What is the proper technique and frequency for using floss (interdental floss) in daily oral hygiene?

Proper Technique and Frequency for Using Dental Floss

Dental floss should be used once daily with proper technique, including gentle insertion between teeth and using a C-shape motion against each tooth surface to effectively remove interdental plaque and reduce gingivitis. 1

Recommended Flossing Technique

Basic Technique

• Use approximately 18 inches of waxed floss to minimize trauma to the gums 1
• Wind most of the floss around the middle fingers of both hands, leaving 1-2 inches to work with
• Hold the floss tightly between thumbs and forefingers
• Guide the floss gently between teeth using a sawing motion to avoid snapping the floss against the gums
• Curve the floss into a C-shape against one tooth and slide it gently into the space between the gum and tooth
• Rub the floss gently up and down against the side of each tooth 2, 1
• Use a clean section of floss for each tooth pair

Advanced Technique (AHVFT - Adapted Horizontal Vertical Flossing Technique)

Research shows this technique may be more effective:

• Insert floss between teeth
• Move floss horizontally against one tooth surface
• Then move vertically up and down against the same surface
• Repeat for the adjacent tooth surface 3

Frequency and Timing

• Floss once daily, preferably in the evening before brushing teeth 1
• Studies show that daily flossing can reduce interproximal bleeding by up to 70% over 8 weeks when using proper technique 3

Flossing Aids and Alternatives

• Traditional string floss is effective when used correctly
• Floss loops may improve plaque removal compared to traditional floss for some users 4
• Water flossers can be an effective alternative, especially for:
  • People with dexterity issues
  • Those with orthodontic appliances
  • Patients with dental implants
  • Individuals with bridges 5

Common Pitfalls and How to Avoid Them

Technique Issues

• Snapping floss against gums: Use gentle sawing motion to guide floss between teeth
• Not reaching below the gumline: Ensure floss curves around the base of each tooth
• Using too short a piece of floss: Always use at least 18 inches
• Reusing the same section of floss: Move to a clean section for each tooth pair
• Flossing too aggressively: Use gentle pressure to avoid gum trauma 1

Compliance Issues

• Inconsistent flossing: Set a daily reminder
• Difficulty with traditional floss: Consider floss holders, floss loops, or water flossers
• Bleeding gums: This often indicates gingivitis and is a sign to continue flossing, not stop 1

Special Considerations

For Patients with Gingivitis

• Flossing is particularly important for reducing gingival inflammation
• Expect some bleeding initially, which should decrease with regular flossing
• Consider combining flossing with an antimicrobial mouthrinse for enhanced results 6

For Cancer Patients

• Patients undergoing cancer therapy should maintain good oral hygiene including daily flossing
• If already accustomed to flossing, continue during treatment
• If not accustomed to flossing regularly, do not start during cancer therapy as it may break the epithelial barrier 2
• Consult with a dental hygienist/dentist about the most appropriate interdental cleaner 2

Evidence of Effectiveness

• Daily flossing combined with proper brushing significantly reduces gingivitis and gingival bleeding 6, 3
• The effectiveness of flossing is technique-dependent, with proper instruction leading to significantly better outcomes 3
• When comparing different interdental cleaning methods, proper technique is more important than the specific tool used 7

Remember that while flossing is essential for interdental cleaning, it works best as part of a comprehensive oral hygiene routine that includes twice-daily brushing with fluoride toothpaste and regular dental check-ups.