Brush and floss…brush and floss…brush and floss…
You hear that so often, you start thinking that’s the order in which you need to do them: Brush, then floss. Brush, then floss.
But is that the best way?
Many insist that it doesn’t really matter so long as you do both thoroughly. Brushing breaks up the biofilm (plaque) that forms on the exposed sides of your teeth. Floss destroys the biofilm from between your teeth and along the gum line. Between the two, you keep harmful microbes – bacteria, viruses, fungi – from overwhelming the good bacteria that also lives in your mouth.
And according to recent research, it does make a difference which one you do first.
The study observed a group of students for 5 weeks. During the first two, the students flossed first, then brushed. For the last two, they brushed first, then flossed. The week between, they followed their usual hygiene routine.
At the end, the researchers found better plaque control when students flossed first – “more statistically significant improvements over brushing followed by flossing,” as the authors put it.
The study was published in Oral Health and Preventive Dentistry.
“But I HATE Flossing!”
Fortunately, there are other methods of cleaning below the gum line and between the teeth: interdental (or interproximal/”proxy”) brushes, woodsticks, and oral irrigators such as Waterpik. According to a research review published early last year in the Journal of Clinical Periodontology, all of these are effective for removing plaque.
Waterpik is our favorite option – Dr. Y’s go-to, in fact, for controlling and preventing gum disease. Not only does it reduce plaque; it flushes bacteria from the periodontal pockets, as well. These pockets form as bacteria run rampant in the space between your gums and teeth, an area called the sulcus. As pathogens destroy tissue, the sulcus gets deeper – and more hospitable to harmful bacteria.
Pockets over 3mm deep are a sign of gum disease’s progression – and a sign that ramped up hygiene is called for. That includes oral irrigation.
Studies have shown that daily oral irrigation has the potential to suppress periodontal pathogens located within the pocket. Oral irrigation has demonstrated a reduction in proinflammatory mediators. Periodontal disease causing bacteria cause an increase in cytokine levels, which leads to bone resorption. Daily oral irrigation leads to a reduction in pro-inflammatory cytokines that leads to a slight, but significant, improvement in mild to moderate periodontal disease. In addition, oral irrigation has demonstrated a significant reduction in bleeding, gingivitis, periodontal pathogens and probing depths.
And this is exactly what we see among patients who have made oral irrigation a regular part of their home care.
Irrigation can be done with just plain water, though Dr. Y suggests adding a bit of baking soda or sea salt. Both have good antimicrobial properties.
In fact, baking soda is helpful for oral health in general. More and more, we recommend brushing with plain baking soda instead of toothpaste. Not only do you get the antimicrobial benefit; its grit helps remove plaque and surface stains. Just wet your toothbrush, dip it in baking soda, and brush.
It’s a lot less expensive than toothpaste, too. (A few dollars will get you 5 pounds of it!)
The main thing? Clean your teeth. All sides. Between them. Along and below the gum line. Thoroughly. Regularly. Brush twice a day. Irrigate once a day.
It’s one of the best things you can do to get the better of gum disease – or keep it from developing in the first place. More than half of all adult Americans have the severe form, periodontitis. Nearly all – as many as 75% – have some degree of infection.
Following good hygiene practices can help make you exceptional!