Clean the Toilet or Floss: Which Would Your Patients Rather Do?

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This article is not about whether flossing works or not. We believe there is enough evidence to prove flossing works if done daily and done properly. So the real questions are, do patients floss daily and do they floss properly?

Do Patients Floss Daily?

If you’re currently chuckling to yourself thinking only a few of your patients even make an attempt to floss, you’re not alone. In fact, in a poll conducted on Today’s RDH, dental hygienists reported only about 20% of their patients floss their teeth daily. Some patients only feel compelled to floss when they have something they can feel between their teeth. Others find flossing to be gross, hard, and time-consuming.

The American Academy of Periodontology (AAP) reports more than a quarter of adults are dishonest about how often they floss their teeth. Patients are likely dishonest because they know they are supposed to floss. However, they simply choose not to and avoid it at all costs. The AAP lists unpleasant tasks patients would rather do instead of flossing, including sitting in gridlock traffic, cleaning a toilet, and washing a sink full of dishes.

If our patients are this desperate not to floss what can we do? Educate them more? On average hygienists take 10-15 minutes of the appointment time to educate their patients. A main focus of oral hygiene education is cleaning interdentally, yet the problem remains; patients don’t floss, and the lack of flossing is not helping arrest any sort of disease process.

Let’s say the other 75% are making an effort with their oral health and are trying to clean interdentally. Here the question is, would dental professionals be happy with their technique?

Do Patients Floss Properly?

Here is the American Dental Association’s description of how to floss properly:

  1. Use about 18 inches of floss wound around one of your middle fingers, with the rest wound around the opposite middle finger.
  2. Hold the floss tightly between the thumbs and forefingers and gently insert it between the teeth.
  3. Curve the floss into a “C” shape against the side of the tooth.
  4. Rub the floss gently up and down, keeping it pressed against the tooth. Don’t snap or jerk the floss.
  5. Floss all of your teeth. Don’t forget to floss behind your back teeth.

Now, after reading this article, I challenge you, instead of flossing your patient’s teeth for them during the appointment, hold the mirror and let them show you how they floss. I would bet you dinner they don’t go under the gumline nor do they wrap the floss around each tooth. Many patients break the contact and consider this flossing. Though that might remove the chunk of food that is stuck in there, it is highly unlikely this will prevent periodontal disease.

Half of American adults have periodontal disease. Meaning they have already lost bone, and possibly some teeth. This statistic doesn’t include the vast majority whose gingiva bleed every day. If patients were cleaning interdentally daily and properly, periodontal disease would not be as big of a problem. Interdental cleaning is an area dental professionals are focused on improving and are realizing that string floss may not be the only solution.

A lot of your patients don’t floss daily, and even fewer do it properly. So, what’s the solution? When it comes to treating periodontal disease, you must kill bacteria, reduce volatile sulfur compounds, and regularly break-up biofilm. This must be easy enough to be done daily and must be more than just mechanical. This is where rinses come in.

A Rinse’s Role in Periodontal Disease and Plaque Reduction

There are many attributing factors which can cause periodontal disease. Bacteria tend to be the focus, but we must understand studies show viruses, fungi, and volatile sulfur compounds are also factors when dealing with gingivitis and periodontitis.1-6 Plaque and calculus must also be removed so the gingiva can properly heal. Because keeping periodontal diseases at bay is an ongoing fight, you must find a rinse that is safe to be used daily and long-term. Rinses can also reach areas that patients miss or neglect with interdental cleaning.

Rinsing is Easy; Flossing is Hard

Compared to cleaning interdentally with proper technique, rinsing is easy, making patients more compliant. We are not advocating not to floss, but so many patients don’t do it properly even after all the education we provide. We all know what the definition of insanity is, repeating the same thing over and over while expecting different results. Are we driving ourselves crazy by talking about flossing to patients who don’t want to or refuse to learn how? If choosing a rinse improves treatment outcomes and gingival health, why not try changing how we care for these areas?

If you’re interested in finding a rinse to help your patients who aren’t great flossers, let OraCare help. OraCare’s active ingredients, Activated Chlorine Dioxide and Xylitol, eliminate microbes linked to periodontal disease, break up biofilm, and is safe enough to be used every day. Professional rinses should play an essential role in maintaining and elevating your patient’s oral health.

You can learn more about OraCare’s revolutionary health rinse by clicking here. You can also schedule a webinar, which can include free lunch and provides CE, by clicking here, or by calling 1-855-255-6722.

Article presented by OraCare.

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  1. Azodo, C. C., Erhabor, P. The roles of viruses in periodontal diseases. J Dent Res Rev. 2015;2:37-41.
  2. Bolepalli, A.C., Munireddy, C., Peruka, S., Polepalle, T., Choudary, A.L.S., Mishaeel, S.J. Determining the association between oral malodor and periodontal disease: a case control study. Int Soc Prev Community Dent. 2015 Sep-Oct. 5(5): 413-8. doi: 10.4103/2231-0762.165929. Retrieved from
  3. Ehizele, A.O. Ojehanon, P.I. Relationship between the concentration of volatile sulphur compound and periodontal disease severity in Nigerian young adults. Nigerian medical journal: journal of the Nigeria Medical Association.2013. 54(3): 149-52.
  4. Ghannoum, M.A., et al. Characterization of the oral fungal microbiome (mycobiome) in healthy individuals. PLoS Pathog.2010. 6(e1000713). doi: 10.1371/journal.ppat.1000713.
  5. Brandilyn, A. Peters, J.W., Hayes, R.B., Ahn, J. The oral fungal mycobiome: characteristics and relation to periodontitis in a pilot study. BMC Microbiol.2017. 17(157). doi: 10.1186/s12866-017-1064-9. Retrieved from
  6. Yost, S., Duran-Pinedo, A.E., Teles, R., Krishnan, K., Frias-Lopez, J. Functional signatures of oral dysbiosis during periodontitis progression revealed by microbial metatranscriptome analysis. Genome Med. 2015. 7(27). doi: 10.1186/s13073-015-0153-3.
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Kristin Goodfellow, RDH
Kristin Goodfellow is a practicing Registered Dental Hygienist in the state of West Virginia. Originally from Pennsylvania, Kristin and her husband Joe decided to stay in the area after both attending West Virginia University. While there she obtained a Bachelor of Arts Degree in Communication. Due to a high interest in the dental field Kristin decided to continue her education and enrolled in Allegany College of Maryland ‘s Dental Hygiene program, there she completed her Associate’s of Science Degree in Dental Hygiene. At graduation for her outstanding chair side education Kristin was chosen by instructors to receive Proctor & Gamble’s Excellence in Patient Communication Award. Kristin is currently practicing dental hygiene throughout the state of West Virginia, providing care to patients in the offices of Wilson Martino and TLC Dental. She is also a product specialist for Dentist Select’s revolutionary health rinse-OraCare.