Dental floss (or simply floss) is a cord of thin filaments used to remove food and dental plaque from between teeth in areas a toothbrush is unable to reach, according to Wikipedia.
The use of floss is commonly recommended in order to prevent gingivitis and the buildup of plaque. Namely, the American Dental Association claims that up to 80% of plaque can be eliminated with this method, and flossing may confer a particular benefit in individuals with orthodontic devices. However, empirical scientific evidence demonstrating the clinical benefit of flossing as an adjunct to routine tooth-brushing alone remains limited.
Levi Spear Parmly
Is 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. During the war, nylon floss was developed by physician Charles C. Bass. 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.
Floss became part of American and Canadian daily personal care routines in the 1970s.
Recommended Times Of Use
Dental professionals recommend that a person floss once per day before or after brushing to reach the areas that the brush will not and 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 gum-line. This removes particles of food stuck between teeth and dental plaque that adhere to dental surfaces below the gum-line.
A variety of dental flosses are commonly available. Floss is available in many forms including waxed, unwaxed mono-filaments and multi-filaments. Dental floss that is made of mono-filaments 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 inter-dental cleaning device is appropriate may be based on:
- The tightness of the contact area: determines the width of floss
- The contour of the gingival tissue
- The roughness of the inter-proximal 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.
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 inter-dental cleaning aid.
Is Flossing Really Necessary?
The American Dental Association has stated that flossing in combination with tooth brushing can help prevent gum disease and halitosis.
However, evidence favoring commonplace use of floss remains limited. A 2008 systematic review concluded that adjunct flossing was no more effective than tooth brushing alone in reducing plaque or gingivitis. The authors concluded that routine instruction of flossing in gingivitis patients as helpful adjunct therapy is not supported by scientific evidence, and that flossing recommendations should be made by dental professionals on an individual basis.
A 2011 Cochrane Database systematic review identified “some evidence from twelve studies that flossing in addition to tooth brushing reduces gingivitis compared to tooth brushing alone”, and “weak, very unreliable evidence from ten studies that flossing plus tooth brushing may be associated with a small reduction in plaque at one and three months.”
More recently, a 2019 Cochrane Database systematic review compared tooth-brushing alone to inter-dental cleaning devices, and also compared flossing to other inter-dental cleaning methods. In all, thirty five Randomized Control Trials met the criteria for inclusion, with all but two studies at high risk for performance bias. The authors concluded that “overall, the evidence was low to very low certainty, and the effect sizes observed may not be clinically important.”
As many authors note, the efficacy of flossing may be highly variable based on individual preference, technique, and motivation. Moreover, flossing may be a relatively more difficult and tedious method of inter-dental cleaning compared to an inter-dental brush.
In response to an Associated Press investigation, the US government stopped recommending flossing in their 2015 U.S. dietary guidelines, noting that the effects of flossing had never been researched as required.
The Use Of Floss For Orthodontic Appliances
Orthodontic appliances, such as brackets, wires, and bands, can harbor 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 colonization of pathogenic bacteria.
Patients undergoing orthodontic treatment may be recommended to maintain a high level of plaque control through not only conscientious tooth-brushing, but also proximal surface cleaning via inter-dental aids, with dental floss being the most recommended by dental professionals. Notably, small-scale clinical studies have demonstrated that dental floss, when used correctly, may lead to clinically significant improvements in proximal gingival health.
Threaders And Picks
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.
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.
Dates Of Inter-dental Aids Inventions And Their Inventors
In 1888, B.T. Mason wrapped a fibrous material around a toothpick and dubbed it the ‘combination toothpick.
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 1972, another inventor named Harry Selig Katz came up with a method of making a disposable dental floss tooth pick.
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