The Good, the Bad and the Ugly of String Floss

Hi everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way.

Welcome to today's show on the good, the Bad and the ugly about dental floss. But before we get into it, I really want to thank all of you for listening and all the comments and the good feedback I'm receiving about the information that I bring forward. And for those of you who were having trouble and really wanted to go to my YouTube channel and find the podcast shows, because some of my guests are demonstrating certain things, I was demonstrating certain techniques, especially when we talk to brushing. Now those videos have been edited and uploaded. So go ahead and visit my YouTube channel, YouTube.comaskdoctorsanda.a S K D R S A N D A and we have a whole side that's actually dedicated towards podcast shows. But what about flossing? The reason why I wanted to talk about this topic is because string floss is being pushed by pretty much most dentists and most hygienists. Floss, floss, floss. But is it really the best tool to use? So I actually went into research online, all the articles that have been written lately on string floss, and you're going to be surprised of what I found. What is dental floss? Well, dental floss is really a string is a tool that helps us remove plaque from areas in between the teeth where the toothbrush doesn't really completely reach. According to most sources, credit for the invention of dental floss as we know it goes to a New Orleans dentist in 1815 who began advising his patients to use a thin silk thread to clean between their teeth. 1815. So this idea of string floss is really archaic and that's what I'm trying to point out here. When this first got started, it was just a tool to be used. But the idea caught and in 1882, a company called the Codman Shirtloft Company based in Massachusetts, began to market an unwaxed silk dental floss. This was followed in 1896 by the first dental floss from Johnson and Johnson. So we're talking here over 100 years ago, they used silk because at the time we didn't really have plastics. The New Jersey based JJ took out a patent on dental floss in 1898, right around the Same time that the ozone machine was actually invented by Nikola Tesla. Interesting coincidence, that was made from the same silk material used by doctors for silk stitches. Because again, they didn't really have anything else. And silk was pretty durable in the 1940s and 50s when plastics were more available. That's when a lot of the dental floss innovations came about. During the 1940s, nylon replaced silk as the material for dental floss. A consistent texture and resistance to shredding were an improvement over the silk version of dental floss. The use of nylon also allowed for the development of waxed floss in the 1940s and also dental tape in the 50s. Why dental tape? Because at the time, people had a lot of gaps in between the teeth, and string floss just wasn't sufficient enough. So dental tape was great for bridges, for big open holes in between the teeth. What about dental floss today? A variety of types of dental floss were expanded to include newer materials such as Gore Tex, the same thing that's used for in sports and hiking, outdoor activities, and different textures, such as spongy floss, which is called super floss as well, and soft floss. Today's floss has other features to make flossing easier. For example, floss with stiffened ends. And this is designed to help with flossing around braces or around other dental appliances. The choices for dental floss are unwaxed waxed dental tape or ptfe. It really falls in through those four categories in terms of the type of texture and material that the floss is made out of. The unwaxed floss is, like, basically made out of nylon. Many, many little threads, usually about 35, that are twisted together, and it could fit really into tight places. But I'm sure some of you have noticed, especially if you have tight contacts, if you're trying to floss with unwaxed floss, it's going to shred. And if you have those little pieces of floss that get stuck in between your teeth, they could be a real pain to take out. I know this because it's happened to me many times. And oftentimes you're trying to jam, now another piece of floss in between the teeth, trying to get these little threads out, and all you're going to end up doing is cutting the gum. Because as you're forcing the floss in, and then all of a sudden it snaps. So floss injuries are common. Is that a problem for the gums, you might ask? Of course it's a problem. If you're gonna jam floss there or worse even leave floss in between your teeth. The floss can actually gather bacteria. But if you're pushing down really hard against the gums, it's going to cut the gum and injure the gum. The gum is attached to the tooth via a little muscle attachment and if you're going to damage that attachment, it doesn't heal necessarily in the same place. So being very aggressive with floss and I see a lot of people flossing this way, they take the floss and snap it vigorously in between the teeth. That's just definitely not a way to to floss correctly if you're going to use string. Waxed floss is a better version of the unwaxed floss. And why is that? Wax produces the soft basically lining, this slippery lining that allows you to move floss in between tight contacts in between the teeth. A lot easier than on wax floss. And typically we see a lot less shredding with with wax floss. But the problem with the wax, the wax itself, usually it's a petroleum based material and it's not necessarily healthy to use. Dental tape is a broader and flatter than standard floss and it comes in waxed and unwaxed versions. And again, this is meant for bigger space in between the teeth. Often people that have experienced gum disease. PTFE floss. I really want to talk about this because this is the latest on the market. Glide makes a PTFE type of floss and the material slides very easily in between the teeth and it's less likely to shred compared to standard floss. So I know a lot of you like Glide floss. A lot of my patients love Glide floss because it's easy. However, it doesn't clean as well. The back bacteria doesn't get picked up on the PTFE floss as it does on the unwaxed floss. Super flosses are thicker and they're made more like of a yarn like material has stiffer section so it can go around the braces and dental bridges. Again made out of nylon flavored floss. Now do you think artificial flavors are any good for your body? I think not. Very rarely you can find a naturally flavored floss. And why you might think why do people have flavors to the floss? Is it really to make you floss more? Is it really working? I highly doubt it. I actually saw a statistics that the average of floss length used in a year by one person is 18 inches. So we have 365 days in the year. And if you're only using 18 inches in that one year. That means most people floss once a year, if that. There's certain healthier flosses that I really like, like cocoa floss and Dr. Tongue and some people like the dental floss picks. You might have seen those. They're like basically a plastic device with about an inch or less of floss in between. They can easily grab in between your fingers, almost like a handle, and use that to floss in between. My problem with that, I see them everywhere. I see them thrown away in the parking lot, on the street, and they just accumulate more plastic in the world. If you're going to use those, please do the right thing and at least put them or recycle them. But in my opinion, there's just based on the research that I've done, there are better tools out there. A handheld flosser, for example, you can use that. And those hold the flosser handle firmly. Point the flossing tip at an angle facing the area you want to floss first, then glide the floss between the two teeth. Don't snap the floss. This is very, very important. Use a zigzag type of motion, whether you're going to use your two hands in a zigzag motion or, you know, you can use a little dental floss pick or the handheld flosser zigzag motion to get it in between the contacts. But not everyone can floss their teeth easily. For example, young children who just learn to floss, or older adults who might have really arthritic hands and limited finger flexibility. Anyone who really doesn't like to put their fingers in their mouth, I mean, you have to use a different tool. Flossing correctly is a difficult technique. You actually have to wrap it in between your hands, be able to go all the way behind the last tooth and wrap it like a C around each tooth, the front tooth and the back tooth. So this becomes a little bit more technical. How many people actually floss correctly? I would say most people don't. In my practice. Oftentimes I see floss cuts or what are those actually damage on the gingiva or actually point it out to patient. I say, oh, I see you've been flossing very vigorously, but if you repeatedly injure your gum over and over again, you're actually also end up injuring the bone that's underneath the gum. So what I see oftentimes in areas of floss cuts is gum recession. And a lot of people think gum recession is just the gum basically. That's coming away and expanding, exposing the root. It's actually also bone loss. That root needs to be covered by bone and then covered by gum. So be careful. With string floss, you have to really use the 18 inches. If you look at a lot of the instructions, you know it says wind the 18 inches of floss around either the middle finger or the index finger, whichever you prefer, and a small amount onto the middle or index finger of the other hand. Using the middle finger leaves your index finger free to manipulate the floss. That sounds like a lot. And it is for most people. That's why most people don't floss. Pinch the floss between the thumbs and the index finger, leaving 12 inches in between. Use the thumbs to direct floss between the upper teeth. So already a lot of you probably got lost in that explanation. Probably. An easier way to remember is guide glide and slide. You guide your floss in place, you glide it in a zigzag motion and you slide it out. And it really doesn't matter whether you want to start with your upper or lower teeth or whether you start in the front or the back. Just make sure that you floss all your teeth, including the backside of every last tooth that you have in your mouth. And also important, don't forget to floss under the gum line because there's bacteria that's actually sitting right under the gum line. When do you want to start flossing? Really? As soon as we have permanent teeth. Kids that have primary dentition, usually they have a space in between and you can easily evaluate or examine your kids teeth. If you see that the teeth are crowded already and they're really close together, you might want to have them start to floss. Not necessarily string floss. I think kids are much easier with a water flosser to use, especially because some of them don't have the dexterity. Now let's look at some of the studies that I actually found. By all means, if you are a great flosser and you love your floss and your dentist tells you, oh, you know, you're doing a great job, continue to floss. But for the 80% of you plus that are not flossing correctly, this is going to be interesting. So listen up. I actually found an article that was published looking at the home use of interdental cleaning devices in addition to toothbrushing for preventing and controlling gum disease and dental cavities. This was published in 2019 in the Cochrane Database. This is a large database of scientific articles. And basically the article says the following using floss and interdental brushes, which are basically those little brushes that sometimes look like Christmas trees. They're made out of nylon bristles and they have a handle that's an interdental brush. So using string floss or interdental brush in addition to tooth brushing may reduce gingivitis or plaque or both more than toothbrushing alone. However, those little brushes are more effective than string floss. So if you find that you don't like string floss, move to one of those interdental brushes. According to some national population surveys, 1/3 of the general population, 34%, uses dental floss, while only 18% of the population uses the interdental brushes, which in fact are actually more effective against plaque and inflammation. Traditional dental floss, on the other hand, has been linked to infection such as peri implantitis, which can lead to dental implant failure. This is in the same article that I mentioned and I will have a link below in the show notes so you can look it up. This is because dental floss, especially when used around dental implants, is prone to shredding. When dental floss shreds, it leaves particles or pieces behind that can become trapped between the implant and gum issue, resulting in an infection. I know a lot of you listening either have dental implants or are planning to get dental implants or know somebody who has dental implants, please advise them. Instead of using string floss, they should go to a water flosser. We know that water flossers today are 80% more effective for dental implants in reducing plaque and inflammation. So there's no reason why any dentist should be recommending string floss around dental implants. I also found another study which was interesting was a network of meta analysis of interproximal oral hygiene methods in reducing inflammation. And this was was published in 2018 in the journal of Periodontology, which is the journal of my association. And what is a meta analysis? A meta analysis is really study of multiple research papers. So we're looking basically of all the research papers that are out there on interdental brushes, in this case water jets, toothpicks and string floss. And they came out with some very interesting findings. And these particular findings basically change the way the European Workshop in Periodontology looks at the recommended devices for cleaning in between teeth. This is what it says. Inter dental brushes and water jets ranked high for reducing bleeding. Toothpicks and string floss ranked last. So don't you want to be effective with your oral hygiene? Why would you still be using String floss, you're better off using interdental brush or a water flosser. Don't use a toothpick if you're used to using it all the time. We know that can damage the teeth and gums. The present findings in the study are aligned with the recommendations set for forth following a consensus meeting during the 11th European Workshop in Periodontology that forced the Periodontal Community to rethink the recommendation for flossing across groups and levels of periodontal health. So this work actually corroborates the recommendations derived from the workshop proceedings. They state clearly that flossing cannot be generally recommended anymore for managing gingivitis. Except for those really tight spaces that do not allow the passage of an in between or interdental brush or a water flosser, which is very few spaces. Most of you will be able to use a interdental brush or a water flosses successfully. Trials assessing the efficacy of self administered flossing and dental caries have largely failed to show any effect. So people think, oh, I'm going to use string floss because it's going to prevent cavities. We don't have those studies. Persons that are effectively using floss, keep using it, don't discontinue it. However, if you're not using floss, we have better tools. So you're in luck. You can start using either a water jet or a water flosser. What is that? It's actually an electric device. You can insert water in and on a medium. Pulsation has been scientifically proven to decrease inflammation. If you don't have access to a water jet or water flosser, you could use an in between brush or an inter dental brush. And there's plenty of them available out there from really, really extra small to fit in tight places to extra large to fit in big places. So choose a size that's right for you. One last thing I want to say about flossing. I don't know if you remember, but a few years back it was all over the news that glide floss actually leeches PFAs and PFOs. Some of you know PFAs. PFOs because it is the same substance that is found in nonstick cookware. And you know, a lot of those Teflon cookwares have been basically they're not in use anymore and people don't buy them because we know the PFAs and PFOs, we end up ingesting it. This particular study came out in 2019 and they were looking at the PFAS concentration in the African American and non Hispanic white women based on their behavior of using glide floss. So what is PFAS being used in? It's really used in water and grease resistant linings because it's waterproof. But a few studies have explored really the exposure route. They actually used multiple regression analysis to look to see in these 178 middle aged women what is going on with their blood. They collected blood samples between 2010 and 2013 and participants were interviewed about their behavior. The results basically show that African American women had lower levels of PFOA compared to non Hispanic white women. In African Americans, frequent consumption of prepared food in coated cardboard containers associated with pfas. But flossing with oral B glide, having stain resistant carpet or furniture and living in a city served by PFAS contaminated water supply were also associated with higher level of blood concentrations. Basically eating microwave popcorn and using floss with PFAS are just as dangerous to your health. That's what the study shows. Think again when you're going to buy that floss with pfas. Let's look at what are some of the flosses that contain the PFAS. Fluorine was detected in 6 out of 18 dental floss products that were tested in this particular study. So there's different brands out there. Even some of the local, let's say CVS type suppliers use something called Super Slip Ease between which was actually labeled as a wax floss. However, it did have PFAS because we detected fluorine in this particular study. Glide of course by Crest. And there's also Colgate, they do a total dental floss. Mint fluorine was detected in that as well. And what's the problem? Let's say you take a PFAS floss and you start flossing. Now all of a sudden your gums are bleeding. This is the time and it's a warmer environment. So as you're gliding the floss, especially between the tight contacts, minute particles will stay underneath the gum. And when the gums bleed, that's when the PFAS actually has an opportunity to get inside your bloodstream. And with time, especially with years and years of flossing. And that's the nice thing about the study, it's a three year study, they really saw this increase in PFAS levels. So with that, I hope I have proven my point here, that string floss is not the best we have to offer today. So it's great news for a lot of you, especially for those of you that don't like to floss, water flossers or water jets, great tool. In 90 seconds you can do your whole mouth. And not just in between the teeth, but also, you know, on the outer surfaces, inner surfaces of the teeth, or interdental brushes. Both great choices for cleaning in between. With that, I leave you have an amazing day.

Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. Doctorsanda this is Dr. Sanda and and remember, your mouth is the gateway to your health. So take care of it in the most natural and best way possible.