The effect of dental flossing on periodontitis and dental caries cases is associated with the maximal cleaning teeth method. Cleaning teeth using dental floss is considered to be able to reach the interdental area. Good oral hygiene will prevent periodontitis and dental caries. The absence of dental plaque characterizes good oral hygiene.

Prevent Periodontitis and Dental Caries using Dental Floss


Dental plaque on the interdental or interproximal teeth surfaces has a higher acidity level than the other side. Therefore, dental plaque tends to accumulate more on the proximal surface of the tooth. If not cleaned, dental plaque can cause gingival inflammation that can develop into periodontitis and cavities or dental caries.

The toothbrush is one of the efforts to clean dental plaque. However, toothbrushes can only remove supragingival plaque or the superficial surface of a tooth. Thus, additional dental cleaning tools (such as interdental brushes, toothpicks, oral irrigators, and dental floss) are needed to reach all teeth surfaces. These tools aim to maximize teeth cleaning to the entire surface covering the interdental area.



Dental Floss

Flossing using dental floss is the most recommended effort to maximize the process of cleaning teeth and gums. Dental floss is useful for cleaning interdental plaque.


Types of dental floss

Dental floss has several types: waxed or unwaxed, aromatic or non-aromatic, and with or without a handle. Various types of dental floss provide ease of use. Waxed dental floss is recommended for people with very tight interproximal contact conditions. As for teeth with normal contact conditions, use floss without wax to facilitate the interdental area's floss movement threads. There is also dental floss that makes it possible to clean areas of teeth that use braces or dentures.


How to use Dental Floss

Interdental cleaning with dental floss is most effective twice a day, after brushing the teeth in the morning or after lunch, and at night before going to bed. To clean the interdental area by using dental floss, direct dental floss toward the tooth gap or interdental. Then move the yarn up and down the interdental surface while lifting plaque on the interdental. It should be noted that do the movement slowly, like sawing, to not injure the gum in the interdental area. Parents or adults should guide the use of dental floss by children.


Effect of Flossing on Periodontitis

Plaque is a layer of bacterial biofilm that causes chronic gingival and periodontal disease. Periodontitis is a chronic disease condition characterized by inflammation of the gingiva and tooth-supporting tissue. In about 45% of adults, it is a major cause of tooth sway.

Risk factors for periodontitis are age (over 30 years are more at risk), gender (women are more at risk due to hormonal changes), smoking, uncontrolled diabetes, and low socioeconomic levels. It is also influenced by the frequency of visits to the dentist for dental check-ups.


Science Evidence

A cross-sectional study in 2011-2014, using the National Health and Nutrition Examination Survey (NHANES), showed that to achieve optimal dental and oral hygiene, brushing teeth and adding interdental cleaning, one of which is by flossing. Flossing can reduce the prevalence of periodontitis risk. Routine flossing 2-4 days per week is considered to be able to maintain the health of periodontal tissue. However, it should be noted that techniques using dental floss must be correct.

Adding a routine habit of flossing besides brushing teeth is also known to reduce the risk of periodontitis and gingivitis compared to only brushing teeth.

In a study of 582, subjects were divided into two groups that only brushed their teeth and groups that brushed their teeth and added flossing in the oral cavity cleansing. It was proven that adding flossing experienced a decrease in the Loe-Silness gingivitis index by three times compared to only cleaning through a toothbrush.


Effects of Flossing on Dental Caries

Dental caries is a disease that is initiated by bacteria from dental plaque and other multifactorial causes. By maintaining oral hygiene through plaque control prevents dental caries. Routinely cleaning teeth with a toothbrush can only clean plaque on supragingival. The toothbrush can not reach the interdental area, especially in deep pits, fissures, and narrow interdental spaces. It is known that plaque on teeth' interdental surfaces is more acidogenic than other teeth' surface areas. Therefore cleaning the interdental area is highly recommended to reduce the risk of dental caries.

A meta-analysis, covering 35 randomized clinical studies and 3,929 adults, concluded that brushing teeth and cleaning interdental areas using threads or brushes can reduce gingivitis or plaque, or both, better than brushing teeth alone. Interdental brushes may be more effective than dental floss. Evidence for using toothpicks and oral irrigation is still limited and inconsistent. Most of the research was conducted in a short period, and participants initially had mild gingivitis.

A study with 808 subjects, age category 4-13 years, explained that in the children's teeth case with a high risk of caries, cleaning with a toothbrush plus flossing reduces the risk of proximal caries in deciduous or deciduous teeth, both in children who do it alone or be guided by parents. Therefore, caring for the oral cavity with a toothbrush and dental floss must be instilled from childhood to adulthood.




Conclusion
Oral hygiene can be optimized through brushing and interdental cleaning with flossing regularly. Flossing is recommended 2-4 days per week, or the more often it is better. Good habits in treating the oral cavity must be instilled from childhood to adulthood. Brushing along with interdental flossing or brush can control plaque growth in all parts of the teeth and gums to prevent periodontitis and dental caries.