Learning Objectives

• Recognize the history of interdental cleaning and flossing and how it shaped current methodologies.
• Interpret data and existing research on interdental cleansing.
• Demonstrate the skills to apply and teach the step-by-step approach to flossing.

Module Outline

• History of flossing
• Introduction
• When to floss
• Flossing effectiveness
• Flossing methods
• Flossing step-by-step procedure 
• Motivation for homecare
• Key points

Crocombe, L. A., Brennan, D. S., Slade, G. D., & Loc, D. O. (2012). Is self interdental cleaning associated with dental plaque levels, dental calculus, gingivitis and periodontal disease?. Journal of periodontal research, 47(2), 188–197. https://doi.org/10.1111/j.1600-0765.2011.01420.x

De la Rosa, M., Zacarias Guerra, J., Johnston, D. A., & Radike, A. W. (1979). Plaque growth and removal with daily toothbrushing. Journal of periodontology, 50(12), 661–664. https://doi.org/10.1902/jop.1979.50.12.661

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England), 392(10159), 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7

Heng C. (2016). Tooth Decay Is the Most Prevalent Disease. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 33(10), 31–33.

Hujoel, P. P., Cunha-Cruz, J., Banting, D. W., & Loesche, W. J. (2006). Dental flossing and interproximal caries: a systematic review. Journal of dental research, 85(4), 298–305. https://doi.org/10.1177/154405910608500404

Jolkovsky, D. L., & Lyle, D. M. (2015). Safety of a water flosser: a literature review. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 36(2), 146–149.

Kiger R.D., Nylund K., Feller R.P. A comparison of proximal plaque removal using floss and interdental brushes. J. Clin. Periodontol. 1991;18:681–684. doi: 10.1111/j.1600-051X.1991.tb00109.x.

Marchesan, J. T., Morelli, T., Moss, K., Preisser, J. S., Zandona, A. F., Offenbacher, S., & Beck, J. (2018). Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence. Journal of dental research, 97(7), 773–778. https://doi.org/10.1177/0022034518759915

Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry Journal. 2019; 7(2):56. https://doi.org/10.3390/dj7020056

Richards D. (2013). Oral diseases affect some 3.9 billion people. Evidence-based dentistry, 14(2), 35. https://doi.org/10.1038/sj.ebd.6400925

Salzer S., Slot D.E., Van der Weijden F.A., Dorfer C.E. Efficacy of inter-dental mechanical plaque control in managing gingivitis—A meta-review. J. Clin. Periodontol. 2015;42(Suppl. 16):S92–S105. doi: 10.1111/jcpe.12363.

Vernon, L. T., & Seacat, J. D. (2017). In Defense of Flossing: Can We Agree It’s Premature to Claim Flossing is Ineffective to Prevent Dental Caries?. The journal of evidence-based dental practice, 17(2), 71–75. https://doi.org/10.1016/j.jebdp.2017.03.008

Worthington HV, MacDonald L, Poklepovic Pericic T, Sambunjak D, Johnson TM, Imai P, Clarkson JE. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD012018. DOI: 10.1002/14651858.CD012018.pub2.

Yost, K. G., Mallatt, M. E., & Liebman, J. (2006). Interproximal gingivitis and plaque reduction by four interdental products. The Journal of clinical dentistry, 17(3), 79–83.