How often do you floss?

This is a question I ask all of my patients because the area just between your teeth comprises about 30-40% of the tooth surface. That is a lot of surface area not to remove harmful bacteria from. Your toothbrush cannot reach between your teeth to remove the bacteria that may damage the tooth and its supporting structures, the bone and the tissue. Additionally, since the area between your teeth is not exposed, it creates an area of protection for bacteria and provides a warm, dark place which is a perfect environment for bacteria to grow.

The bacteria between your teeth constantly form a sticky biofilm called plaque. Brushing two to three times daily and flossing daily can help remove the plaque. Plaque that is not removed by thorough brushing and daily flossing can harden and form calculus, more commonly known as tartar. Calculus can only be removed by a dental professional. The longer the bacteria filled plaque and calculus are on the teeth, the more harmful they become and the more damage they are capable of doing.

Sign Up for E-News


Gingivitis is inflammation of the gum tissue which results in red, swollen gums that bleed easily. Gingivitis is an early stage of gum disease that can be reversed with better brushing, daily flossing, and regular dental cleanings. Gingivitis can progress to periodontitis if not treated. Since gingivitis most often starts between your teeth—the flossing area, establish a healthy habit of flossing before it progresses to periodontitis.


Periodontitis is a bacterial infection that causes destruction of the supporting structures of the tooth. Bacteria produce toxins as they grow, along with the body’s natural immune response to the bacteria cause a breakdown of the bone and tissue that support the tooth. This breakdown causes irreversible damage to the bone that holds the tooth in place and causes the tissue to detach from the tooth creating periodontal pockets. This increases the area between the tooth and the tissue allowing an increase in the number of harmful bacteria that occupy the space.

Not only does flossing help to remove the harmful bacteria from between the teeth that damage the bone and the tissue, but it also helps to protect the tooth from decay. The acids produced by the proliferation of bacteria causes demineralization and breakdown of the tooth creating cavities.

Gum Disease and Your Overall Health

There is a link between gum disease and other systemic conditions such as heart disease, stroke, diabetes, respiratory disease, and premature birth. Since periodontitis is a chronic bacterial infection which destroys the tissue and the bone that support the tooth, the harmful bacteria involved in this chronic infection can readily enter the blood stream through the damaged blood vessels of the bone and tissue and travel to all systems of the body.

How do you clean between your teeth?

There are many interdental devices to clean between the teeth such as floss picks, small brushes, and string floss. I recommend string floss since it is easier to manipulate and can better reach below the gum tissue to remove bacteria, especially when there are periodontal pockets that harbor more bacteria below the gum tissue because of its increased space due to detachment of the tissue from the tooth caused by periodontitis.  Using string floss also ensures that you are always using a clean section of floss and not transferring bacteria from one site to another as with other interdental devices. If you are using other devices such as floss picks, rinse them off after using them between each tooth to remove the plaque and bacteria from the previous site.

Flossing properly also matters. Guide the floss between your teeth using a gentle motion.  When the floss reaches the gum tissue, curve it into a C shape against one side of the tooth. Gently slide it into the space between the gum and the tooth using a rubbing motion against the tooth to remove bacteria from below the gum tissue and the sides of the tooth. Follow the same procedure for the other side of the tooth. Children need to clean between their teeth as well. Young children will need the help of a parent since it takes more manual dexterity to floss and will ensure the plaque and bacteria is thoroughly removed.