My dental hygienist and I have a longstanding, unspoken agreement: I won’t get any cavities, and she’ll pretend to believe me when I tell her I floss every day. Truth be told, it’s more like once a week.
Despite reports that flossing may be “overrated,” the American Dental Association (A.D.A.) and the US Department of Health and Human Services still recommend flossing every day. The research is limited, and flossing is not a cure-all, but it is still one of the few things people can do — along with brushing, drinking fluoridated water, rinsing with mouthwash, eating well, and going to the dentist regularly — to stand a chance against severe, long-term oral-health problems.
Thankfully, in addition to string floss, you can find other interdental cleaners — things designed to clean between teeth — that are safe and effective. The best way to know whether an interdental cleaner is right for you is by asking your dentist, said Dr. Michele Neuburger, a dental officer in the Centers for Disease Control and Prevention’s Division of Oral Health.
“It’s really important that you choose something that works for you, so you can feel comfortable using it on a daily basis,” Dr. Neuburger said. “Your dentist will be able to give you a personalized recommendation based on the spacing between your teeth, the health of your gums, or any dental work you might have like braces or a bridge.”
If you have any kind of manual dexterity difficulties, or developmental disabilities that make it hard to floss, it’s especially important to talk things through with your dentist.
Whatever you can do to consistently disrupt the plaque between your teeth and stimulate your gums is better than nothing. If you fear floss, some alternatives have been shown to “demonstrate safety and efficacy” in clinical or lab data submitted to the A.D.A. Dr. Ruchi Sahota, a spokesperson for the organization, said she always tells her patients to look for the A.D.A. Seal of Acceptance when shopping for interdental cleaners, and Dr. Neuburger recommends making sure dental items are approved by the Food and Drug Administration (F.D.A.) in addition to having the A.D.A. Seal of Acceptance.
Here are some types to try:
These electronic devices shoot either a thin stream of water (water flossers) or a thin stream of air punctuated by bursts of tiny water droplets (air flossers) between teeth to remove plaque. Of these, Wirecutter recommends the Waterpik Aquarius.
A 2019 Cochrane Review examining 35 randomized controlled trials found that oral irrigation has been shown to reduce gingivitis symptoms (bleeding gums) in the short term but found no evidence for overall plaque reduction.
These small, textured brushes made for cleaning between teeth can be easier to hold and maneuver than floss. The Cochrane Review found that such tools can reduce gingivitis symptoms and plaque in the short term, and a 2015 review of nearly 400 studies, published in the Journal of Clinical Periodontology, found “moderate” evidence that interdental brushes reduce plaque and gingivitis symptoms. People with tightly spaced teeth may have trouble using them, and according to the A.D.A., people with electronic implants in their mouths should avoid interdental brushes with an exposed metal wire.
Like interdental brushes, some toothpicks (usually made of wood, rubber, or plastic) may be easier to hold than a strand of floss. The toothpicks you might pick up at your local diner are probably not A.D.A. approved, but you can find wooden “plaque removers” with the A.D.A. Seal of Acceptance. The Cochrane Review found that wooden “cleaning sticks” can help reduce gingivitis but not plaque, whereas those made of synthetic materials can help reduce plaque but not gingivitis symptoms.
A floss pick is a disposable tool with a toothpick on one end and a bit of floss held taut on the other. A 2007 study published in the Journal of Clinical Dentistry found that floss picks are “at least as good as” regular dental floss when it comes to removing plaque. Reusable floss holders are also available — some are just a plastic handle that you can string floss onto, and others have disposable floss cartridges that you have to buy separately — but none of these tools have the ADA Seal of Acceptance, and a 2011 study published in Clinical Oral Investigations found that many reusable floss holders are difficult to maneuver.
According to the A.D.A., your flossing technique and frequency are more important than what your floss is made out of — nylon, plastic, waxed, or unwaxed. Some people find that a wide, flat, tape-style floss (rather than a strand of fibers woven together) is more comfortable and easier to slide between tightly spaced teeth.
Some things just can’t take the place of flossing, according to the A.D.A. Charcoal, for example, wears away at tooth enamel. Tongue scrapers don’t work. Oil pulling doesn’t improve oral health — and, according to the British Dental Journal, harmful side effects such as upset stomach have been reported.
Regardless of what kind of toothbrush you use — and how good your brushing technique is — it can’t replace flossing. A 2014 Cochrane Review found that electric toothbrushes are generally more effective than manual brushes at reducing plaque and gingivitis symptoms. But even the best toothbrushes clean only the top, front, and back surfaces of the teeth. Unless you use an interdental cleaner, you’re leaving the side surfaces exposed.
“Cleaning in between our teeth is one of the best things we can do to prevent cavities, bleeding, gum disease, and infection,” Dr. Sahota said.
For patients who struggle with cleaning between their teeth, Dr. Sahota’s main piece of advice is to power through for 10 days in a row.
“On that 11th day,” she said, “I guarantee it will be comfortable, or at least it won’t be quite as uncomfortable.” And by that time, “it won’t make you bleed.”
After the initial discomfort subsides, said Dr. Sahota, people start to feel a difference — their teeth feel cleaner and less sensitive. Flossing becomes a habit, not a chore. It gets to a point where they can’t imagine not flossing every day.
“It would be like washing your hands and not cleaning in between your fingers,” she said.
If it hurts to floss, or if it remains uncomfortable after two weeks, you could have an underlying problem, for which you should see a dentist. Or maybe you’re just flossing too hard.
“You shouldn’t be flossing so aggressively that it traumatizes or damages that gum tissue,” said Dr. Sahota. “You have to be gentle. Don’t be so gentle that you fail to disrupt the plaque, of course, but there’s a happy medium.”