Should you floss before or after brushing?

You have just spent the required two minutes brushing your teeth. You used a recommended fluoride toothpaste and a soft-bristled toothbrush given to you by your dental hygienist. You held the bristles against your gum line and rolled the brush in a gentle, circular motion just like your hygienist instructed. Even your tongue got the treatment to fight bad breath. Now your teeth are as clean as you can get them, right?

Wrong.

Lurking between your teeth in nooks and crannies that the bristles of your brush cannot reach are millions of bacteria, food debris, and sticky plaque. The best brushing techniques still leave two sides of most teeth untouched. 

Think of your teeth as a row of boxes sitting on the floor. Each box sits tightly against the boxes on either side. Using a scrub brush, you can clean the front, top, and back of each box. But the brush cannot reach the right and left sides, which are situated tightly against the right and left sides of the adjacent boxes.

Teeth are much like this row of boxes. No matter how careful you are to brush correctly and for the required amount of time, the right and left sides of the teeth are still covered with plaque, and food debris hides between the teeth and under the gums.

Dental floss helps prevent cavities

According to the American Dental Association (ADA), cleaning between your teeth with dental floss or other devices helps prevent cavities and gum disease by removing the hidden, sticky film called plaque. Plaque is made of colonies of bacteria that feed on your teeth whenever there is food debris or a sugar film on the enamel, the hard coating of your teeth. Plaque eats away at the enamel if it is not removed each day.

While brushing removes the plaque from the tops (chewing surfaces), fronts (the sides that meet the lips and cheeks), and backs (the side that touches your tongue) of your teeth, only dental floss, or other types of devices that clean between the teeth, can remove the harmful bacterial plaque on the left and right sides of the teeth.

Plaque that remains on your teeth for a long time eventually hardens into a coarse substance called tartar or calculus. Tartar collects between the teeth and along the gums and can lead to serious gum disease. 

Using dental floss daily to remove the plaque between your teeth before it has a chance to harm the enamel or harden into tartar is one of the easiest ways to keep your teeth and gums healthy. 

Should you floss before or after brushing teeth?

Recent research by the American Academy of Periodontology (AAP) found that flossing first may result in a cleaner mouth, lower plaque levels, and maximizes the ability of fluoride in toothpaste to fight decay.¹

Researchers found there were significantly lower levels of plaque and bacteria in people who flossed first. This group also had a higher concentration of fluoride, a bacteria-fighting additive in toothpaste, indicating that the toothpaste was more efficient in its cavity-fighting abilities when floss or other interdental cleaning devices removed the plaque between the teeth before the application of the fluoridated toothpaste with the brush.

One of the actions of dental floss is to loosen the bacteria, food debris, and plaque from between the teeth. When tooth brushing with fluoride toothpaste follows flossing, this clears the loosened plaque and particles out of the mouth. 

What if I forget and brush first?

There is a lot to be said for routines, especially when it comes to oral hygiene. Having a regular schedule for brushing your teeth helps us remember essential tasks to stay healthy and clean.

If you are in a habit of brushing first then flossing, it may be hard to break the habit. But, your teeth and gums will not suffer if you keep the same routine you have used for years. If you do change, you will soon notice the difference in how your mouth feels and tastes when you start the new “floss first” routine.

If you brush and rinse first, flossing afterward cancels all the freshening effects of the foamy, minty paste. 

After trying this method for a few days, you will probably have no problems making the floss-first method your new habit.

Other ways to clean between your teeth

There are some situations where flossing is not possible. People with medical conditions, such as arthritis, carpal tunnel syndrome, and other diseases that affect a person’s ability to use their hands and fingers may not be able to use floss at all. Tendonitis, tremors, Parkinson’s Disease, repetitive motion syndromes, and trigger fingers are other debilitating conditions that might hinder a person’s ability to use floss.

There are many products on the market made especially for patients who are unable to use floss and are easily carried in a purse or pocket for times when flossing is not possible. 

Interproximal brushes

These tiny, cone-shaped brushes come in various sizes and thicknesses. Choose the thinnest ones if your teeth are tight together and your gums extend into the spaces between the teeth. Thicker interproximal brushes are useful where the teeth have gaps between them, where teeth are missing, or if you wear braces. They can also clean underneath fixed bridges to clean debris from under the false tooth.

Gently push the tiny brush through the gap between your teeth. Move it in and out of each space a few times to ensure that you have cleaned both sides of the teeth. Like dental floss, it is best to use these before brushing so the brush and paste can remove the debris that the interproximal brush dislodges. 

Floss picks

These are small, u-shaped devices that have a piece of floss connected to each side of the “u.” The user holds the small handle and pushes the piece of floss between the teeth. These are easy to carry in a purse for use after a meal in a public restaurant or meeting. They work best between teeth that are not too tight and on easy-to-reach front teeth.

Floss handles

Floss handles work much the same way as the floss picks only they are much larger. People with limited use of hands and fingers find floss handles especially helpful. 

Like the floss picks, one end of the floss handle is u-shaped with a piece of floss firmly connected to either side of the “u.” But, unlike the picks, these devices have a long, large handle that is easy to grip in a fist. Floss handles are useful in reaching the back teeth due to the length of the handles.

Rubber-tipped stimulators

These have a cone-shaped rubber tip attached to a long handle. While they do not remove plaque on the sides of the teeth as well as floss, floss picks, and floss handles, they do remove food debris and provide stimulation to the gum tissue.

Wooden stimulators

One of the earliest types of cleaners for using between teeth, these are wedged-shaped soft wooden devices. Like the rubber-tipped stimulators, these are not as efficient as floss in the removal of plaque from the sides of the teeth, they are still useful for removing food debris and providing needed stimulation for the gums.

Water irrigators

Many patients with arthritis and other conditions that limit the ability to grip and use the fingers find water irrigators helpful. These can remove plaque, bacteria, and food particles from between teeth and provide gentle massaging actions to the gums. 

You can fill some of these devices with mouthwash or prescription antibacterial rinses instead of water. As with floss, it is best to use a water irrigator first then use your brush and toothpaste afterward.

Keeping your teeth and gums healthy

Having healthy gums and teeth are important for a person’s overall health. People with poor oral hygiene and advance gum disease tend to have more medical problems, like diabetes and heart conditions.

The ability to keep our teeth and gums healthy is largely dependent on the frequency and efficiency of removing plaque, food particles, and bacteria from the mouth. While brushing is the time-honored way to do this, brushing alone is not sufficient for complete cleaning. Harmful plaque hides between the teeth in areas where a brush cannot reach.

To thoroughly clean the plaque from between the teeth, you need to use dental floss or other devices daily before using a toothbrush and paste. Having regular visits with your dentist or dental hygienist for professional cleanings is another way to make sure any build-up that you cannot reach is removed and dental insurance can help you pay for it.

Keeping your teeth and gums healthy takes dedication and commitment to overall good health. Whether you floss first or last, flossing and brushing every day will help ensure that you keep a healthy smile for a lifetime.

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It is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.