Nothing Dentured, Nothing Pained

In my office a hand-lettered sign reads, "You don't have to floss all of your teeth-just the ones you want to keep."
Flossing is the most important step in oral hygiene and disease prevention and also the most neglected step. Many people don't appreciate the importance of flossing and either don't floss often enough, or well enough, or both.

FIRST, WHY FLOSS? Periodontal disease (the cause of roughly 80% of tooth loss in adults) and tooth decay are ongoing processes that begin with plaque--a soft, transparent, sticky layer of harmful bacteria that constantly forms in the mouth. These bacteria convert starches and sugars into irritants and acid. The acid attacks tooth enamel and causes decay, which progresses inward toward the center of the tooth. If left untreated, the decay can reach the pulp, causing infection and often pain. At that point the tooth will need root canal therapy; in severe cases, it may need to be extracted.

 

The irritants formed by plaque inflame the gums. If plaque is not removed daily it can harden into a deposit called calculus, or tartar, that collects under the gumline. Calculus makes plaque removal more difficult. More plaque forms on top of the calculus, further irritating the gums. Left unchecked, the plaque continues to irritate the gums, making them red, swollen, tender and prone to bleed easily. This condition is known as gingivitis. It can be halted by good oral hygiene and professional cleaning. If not treated, the disease often enters a later stage--periodontitis.

In periodontitis the irritated gums pull away from the teeth, forming pockets between teeth and gums. These fill with bacteria and pus and generally become deeper. When that happens, surgery may be needed to save the teeth. If left untreated, the bone supporting the teeth can be destroyed. The teeth begin can to shift or become loose. Eventually, they fall out or must be extracted. Periodontal disease is often painless and you may not be aware that you have the disease until your mouth has sustained serious damage.

 

While all this sounds pretty grim, the very good news is that decay and periodontal disease are entirely preventable--by removing the plaque on your teeth daily with correct brushing (as described in my last article) and flossing. Although brushing removes the plaque from some tooth surfaces, only flossing removes plaque from between the teeth and under the gumline. These spaces are built-in sanctuaries for bacteria and food debris.

Some practice is need to become adept at flossing, so don't become discouraged if you find it difficult at first. After you become proficient, flossing takes only a few minutes and doesn't even require a mirror.

NOW, HOW TO FLOSS. Thin unwaxed floss is generally best. It is abrasive enough to remove plaque very nicely. If you find the floss is breaking, you may want to try shred-resistant, lightly waxed, or waxed floss. Try different brands until you find one you can use comfortably. Perhaps the best brand to use if you have trouble getting floss between your teeth is a product called Glide Floss. It’s a Teflon coated mono-filament of Gortex and will go easily where no floss has gone before.

1. Break off about two feet of floss and wind it around the middle fingers of both hands at about the level of the first joints, with most of the floss on one hand. The finger of the other hand is used to take up the floss as it becomes soiled (figure 1).


2. There should be about one inch of floss held tightly between your thumb and forefinger for your upper teeth, and between both forefingers for the lowers (figure 2). There should be no slack. Use a gentle, sawing motion to glide the floss past the contact between the teeth. Never snap the floss into the gums.



3. When the floss reaches the gumline, curve it into a C-shape against one tooth. Gently slide it into the space between the gum and the tooth until you feel resistance.

 

4. Hold the floss tightly against the tooth (remember—you want to clean the tooth, not damage the gums). Gently scrape the side of the tooth, moving the floss away from the gums (figure 3).

5. Without removing the floss, curve it around the other tooth and scrape it, too.

6. Repeat on the rest of the teeth. Don't forget the back of the last tooth.

If you don't have good finger dexterity, you may find it helpful to use a commercial floss holder. You might also try on of the two new electric flossing devises that have just come out, one made by Oral B and one made by Water Pik. Since these electric flossers are new and have not had much evaluation, I do not recommend them yet. They both work by having a small vibrating filament that is inserted between the teeth (they get costly to use, as the filaments must be changed very often).

 

Most children can't floss their own teeth until about age 8 or 9. Even then, flossing should be supervised.

Establish a pattern and a regular time for flossing so that you don't miss any of your teeth.

Your gums may be sore or bleed for the first week or two you floss. As the environment gets cleaner and healthier, your gums will heal and the bleeding will stop. If not, consult your dentist. Improper flossing can injure your gums. Remember to be gentle when inserting the floss between your teeth and under the gumline.

 

You are now armed with enough information to keep your mouth in excellent health. "May the Floss Be With You!"

-Richard B. Shapiro, D.D.S. 
Reprinted from The Bond Community Star