Q: Can you tell me what you think about water flossers? Are they really something that is worthwhile? I find flossing to be difficult and I would love to think that those gadgets really work. Can you comment? I really enjoy your question and answer column.
- L.C., Middleton, Massachusetts
A: I can completely relate to what you are asking. I have to say that I became a dentist in 1968 and I do not believe that I flossed on a regular basis for at least 10 years. What finally motivated me was that my gums were tender when I did floss and at times, I had a bad taste in my mouth. I realized that there was something wrong with what I was doing on a daily basis.
I think that first of all, you and all my readers need to understand that what you are trying to clean off your teeth by brushing is the sticky substance called plaque. This plaque forms on your teeth every day, taking about 24 hours for the substance to adhere to the tooth surface. If it is not removed each day, it builds up layer by layer and at some point, depending on the character of your saliva and other substances in the oral cavity, it can harden or calcify. When this happens, it has to literally be scraped off your teeth and this is where the professional hygiene comes into play. The better you do at removing this substance when it is just sticky, the less the need for professional hygiene.
Your teeth are the major target and where this bacterially-laden substance does its damage. For many, the result is tooth decay and gum disease. To prevent these from occurring we have to remove it from all surfaces of your teeth. We need to remember that a tooth has four surfaces and a top. The back teeth have a wider top surface and your front teeth have a narrow edge or top surface. The toothbrush is able to clean all five of these surfaces if you picture a tooth standing alone with nothing on either side. If you can picture having a mouth of teeth that do not touch side by side, the brush could get all the surfaces. It is only when these spaces close and teeth touch each other that the brush will not be effective. To get the plaque in between we need to rub against the surface with something mechanical. This substance is very sticky and has to be physically rubbed off. Can water do that? Absolutely not.
The best way to think of water as a cleanser is to imagine starting to wash your car. Think of taking a hose and spraying it all over your car that is covered with dirt, some areas heavy and some light. If you just spray the water and even if you do it with a powerful spray from your hose, you might get a light bit of dirt off but if you let the car dry by itself after the hose spray, you will see the surface still remains pretty much as it was. Just plain dirty.
A water flosser or any water irrigating device has its place to aid in cleansing the mouth. It will remove particles that are just sitting loose in and around your teeth but the sticky plaque will remain. There are solutions that can be rinsed around your mouth that will stain plaque and a good exercise is to brush as thoroughly as you can and then rinse with these “disclosing solutions.” Wherever they leave a color is where the sticky substance has remained. The water will not remove any of that sticky adherent substance. It has to be brushed off thoroughly and you can check how effective you are by using that staining solution again. The stained color will show if you missed an area. Since your brush does not go in between teeth that touch each other, you have to get something to the area and as of these days, actual dental floss is the only answer. If it is a manipulation issue, there are handles that can be an excellent aide so placement of your fingers and winding floss around your fingers is not necessary. They either come with floss attached or you wind floss around them and use these floss aides to work the floss in between to rub on each surface.
As it did with me and most of us, having an odor or taste in your mouth will be a good motivator to cleanse more thoroughly. This is why I always recommend that at least once a day, each and every one should brush and floss with no toothpaste. It will be just as effective at removing plaque and the paste itself will not cover up anything offensive like bleeding or tenderness of your gums or any offensive odors. All toothpaste will do is make your mouth taste good for a very short while if indeed the plaque remains.
L.C., I wish cleansing the oral cavity well was a casual and easy endeavor but like cleansing your entire body, it takes time and diligence.
By the way, when you do visit your dentist, make sure they examine your mouth very carefully to look for plaque that you might have missed or even the calcified substance if it is present. That way, they can demonstrate to you how to access and cleanse those areas better so their help will not be needed so often. Think of the dollars you will save if you only need to have your teeth professionally cleaned once a year instead or two, three or four.
Thanks so much to you and all my readers to continue to ask any and all questions whether you think they are important or not. Someone else thinks the same.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at firstname.lastname@example.org.