clinical Dentistry. 1996; II(3):65-69.3. Finkelstein P, Grossman E. The effectiveness of dental floss in reducing gingival inflammation. J Dent Res. 1979; 58(3):1034-1039.4. Oliver RC, Brown LJ, Löe H. Periodontal diseases in the United States population. J Periodontol. 1998;69:269-278.5. Bauroth K, Charles CH, Mankodi SM, Simmons K, Zhao Q, Kumar LD. The efficacy of an antiseptic mouthrinse vs. dental floss in controlling interproximal gingivitis: A comparative study. JADA. 2003; 134:359-365.6. Council on dental Therapeutics, American Dental Association. Accepted Dental Therapeutics, 40th ed., Section III, 1984.7. American Dental Association. Floss and Other Interdental Cleaners. www.ada.org/1318.aspx.Accessed March 2011.8. Lobene RR, Soparkar PM, Newman MB. Use of dental floss effect on plaque and gingivitis. Clinical Preventive Dentistry. 1982; 4(1):5-8. 9. Bader HI. Floss or die: implications for dental professionals. Dent Today. 1998;17:76-82.10. Berchier CE, Slot DE, Haps S, Van der Weigjden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. International Journal of Dental Hygiene, 2008; 6:265-279.11. Hujoel PP, Cruz JC, Bantin DW, Loesche WJ. Dental flossing and interproximal caries: a systematic review. J Dent Res; 2006. 85(4):298-305.12. Colgate Oral and Dental Health Resource Center. How to Floss. www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Oral-Hygiene/Brushing-and-Flossing/article/How-to-Floss.cvsp. Accessed March 2011.13. Morris A, Santos S, Sinatra K, Cronin M, Goyal CR, Sharma N, Dembling W, Qaqish K, Qaqish J, Perfekt R, Wu MM, Demissie S, McGuire JA, Gell C, Queiroz D, Coelho J. Plaque removal of a revolutionary monofilament floss with flexible MICRO-GROOVES (ABSTRACT #1574). IADR/AADR 87th General Session and Exhibition, April 1-4, 2009.14. Morris AD, Santos SL, Cronin MJ, Goyal CR, Sharma NC, McGuire JA. Comparative plaque removal evaluation of two floss technologies (ABSTRACT). The Journal of Dental Hygiene; 2009. 83(4):206.15. Ciancio SG, Shibly O, Farber GA. Clinical evaluation of the effect of two types of dental floss on plaque and gingival health. Clinical Preventive Dentistry; 1992. 14(3):14-18.