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Current Concepts in Preventive Dentistry

Course Number: 334

Interdental Aids

Dental Floss and Flossing Methods

There are many different types of floss, tape, flossers, and floss holders on the market. Patients need to find a type of floss that they will like to use daily to disrupt plaque. There are two flossing methods available to teach your patients. One is the circle or loop method and the other is the spool method. The circle or loop method is preferred for children or a patient with low manual dexterity. A piece of floss approximately 18-24 inches long is tied at the ends to form a loop or circle. The patient uses the thumb and index finger of each hand in various combinations to guide the floss interproximally through the contacts. When inserting floss, it is gently eased between the teeth with a seesaw motion at the contact point, making sure not to snap the floss and cause trauma to the gingival papilla. Once through the contact area, gently slide the floss up and down the mesial and distal marginal ridges in a C-shape around the tooth directing the floss subgingivally to remove the debris.

The spool method (Figure 14) utilizes a piece of floss approximately 18-24 inches long where the majority of the floss is loosely wound around the middle finger of one hand and a small amount of floss around the middle finger of the opposite hand. The same procedure is followed as the loop method when positioning the floss interproximally. After each marginal ridge is cleaned, the used floss is moved or spooled to the other hand until all supragingival and subgingival areas have been cleaned, including the distal areas of the posterior teeth.

18-24 inches of floss

Figure 14a. Use about 18-24″ of floss, leaving an inch or two to work with.

Spool flossing method

Figure 14b. Gently follow the curves of your teeth.

Cleaning beneath gingiva

Figure 14c. Be sure to clean beneath the gingiva, but avoid snapping the floss on the gingiva.

Patients with fixed prosthesis such as bridges, orthodontics, and bonded orthodontic retainers should be encouraged to use floss threaders (Figures 15‑16) to remove debris. The floss is threaded underneath the prosthetic to remove any debris caught underneath. Patients should be instructed on their use and again asked to demonstrate to the dental professional that they understand and know how to use it.

threader floss

Figure 15. Floss Threader.


Figure 16. Floss Threader.

Floss holders and flossers (Figure 17) are an alternative if the patient has difficulty flossing manually or for a patient with large hands, physical limitations, a strong gag reflex, or low motivation for traditional flossing. A floss holder or flosser is a good alternative to spool flossing and should be shown to patients as another means of removing plaque biofilm. I’ve had good luck with patients flossing daily with Plackers tape flossers. They resist shredding and stay taut when flossing. I encourage patients to keep bags in their car, work, and home for quick access after meals and snacks. I’ve also had success getting orthodontic patients to floss daily by using FlossFish. Their website has a video that you can show your patients, in addition to showing them in their own mouth.

fig17 floss holder

Figure 17. Floss Holders.

Image courtesy of

Toothpicks or Wooden/Plastic Triangular Sticks

If your patients have large embrasures (spaces), they should be encouraged to utilize interproximal aids such as Stim-U-Dents. Made of balsa wood, Stim-U-Dents are used to remove debris and plaque, and are preferred by dental professionals over standard toothpicks, as toothpicks can splinter into the gingiva and damage the gingival tissue. If patients do not have access to floss, they can use the wooden balsa sticks to remove plaque and stimulate the gingiva (Figure 18).

Image showing interproximal stick

Figure 18. Interproximal Stick.

Interproximal Brushes

These small interproximal brushes are attached to handles and are used for large spaced interproximal areas and for orthodontic patients to use between their brackets to remove debris. There are a variety of brushes available, including travel sizes for pockets and purses. The brushes are tapered for easy access to difficult areas and patients seem to adapt well to instructional use (Figure 19).

Image showing a travel proxabrush

Figure 19. Travel Proxabrush.

Image courtesy of Sunstar Americas