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To Floss or Not to Floss?

SCM-COVER-080911 copy.inddby Chris Edwards, DDS

August/September 2011

Sharp Pain, Sensitivity Characterize Condition

FLOSSING ALLOWS for the removal of the biofilm called plaque from between the teeth. Biofilm is comprised of bacteria and a sticky matrix secreted by the bacteria. The bacteria replicate and eat the foods we eat. The byproduct of this is the secretion of acid, which causes the breakdown of the enamel. Once the enamel is compromised and made porous, the bacteria can enter the tooth and start decaying the inside of the tooth.

Flossing is the most important aspect of home care. Historically, it has been all about brushing your teeth after every meal. Recent evidence and understanding of the oral-systemic connection has shown the importance of controlling the bacteria in the mouth. To do that effectively you need to floss.

What does flossing accomplish? Flossing allows for the removal of the biofilm called plaque from between the teeth. Biofilm is comprised of bacteria and a sticky matrix secreted by the bacteria. The bacteria replicate and eat the foods we eat. The byproduct of this is the secretion of acid. Acid is what causes the breakdown of the enamel. Once the enamel is compromised and made porous, the bacteria can enter the tooth and start decaying the inside of the tooth (the dentin). The same bacteria are recognized by the body’s immune system and is the basis of gum (periodontal) disease

If this biofilm is not removed regularly the bacteria will continue to mature and start developing calcified deposits on the side of the tooth. When the bacteria and these deposits are under the gum there is an intensifying inflammatory response that is set up by the white blood cells inside the gum. Unfortunately, our immune system cannot “grab” and engulf and destroy these bacteria, which are effectively “outside” the body.

This inflammatory response is the first stage of gum disease. The gums get swollen which leads to a deeper space for the bacteria to hide and replicate. This happens between the teeth and flossing is the most effective way to remove the bacteria that are adhering to the side of the tooth, particularly under the gum. As time progresses, the plaque organizes and more bacteria, some more pathologic, start moving in. The inflammatory response progresses, and often the resultant bleeding response is not even evident, primarily because the area where the fight is going on isn’t being brushed or flossed. The disease progresses and then flossing becomes only partially beneficial as the more tenacious deposits are not removed by the floss, and can only be removed by a professional scaling from a hygienist or dentist.

The inflammatory response continues and the depth of the problem increases under the gum. Often there is destruction of the jawbone that surrounds the root. This is now called Periodontitis and is a much more serious problem, that, if not treated, can lead to serious health problems as well as infection and loss of the tooth.

Clean Below the Gum

The cornerstones of good oral health are regular visits to dental professionals for removal of the biofilm and excellent oral hygiene.

Excellent oral hygiene is the removal of the biofilm (plaque) from the surface of every tooth once every 24 hours. It takes that long for the bacteria to colonize enough to start creating damage. The most important area to clean is the surface that is below the gum.

A soft toothbrush should be angled at a 45-degree angle to the gum and with short strokes the bristles will remove the biofilm from the surface of the tooth as deep as 3 mm under the gum. Flossing this area is critical and requires the curving of the floss to the shape of the root and sliding it under the gum as far as it will go without hurting the gum. This can cause bleeding in a diseased situation, but it will start a healing response and a gradual daily decrease in bleeding.

Detecting Proper Plaque Control

The use of disclosing tablets will often leave a layer of plaque visible to the naked eye on the tooth. The plaque is most commonly at the gum line and between the teeth. It is usually the heaviest at the gum line on the tongue side of the teeth. Going back with the floss and brush to remove this stain is the best way to improve one’s technique and show areas on which to concentrate.

Numerous studies have established the link of Periodontitis with heart attacks, strokes, diabetes, prostate cancer and other conditions. This is not a condition to take lightly. The investment in daily flossing is perhaps the best investment in dental health and can prevent dental caries and periodontal disease and help avoid dental treatment. Couple this with regular visits to the dentist for professional cleanings and exams and you are on the road to oral health.

There are numerous resources to learn how to floss. It takes practice and it is often helpful to use a mirror and good lighting to observe your technique. There is information at the ADA website. www.ada.org/. There is also a flossing video on the SmileTube at www.SmileDesignCenter.us

 

What kind of floss works best?

  • The question of the type of floss is not as important as the quality of the scraping, conforming the floss to the root and getting all of the way under the gum.
  • There are a lot of prepackaged floss holders and devices available. They are not as effective as control of the floss with the tips of the fingers but certainly more effective than not flossing at all.
  • Interproximal brushes and tooth picks are helpful but are not as effective at getting “under” the gum like floss can. They are more effective at removing food than plaque.

 

 

Dr. Edwards graduated from the United States Merchant Marine Academy and Temple University School of Dentistry. He completed a general practice residency at the Queens Medical Center in Honolulu. To reach Dr. Edwards you may call 321-751-7775 or visit www.SDICFL.com