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Perhaps the only downside to Get Out the Brush campaign fervor is that flossing tends to fall by the wayside. A shocking number of patients, young and old, don’t know how to floss, don’t think they need to, or simply don’t do it, for reasons that continue to drive dentists nutty. Though we have seen some progress in recent years, American Dental Association indicates that only about half of Americans floss daily and as much as 18% do not floss at all.

For dental professionals, this is terrifying, because some studies show that flossing can be more important than brushing.

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It might be useful to think of your teeth like plants, which, in many ways, they are. They grow in the mouth, after all, have protective layers, spongy, mineral-rich internal tissue and roots that go deep down “underground.” Gums, in this analogy, are the soil, then. They provide the environment, stability and nutrients the plants need to grow. If something happens to a plant leaf or even stem, the plant may still survive. But take away the soil, and the plant can only shrivel. Open your mouth, and the teeth are what you see, but it’s the gums that will keep them there and keep them healthy.

What flossing does is remove plaque from the spaces between the teeth and the gums. It isn’t about the chunk of spinach that gets stuck there, as the common logic goes, but the bacteria that feed off it, and go on to infect the soil. Flossing reaches places toothbrushes can’t to get at the cause of periodontal diseases such as gingervitus. It prevents gum recession, which leaves teeth exposed and brittle, and sensitivity and is proven, over and over again, to do more for overall oral hygiene than brushing.

So why don’t more people do it?

Well, partly it is because people are not aware of how important flossing is or mistake a complimentary habit for an optional bonus. And partly it is because flossing is simply difficult from a physical coordination standpoint. It takes a while to learn, and shoving your hands in your mouth never really gets fun.

Even people who do floss often don’t do it right. They see a little blood or break the floss and then give up. But bleeding is likely a just a sign that you haven’t flossed enough. And if frayed or snapped floss strings has more to do with the structure of your teeth, there are plenty of types of floss to choose from. It’s normal for bleeding to last for about a week after the start of flossing. And waxed floss, for example, is a good alternative for people with tightly packed chompers. If either of these problems continue, it’s probably because you’re doing something wrong. (Consistent bleeding past a week could be a sign of gum disease, and is worth having checked out.)

Proper flossing technique starts with the right amount of floss. Dentists recommend about a foot-and-a-half. If that seems excessive, it’s better to err on the side of too much, because otherwise you end up reusing dirty string and spreading the bacteria you’re trying to get rid of. Loop most of the string around one index or middle finger, and tie the other end to the opposite finger. Once you pass the string between two teeth, pull it tightly against one or the other, hugging it in a c-shape. Then drag it up and down, first above the gumline and then below. A few times should be enough, as long as you are applying enough pressure against the tooth. (Pressure is important. If you leave the string in the middle of two teeth you will cut the tip of your gum, causing unnecessary bleeding.)

Unspool the string slightly and repeat on the other side of the same tooth gap. Then move across the rest mouth. Most people work from the middle out, but order doesn’t matter, so long as you get every tooth surface, including the back of your last molar. Timing isn’t important, either. Some will say that flossing before brushing is better, because it frees up particles the brush can later eliminate, but studies haven’t proven the theory. Once a day, everyday, should be enough, no matter when you do it, though with flossing, unlike with brushing, there is no such thing as too much. (Within reason. It’s hard to say what a marathon flossing session would do. But why would you try anyways?) How long it should take is also fairly ambiguous. As you get more proficient at the movement, the process itself should become quicker. But if things are still clumsy, don’t let that stop you. There’s no good reason to pick one over the other, but if you have to choose, go with flossing over brushing.

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