The goal of oral hygiene is to remove plaque from teeth and gums. Ineffective removal of plaque leads to bad breath, cavities (decay) and periodontal (gum) disease. Plaque is the soft sticky bacteria-filled substance that clings to teeth. To accomplish this hygiene goal, we have been taught by our dentist and dental hygienist to first brush, then floss and finally rinse; but new reviews of the science are leading us down a slightly different path.

Traditionally, dentists and hygienists have been taught, and then teach their patients, that brushing is the most important part of home dental hygiene but plaque removal between the teeth needs more attention and for most adults should be a priority. Brushing is effective in removing plaque from the top (biting surfaces) front (cheek side) and back (tongue side) of the teeth and using an electric brush for two minutes at least twice a day is more effective than using a manual brush. However, brushing is not effective in plaque removal between the teeth. Periodontal disease and most adult cavities start between the teeth and brushing does not reach these areas.

Usually after using the toothbrush removal of plaque between the teeth (interproximal areas) with floss is the next step. Bleeding from the gums when brushing or removing plaque between the teeth is a sign of infection. The gum tissues on the front and back side of the teeth, where the toothbrush touches, are keratinized (like our skin) and as such are more resistant to bacterial gum infection. The gum tissue between the teeth, where the toothbrush misses, is not keratinized and is more susceptible to gum infection. Flossing with string floss is minimally effective at removing plaque between teeth, especially if any gum recession is present. Due to its configuration, floss is not able to get into the concavities on the tooth surfaces found between teeth and floss can be difficult to use. Interproximal brushes are easier to use than floss and are extremely effective for plaque removal between teeth where most cavities and gum disease start. There are many different sized and shaped interproximal brushes. Your dental team can assist you with the right choices. Water flossers like Water Pic® have been promoted for years as an alternative to flossing. New research confirms that water flossers are effective in plaque removal between teeth. For some, a water flosser is too messy so a shower flosser or interdental brush may be more appropriate.

Rinsing is usually the final step of oral hygiene. Sometimes certain rinses are recommended for their antimicrobial effects. Some rinses are specific for bad breath, others for cavities or gum disease. There are some rinses that are effective as a general antimicrobial rinse. Rinsing is not an effective means to deliver these antimicrobial materials between the teeth. Instead, these rinses can be used in a water flosser and/or used dipped on to an interproximal brush to get the needed antimicrobial material between the teeth.

The take home message here is that effective oral hygiene between the teeth needs to be a priority in everyone's homecare regime. Interproximal maintenance with the appropriate tool, like an interdental brush, is more or at least as important as brushing. Each patient should ask their dentist and hygienist what they can and will do to achieve and maintain oral health so together they can come up with the best homecare routine.