Dental floss

History

Levi Spear Parmly, a dentist from New Orleans, is credited with inventing the first form of dental floss. In 1819, he recommended running a waxen silk thread "through the interstices of the teeth, between their necks and the arches of the gum, to dislodge that irritating matter which no brush can remove and which is the real source of disease." He considered this the most important part of oral care. Floss was not commercially available until 1882, when the Codman and Shurtleft company started producing unwaxed silk floss. In 1898, the Johnson & Johnson Corporation received the first patent for dental floss that was made from the same silk material used by doctors for silk stitches.

One of the earliest depictions of the use of dental floss in literary fiction is found in James Joyce's famous novel Ulysses (serialized 1918–1920), but the adoption of floss was low before World War II. Physician Charles C. Bass developed nylon floss during World War II. Nylon floss was found to be better than silk because of its greater abrasion resistance and because it could be produced in great lengths and at various sizes.

Use

Dental professionals recommend that a person floss once per day before or after brushing to allow the fluoride from the toothpaste to reach between the teeth. Floss is commonly supplied in plastic dispensers that contain 10 to 100 meters of floss. After pulling out approximately 40 cm of floss, the user pulls it against a blade in the dispenser to cut it off. The user then strings the piece of floss on a fork-like instrument or holds it between their fingers using both hands with about 1–2 cm of floss exposed. The user guides the floss between each pair of teeth and gently curves it against the side of the tooth in a 'C' shape and guides it under the gumline. This removes particles of food stuck between teeth and dental plaque that adhere to dental surfaces below the gumline.

Types of floss

A variety of dental flosses are commonly available. Floss is available in many forms including waxed, unwaxed monofilaments and multifilaments. Dental floss that is made of monofilaments coated in wax slides easily between teeth, does not fray and is generally higher in cost than its uncoated counterparts. The most important difference between available dental flosses is thickness. Waxed and unwaxed floss are available in varying widths. Studies have shown that there is no difference in the effectiveness of waxed and unwaxed dental floss, but some waxed types of dental floss are said to contain antibacterial agents and/or sodium fluoride. Factors to consider in choosing a floss include the amount of space between teeth and user preference. Dental tape is a type of floss product which is wider and flatter than conventional floss. Dental tape is recommended for people with larger tooth surface area.

The ability of different types of dental floss to remove dental plaque does not vary significantly; the least expensive floss has essentially the same impact on oral hygiene as the most expensive.

Factors to be considered when choosing the right floss or whether the use of floss as an interdental cleaning device is appropriate may be based on:

Specialized plastic wands, or floss picks, have been produced to hold the floss. These may be attached to or separate from a floss dispenser. While wands do not pinch fingers like regular floss can, using a wand may be awkward and can also make it difficult to floss at all the angles possible with regular floss. These types of flossers also run the risk of missing the area under the gum line that needs to be flossed. On the other hand, the enhanced reach of a wand can make flossing the back teeth easier.

Dental floss is the most frequently recommended cleaning aid for teeth sides with a normal gingiva contour in which the spaces between teeth are tight and small. The dental term ‘embrasure space’ describes the size of the triangular-shaped space immediately under the contact point of two teeth. The size of the embrasure space is useful in selecting the most appropriate interdental cleaning aid. There are three interproximal embrasure types or classes as described below:

The table below describes the types of interdental non-powered self-care products available.

The table below describes the different types of Interdental powered self-care products available.

Evidence

The American Dental Association has stated that flossing in combination with tooth brushing can help prevent gum disease and halitosis. A 2011 review of trials concluded that flossing in addition to tooth brushing reduces gingivitis compared to tooth brushing alone. In this review, researchers found "some evidence from twelve studies that flossing in addition to tooth brushing reduces gingivitis compared to tooth brushing alone" but only discovered "weak, very unreliable evidence from 10 studies that flossing plus tooth brushing may be associated with a small reduction in plaque at 1 and 3 months."

A 2008 systematic review of 11 studies concluded that adjunctive flossing was no more effective than tooth brushing alone in reducing plaque or gingivitis. The authors concluded that "the dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal." The review also states that "routine instruction of flossing in gingivitis patients as helpful adjunct therapy is not supported by scientific evidence". Two studies found no effect of floss among dental students. One review reported that professional flossing of children reduced dental caries risk, but self-flossing did not.

The US government stopped recommending flossing in their 2015 U.S. dietary guidelines, having deliberately changed their focus to food and nutrition, and stated that effects of flossing had never been researched as required.

Incorrect usage

Although flossing is commonly used as a means of disrupting the oral biofilm between the teeth and therefore preventing gingival disease (such as gingivitis or periodontitis), its effectiveness is determined by the client's preference, technique and motivation to floss daily.

Flossing is considered to be a more difficult method of interdental cleaning than using an interdental brush. Interdental brushes are said to be preferred due to their one-handed method of use and time efficiency compared to flossing.

A groove in the gingival margin, known as a floss cleft, can form after repeatedly using floss incorrectly along the mesial and distal surfaces of the tooth.

Traumatic flossing immediately after the placement of amalgam fillings can also result in an amalgam tattoo.

Floss for orthodontic appliances

It is widely acknowledged in dental literature that orthodontic appliances, such as brackets, wires, and bands, as an outcome of their greater surface area, can harbour greater accumulations of plaque with more virulent changes in bacterial composition, which can ultimately cause a reduction in periodontal health as indicated by increased gingival recession, bleeding on probing, and plaque retention measurements. Furthermore, fixed appliances makes plaque control more challenging and restricts the natural cleaning action of the tongue, lips, and cheek to remove food and bacterial debris from tooth surfaces, and also creates new plaque stagnation areas that stimulate the colonisation of pathogenic bacteria. It is the general consensus among dental academia that patients undergoing orthodontic treatment maintain a high level of plaque control through not only conscientious toothbrushing, but also proximal surface cleaning via interdental aids, with dental floss being the most recommended by dental professionals. As toothbrushing alone is ineffective at removing plaque between tooth surfaces when bonded appliances are in place, clinical studies have demonstrated that dental floss, when used correctly, leads to substantial improvements in proximal gingival health. Although it is clear that orthodontic patients who utilise floss enjoy better gingival health and less plaque retention relative to those who do not, flossing is not always entirely embraced as it can be difficult and more time-consuming, which is shown to discourage a lot of patients from performing this task regularly to prevent dental disease.

Floss threader

A floss threader is loop of fiber that is shaped in order to produce better handling characteristics. It is (similar to fishing line) used to thread floss into small, hard to reach sites around teeth. Threaders are sometimes required to floss with dental braces, fix retainers, and bridge.

Floss pick

A floss pick is a disposable oral hygiene device generally made of plastic and dental floss. The instrument is composed of two prongs extending from a thin plastic body of high-impact polystyrene material. A single piece of floss runs between the two prongs. The body of the floss pick generally tapers at its end in the shape of a toothpick. There are two types of angled floss picks in the oral care industry, the 'Y'-shaped angle and the 'F'-shaped angle floss pick. At the base of the arch where the 'Y' begins to branch there is a handle for gripping and maneuvering before it tapers off into a pick.

Floss picks are manufactured in a variety of shapes, colors and sizes for adults and children. The floss can be coated in fluoride, flavor or wax.

History of floss pick

In 1888, B.T. Mason wrapped a fibrous material around a toothpick and dubbed it the 'combination tooth pick.' In 1916, J.P. De L'eau invented a dental floss holder between two vertical poles. In 1935, F.H. Doner invented what today's consumer knows as the 'Y'-shaped angled dental appliance. In 1963, James B. Kirby invented a tooth-cleaning device that resembles an archaic version of today's F-shaped floss pick.

In 1972, an inventor named Richard L. Wells found a way to attach floss to a single pick end. In the same year, another inventor named Harry Selig Katz came up with a method of making a disposable dental floss tooth pick. In the end of 1980s floss picks became mass marketed in various versions.