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Daily flossing: the essentials: make the case to patients with scientific approach.

Getting patients to floss daily can be challenging. Explaining the many benefits, including how flossing affects both oral and overall health, including the cardiovascular system, is perhaps the dental assistants' best opportunity for encouraging patients' diligence.

Floss is made from Nylon or Teflon material, but beyond that, floss options abound--waxed or non-waxed, flavored or not flavored, and more. The type of floss used is simply a matter of personal choice; what's important is to floss daily. To better understand how this tiny string that removes food debris between the teeth is so important, patients need to understand how plaque, or clear biofilm mass of bacteria, is developed in the mouth. Millions of bacteria, which love a warm moist atmosphere to replicate, live in the oral cavity--an environment of approximately 98.6 degrees Fahrenheit. The oral cavity is an atmosphere that incubates bacteria. When that bacteria is not removed properly, especially between the teeth, dental problems occur.

Plaque Basics

Dental plaque is composed of food fragments, microbes, glycoproteins, or proteins found in saliva. It is transparent in color and invisible to the naked eye. When plaque isn't removed between the teeth, it adheres to teeth, forming a hard-mineralized bacterial matrix substance called calculus, or tartar. Issues like gingivitis, which can lead to periodontitis or inflammation of the gums, occurs when plaque isn't removed in time.

Due to its hard bacterial-complex matrix formation, dental calculus is not easily removed. It is especially difficult to reach the calculus with a toothbrush between the teeth and below the gum-line, or cervical margin. The bacteria can enter the crevasse of the gum and destroy the periodontium or supporting structures surrounding the teeth, such as bone and gingiva.

Flossing should be done at least once a day to make sure food debris and other microbes are removed from the teeth before the dental calculus hardens from dental plaque; it takes about 12 hours or so for the formation of the bacterial matrix to harden. Because the anatomy of the gums surrounding the teeth have almost like a pocket or a crater filled with space, food debris or plaque can easily lodge inside the gum, causing a place for bacteria to replicate and release acid, particularly lactic acid, causing inflammation and even bleeding gums due to the irritation of the bacteria. It's this bacterial acid that causes gum disease and cavities.

The acid is primarily formed from the bacteria as a waste product. Oral bacteria use sugar as an energy source. The bacteria releases acid or metabolic waste that prompts inflammatory fighters, commonly known as neutrophils and other white blood cells.

The mouth has a normal pH of 7.1, and when the bacteria releases acid, the mouth becomes more acidic of pH between 4.3-5.5, creating a more susceptible environment for the bacteria to colonize, causing dental cavities between the teeth where a toothbrush cannot reach, but dental floss can.

If, overtime, more bacteria accumulates between the teeth, the bacteria enter the PDL space or periodontal ligaments around the gum--specialized connective tissue that keeps the tooth attached or anchored to the bone. The gingival crevicular fluid Is then released, which is inflammatory exudate (or pus) that fights the infection with a team of white blood cells, causing more inflammation of the gums. Eventually, periodontitis occurs; the bacteria reaches the bone, causing irreversible destruction of the teeth.

Clearly, flossing is essential for overall body health. Periodontitis or gum disease is correlated with other serious systemic disease such as heart conditions. While the link between the two are still being studied, periodontitis is of particular concern for individuals who are predisposed to stroke or other cardiovascular issues.

Proper Technique

According to American Dental Association, interdental cleaning, whether floss or any other device such as floss threaders or floss picks, are vital to dental health and have been proven to help remove the plaque buildup that contributes to gum disease and cavities.

Because the gingiva is made of connective tissue covered with mucous membrane that can easily be injured, proper flossing technique is important, especially where the adjacent teeth are very close together or when an there are wide open spaces between teeth.

Gingivitis and periodontitis are preventable with proper flossing, which takes only two to three minutes a day. For dental patients, flossing can become a healthy habit in conjunction with brushing and using mouth rinses. Flossing can even be meditative and relaxing; it doesn't have to be a chore, but rather a stress reliever. 7)

Albina Babakhanov, RDA, began her dental career in 2005 in Boston. She holds a Dental Assistant Certificate as well as an associate's degree in science from Bunker Hill Community College. She plans to pursue her bachelor's degree in public health to further explore the field of science and dentistry.


Federal Government, ADA Emphasize Importance of Flossing and Interdental Cleaners, (n.d.). Retrieved October 15, 2016, from statement-from-the-american-dentalassociation-about-interdental-cleaners

Gum Disease and Heart Disease | (n.d.). Retrieved October 15,2016, from

Gingival crevicular fluid. (2007, July 24). Retrieved October 16, 2016, from
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Author:Babakhanov, Albina
Publication:The Dental Assistant
Geographic Code:1USA
Date:Jan 1, 2017
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