Today, I would like to share my thoughts on the ongoing debate between dental floss and interdental brushes, and what we should be recommending to our patients to enhance their oral health. I will begin by sharing a few recent studies that I have found that are relative to this subject:
Recently, a report by the Associated Press has found that no scientific evidence has proven the effectiveness of flossing and, as a consequence, the US Department of Health removed its recommendation to use dental floss from its latest guidelines. This report sent a shock wave through the dental community. It brought back to the surface the debate between flossing and its alternatives. In light of this situation, we asked ourselves the following question:
Which alternatives to dental floss would both patients and science love?
We strongly believe that patients will benefit most by using a dental aid that they are motivated to use and that science has proven to be efficient. It made us think of a 4-year study done by the University of British Columbia (which conclusions were published in the Canadian Journal of Dental Hygiene*). Some interesting conclusions were:
“Patients rarely use dental floss.”
If patients do not have the dexterity or motivation to use dental floss, how should we expect them to use it? This study demonstrated that patient’s compliance is directly associated with the ease of use they experienced and their motivation. It is important to specify that this study does not suggest to stop using dental floss altogether, because it could definitely be a good solution for the anterior teeth if applying the right technique.
“Interdental brushes are easy to use and well accepted by patients.”
The study found that patients were more than twice as likely to agree that interdental brushes were easier to use than dental floss.
“Interdental brushes significantly reduce bleeding sites.”
When using dental floss or an interdental brush that is not adequate for the interdental space, there is still approximately a third of it that remains unreachable. It is not surprising that many patients who floss, still arrive in our office with caries and gingivitis! To be efficient and to manage inflammation, patients must use interdental brushes that completely fill their interdental spaces.
Another study done in 2015** outlined something that we should all be proud of as dental hygienists and dentists:
“Colorimetric probe and interdental brushing is more beneficial than interdental brushing alone.”
As you may already know, there is an interdental brush system that offers an interdental probe which determines (with a specific color code) the brush size that completely fills the interdental space. This would be done at chair-side during the oral hygiene instruction portion of the appointment. We should be happy about this because it means the treatment that we provide to our patients will be more beneficial as we are educating them on how to best use it!
In fact, since all root morphologies and interdental spaces are different, it is illogical to believe all interdental brushes or dental flosses will fit properly and remove effectively the biofilm. This is why, when using a colorimetric probe to determine the interdental space size, not only do we ensure optimal biofilm removal, but it forces us (and the patients) to better understand why and how they should use an interdental brush.
As a former practicing dental hygienist, I know all too well how frustrating it can be to see patients at their recall appointments and realize there are little to no improvements. It is mainly due to their lack of motivation as the tools available to them are too difficult to use making it impossible for them to see a difference.