Dental floss

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"Dental floss is a soft thread of floss silk or similar material used to clean between the teeth".[1] It is a cord of thin filaments used to remove food particles and dental plaque from between teeth in areas a toothbrush is unable to reach.[2] In dentistry, floss is classed as an interdental (between teeth) cleaning aid. Effective plaque removal is essential for healthy gums and an interdental aid such as floss, is used in addition to toothbrushing as part of regular oral hygiene.[3] The floss is gently inserted between the teeth and wiped along the teeth sides, especially close to the gums or underneath them. Daily flossing is recommended to prevent gum diseases and tooth decay.[2]


In 1815, New Orleans dentist, Levi Spear Parmly, began advising his patients to use a thin silk thread to clean between their teeth.[4] In 1882, a company called Codman and Shurtleft Company began marketing unwaxed dental floss.[4] In 1896 Johnson & Johnson Corporation began developing a dental floss from the same silk material used by doctors for silk stiches.[4] During the 1940’s, nylon replaced silk due to its consistent texture and higher resistance to shredding compared to the silk[4] as well as its rising costs during World War II.[5] This also allowed for the development of waxed floss in the 1940’s and dental tape in the 1950’s.[4] Dr. Charles Bass worked towards making floss an essential part of daily oral hygiene.[5] Today, floss has developed and evolved into many varieties [5] for different versatile purposes. It is stated that nearly 80 percent of people do not floss.[6]


The common advice is that flossing should be carried out once per day prior to brushing to allow the fluoride from the toothpaste to reach between the teeth.[7] The floss is commonly supplied in plastic dispensers that contain 10 to 100 meters of floss. After pulling out the desired amount, the floss is pulled against a small protected blade in the dispenser to sever it then held between the fingers or strung on a fork-like instrument. The floss is guided between each tooth and under the gumline to remove particles of food stuck between teeth and dental plaque that adhere to such dental surfaces. The floss should be gently curved against the side of the tooth in a 'C' shape, and then wiped under the gumline (very gently) to the tip two or three times, repeated on adjacent and subsequent teeth.

Instructions of floss:

1. Cut out approximately 40cms of floss from the container

2. Wrap the floss around each middle finger, until there is approximately 1–2 cm of floss between two hands. Make sure when wrapping around the floss that it is wrapped majority of one side of hand than the other.

3. When flossing the upper teeth hold the floss with the thumb and index fingers and for lower teeth hold the floss down with the index finger only.

4. Set a resting finger either on the cheek or in the mouth

5. With the 1–2 cm of floss remaining unwrapped, hold the floss tightly between the thumbs and forefingers and gently slide the floss between two teeth. Like a saw-like motion (“back and forth”).

6. Curve the floss into a “C” shape around a side of a tooth and clean the tooth surface by rubbing the floss softly up and down a few times

7. Then careful move the floss over the interdental papilla and floss the adjacent surface and repeat step 6

8. Use a seesaw motion and movement out of the interdental space (space between the teeth) and un-wrapping the floss from the either the left or right hand of the middle finger and wrapping onto the opposite hand of the middle finger, so that there is a unused floss

9. Repeat this process on the next interdental space and continue to cleaning the spaces between the teeth until all interdental spaces are cleaned

10. Once complete depose the floss [8][9][10][11]

Types of Floss[edit]

A variety of dental floss are commonly available. Studies have shown that there is no difference in the effectiveness of waxed and unwaxed dental floss.[12][13] Furthermore, there is no significant treatment differences between the three traditional types of flosses; unwaxed, woven and shred-resistant.[13] It ultimately comes down to patient preference and/or ease of use. Floss is available in many forms including waxed, unwaxed monofilaments and multifilaments. Dental floss that is made of coated monofilaments slides easily between teeth, does not fray and is generally higher in cost than its uncoated counterparts. On the other hand, a feature of multifilament floss is the separation of its fibers when used. The most important variable when selecting dental floss is the thickness. Waxed and unwaxed floss are available in varying widths. As mentioned previously, there is no floss that is superior over other floss and factors such as the size of spaces between teeth and patient preference must be considered when deciding the type of floss most suited to the individual.Dental tape is another type of floss product which has a wider and flatter design compared to conventional floss. Dental tape is recommended for individuals that have a larger area of tooth surface to clean.[12]

The material characteristics of floss influence their ability to glide between the contacts of teeth. Polytetrafluoroethylene (PTFE) based flosses are superior to nylon-based flosses in terms of their ease of gliding between teeth.[14]

Some waxed types of dental floss also contain antibacterial agents and/or sodium fluoride. The ability of different types of dental floss to remove dental plaque from between the teeth does not vary significantly,[15]:37 i.e. the very cheapest type of floss has a similar 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:[12] - The tightness of the contact area: determines the width of floss - The contour of the gingival tissue - The roughness of the interproximal surface - The client’s manual dexterity and preference: to determine if supplemental device is required

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.

Individuals who have not flossed before may be put off from flossing when they notice bleeding gums after flossing. This bleeding is often a sign that there is gingivitis (inflammation of the gums), meaning that flossing needs to be carried out regularly, not avoided - but poor flossing technique, using a forceful sawing motion, can damage the tissues and also cause bleeding.

Flossing immediately after the placement of amalgam fillings can result in an amalgam tattoo.[16]


According to the American Dental Association, flossing in combination with toothbrushing can help prevent gum disease[17] and halitosis.[18] A 2012 review of trials concluded that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. In this review, researchers found "some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone" but only discovered "weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months."[19][20] A 2008 systematic review of 11 studies concluded that adjunctive flossing was no more effective than toothbrushing alone in reducing plaque or gingivitis.[21] It has been suggested that these outcomes are caused by the rarity of proper flossing technique,[22] although two studies found no effect of floss even among dental students.[21] One review reported that professional flossing of children reduced dental caries risk, but self-flossing did not.[23]


Although flossing is commonly used as a means of disrupting the oral biofilm between the teeth and therefore preventing gingival disease (gingivitis, periodontitis, etc), its effectiveness is determined by the clients preference, technique and motivation to floss daily.[24][25]

Flossing has been considered a more difficult method of interdental cleaning than using an interdental brush.[24] Interdental brushes are said to be preferred due to their one-handed method of use and time efficiency compared to flossing.[24]

According to Berchier et al. (2008) "The dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal."[26] Berchier et al. (2008) also state that "routine instruction of flossing in gingivitis patients as helpful adjunct therapy is not supported by scientific evidence".[26]

Floss threader[edit]

A floss threader is loop of fiber (similar to fishing line) used to thread floss into small places around teeth. Threaders are sometimes required to floss with dental braces, fix retainers, and bridge.

Floss pick[edit]

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.[27] ossettes.jpg|thumb|400x400px|left|Picture of "D" shaped flossettes]]

History of floss pick[edit]

In 1888, B.T. Mason wrapped a fibrous material around a toothpick and dubbed it the 'combination tooth pick.'[28] In 1916, J.P. De L'eau invented a dental floss holder between two vertical poles.[29] In 1935, F.H. Doner invented what today's consumer knows as the 'y'-shaped angled dental appliance.[30] In 1963, James B. Kirby invented a tooth-cleaning device that resembles an archaic version of today's F-shaped floss pick.[31]

In 1972, an inventor named Richard L. Wells found a way to attach floss to a single pick end.[32] In the same year, another inventor named Harry Selig Katz came up with a method of making a disposable dental floss tooth pick.[33] In the end of 1980s floss picks became mass marketed in various versions.

See also[edit]


  1. ^ Oxford Dictionary: Dental Floss- Definition of dental floss in english from the Oxford dictionary [internet]. 2015 [Cited 30 March] Available from:
  2. ^ a b Colgate. How to floss [internet]. 2015 [Cited 30 March] Available from:
  3. ^ CE Berchier, DE Slot, S Haps and GA Van der Weijden. 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(4):
  4. ^ a b c d e Higgins, C. Mental Floss: A Brief History Of Dental Floss (2007). [cited 27 February 2015]. Available from:
  5. ^ a b c Prichard, D. Spear Digest: A Brief History Of Dental Floss (2013). [cited 27 February 2015]. Available from:
  6. ^ Colgate Oral and Denral Resource Center: Adding “Flossing Teeth” to Your Daily Routine (2015). [cited 27 February 2015]. Available from:
  7. ^ American Dental Association, "Floss and Other Interdental Cleaners". Accessed 12 April 2010.
  8. ^ Darby M, Walsh M. Dental Hygiene Theory and Practice. 3rd Ed. Saunders Elsevier; 2010:pg.426
  9. ^ American Dental Association. How to floss. (accessed 30 March 2015).
  10. ^ Colgate . How to Floss. (accessed 30 March 2015).
  11. ^ Australia Dental Assoociation Inc.. How to use floss properly . (accessed 30 March 2015).
  12. ^ a b c Darby M, Walsh M. Dental Hygiene Theory and Practice. 3rd Ed. Saunders Elsevier; 2010.
  13. ^ a b Terézhalmy GT, Bartizek RD, Biesbrock AR. Plaque-Removal Efficacy of Four Types of Dental Floss. Journal of Periodontology. 2008 Feb;79(2):245-251.
  14. ^ Dörfer CE. Wündrich D. Staehle HJ. Pioch T. Gliding Capacity of Different Dental Flosses. Journal of Periodontology Online. 2001 May;72(5):672-678.
  15. ^ Heasman P (editor) (2008). Restorative dentistry, paediatric dentistry and orthodontics (2nd ed.). Edinburgh: Churchill Livingstone. ISBN 9780443068959. 
  16. ^ Neville BW, Damm DD, Allen CA, Bouquot JE. (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 269–272. ISBN 0721690033.
  17. ^ American Dental Association, Accessed 28 November 2009. What does floss do? Archived February 9, 2009 at the Wayback Machine
  18. ^ American Dental Association, "Bad Breath (Halitosis)". Accessed 28 November 2009. Archived March 6, 2008.
  19. ^ Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV. (2011). "Flossing for the management of periodontal diseases and dental caries in adults". Cochrane Database of Systematic Reviews (12). doi:10.1002/14651858.CD008829.pub2. 
  20. ^ Matthews, Debora. "Weak, unreliable evidence suggests flossing plus toothbrushing may be associated with a small reduction in plaque". Evidence-Based Dentistry 13 (1): 5–6. doi:10.1038/sj.ebd.6400835. Retrieved 4 July 2014. 
  21. ^ a b Berchier CE, Slot DE, Haps S, van der Weijden GA (2008). "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 6: 265–279. doi:10.1111/j.1601-5037.2008.00336.x. 
  22. ^ Winterfeld T, Schlueter N, Harnacke D., Illig J, Margraf-Stiksrud J., Deinzer R., Ganss C. (2006). "Toothbrushing and flossing behaviour in young adults—a video observation". Clinical Oral Investigations. 
  23. ^ Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ (2006). "Dental flossing and interproximal caries: a systematic review.". Journal of Dental Research 85: 298–305. doi:10.1177/154405910608500404. 
  24. ^ a b c Imal P., Yu X., MacDonald D., (2012). "Comparison of interdental brush to dental floss for reduction of clinical parameters of periodontal disease: A systematic review.". Canadian Journal of Dental Hygiene 46: 63–78. 
  25. ^ Bergenholtz A., Brtthon J. (1980). "Plaque removal by dental floss or toothpicks: An intra-individual comparative study". Journai of Clinical Periodontology 7: 516–524. doi:10.1111/j.1600-051x.1980.tb02158.x. 
  26. ^ a b Berchier CE., Slot DE., Haps S., Van der Weijden GA. (2008). "The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: A systemic review". International Journal of Dental Hygiene 6: 265–279. doi:10.1111/j.1601-5037.2008.00336.x. 
  27. ^ "Floss and Other Interdental Cleaners". American Dental Association. 
  28. ^ "Patent US407362 - Combination tooth-pick - Google Patents". Retrieved 2014-04-13. 
  29. ^ "Dental Floss Holder". U.S. Patent. 
  30. ^ "Patent US2076449 - Dental instrument - Google Patents". Retrieved 2014-04-13. 
  31. ^ "Patent US3106216 - Tooth cleaning device - Google Patents". Retrieved 2014-04-13. 
  32. ^ "Patent US3775849 - Dental handpiece attachment - Google Patents". Retrieved 2014-04-13. 
  33. ^ "Patent US3926201 - Method of making a disposable dental floss tooth pick - Google Patents". Retrieved 2014-04-13.