dental floss

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A waxed or unwaxed thread used to remove food particles and plaque from between the teeth and under the gums.

Background

Dental floss is a thin filament used to remove debris caught between teeth and between teeth and gums. In 1994, Americans used more than 2.5 million miles of dental floss, the equivalent of circling the earth more than 100 times.

The use of dental floss helps to remove plaque, a sticky, gel-like substance made of bacteria that forms on teeth and between teeth, as well as on the tooth surface below the gum line. If the plaque is not removed, it hardens and is then called tartar. If tartar is allowed to accumulate, gingivitis, or an inflammation of the gums, usually accompanied by redness, swelling, and bleeding, can result. Eventually, gums begin to separate from the teeth, forming "pockets" that frequently become infected. If this goes unchecked, the bone that supports the teeth is destroyed, resulting in tooth loss. To avoid this, adults and children over age 10 are advised to floss at least once a day. Flossing disturbs bacteria, stopping it before it can create plaque and ultimately cause gum and bone disease.

Floss is available in string or ribbon form, and can be lightly waxed, waxed, or un-waxed. It is also available in several flavors such as cinnamon, mint, bubble-gum, and plain. Ribbon floss is the most effective choice when there are ample spaces between the teeth; since baby and children's teeth are widely-spaced, ribbon floss is the most common selection for children. On the other hand, when teeth have contact points, that is, when they come in contact with one another, the preferred choice is the narrower or string floss. Waxed or lightly waxed is recommended for use between crowded or crooked teeth.

Raw Materials

Dental floss is commonly made out of one of two polymers (synthetic compounds), either nylon or Teflon. Nylon is defined as a fiber-forming substance of a long-chain synthetic polyamide. A polyamide is a compound characterized by more than one amide group; an amide is a chemical related to ammonia. Teflon is the trade name of the polymer polytetrafluoroethylene, or PTFE. Other raw materials are the coatings, which may be wax, flavors, and various proprietary ingredients which vary with the manufacturer.

The Manufacturing
Process

Filament extrusion and twisting (for nylon)

• To make floss from nylon, nylon salt is polymerized and the resulting polymer is poured out as a ribbon. Next, it is cut into small chips, flakes, or pellets. These are blended, remelted, and pumped through spinnerets to form filaments. When the nylon cools, the filaments solidify and regather to form a yarn. The ends of the filaments are combined to create one strand of floss. Correctly twisting the nylon is a vital part of this process; the turns average between 2.5 and 3.5 per inch. Twisting adds strength to the floss as well as greatly reducing fraying or breaking.

  Since floss consists of many filaments, it can be produced in different "decitexes." Decitex is defined as the weight of 10,000 meters of unwaxed nylon in grams. Floss is also measured by "Denier." Denier is defined as the weight of 9,000 meters of uncoated floss in grams. There is a direct correlation between the numerical value of the decitex or denier and the thickness of the strand of floss: if this value increases, the thickness of the strand also increases.

Making floss with Teflon

• To produce a Teflon dental floss, a polymer of polytetrafluoroethylene (PTFE) is formulated. Next, the polymer is melted into a paste and stretched into a long, thin strand. The polymer is then expanded into one or more directions. The PTFE is cut, forming different deniers. After the PTFE is processed, its tensile strength is substantial. Unlike multi-filament nylon flosses, PTFE is a monofilament, which does not shred or break easily. Therefore, twisting is not required for this process. The rates of stretching during the manufacturing process give this floss its added strength.

Filament coating

• This process allows manufacturers to differentiate their products by permeating the floss with distinctive and proprietary coatings. The coating takes place in emulsion baths, where the floss is pulled through waxes, flavors, and other desired coatings at a consistent velocity.

Bobbin winding

• Floss bobbins are next wound in one of two shapes: cylindrical or roll type. Winding the floss bobbins requires the use of equipment that transfers the yarn from one type of spool to another type. A cylindrical bobbin is dispensed through a tube or rectangular-shaped package. It can be wound where the floss is pulled through the center or pulled from the outer layer first. The advantage to this type of bobbin is that it can accommodate more yardage. The roll bobbin is the more conventional type of floss bobbin. It is dispensed through flat containers by pulling from the outer layer only.

Case molding

• The standard case for nylon flosses is an angled, two-piece construction, usually polypropylene, with an insert that holds the floss spool. Recently, many manufacturers have opted to upgrade their floss dispensers by using a one-piece "clam shell" construction that incorporates a window to gauge product use as well as grooves to facilitate gripping.

Assembly

• Floss bobbins are usually assembled manually into the floss container. The bobbin cores are cut to separate them. Next, they are placed into the container, the floss is threaded around a metal cutting clip, and the cover is closed. The package is now ready for labeling, or if the container is pre-decorated, it is ready for packing and shipping.

Decoration

• There are three basic methods of decoration: pad printing, labeling, and thermal transfer. Pad printing is the most prevalent form of decorating used in the U.S. Labeling is the preferred choice for most product exported to Europe. Thermal transfer generates an image quality equal to or better than the pad printing image with the advantage that it allows for a greater range of colors and designs.

Packaging

• Marketers prefer blister packaging (a plastic mold affixed to a cardboard backing, which can hang on a display peg) because it prominently displays the package and eliminates the need for paper packaging, which is deemed better for the environment. Another packaging trend is to co-pack floss along with a toothbrush, toothpaste, or mouthwash.

The Future

Two leading manufacturers have recently developed dental flosses with new types of filament. Oral-B Laboratories introduced Oral-B ULTRA FLOSS. Unlike conventional or ordinary dental floss, which has a series of straight nylon strands, ULTRA FLOSS features an ultra strong filament, containing a patented network of interlocking fibers that resists shredding and fraying. ULTRA FLOSS' woven, spongy texture also works differently than conventional floss; it stretches thin to fit easily between tight teeth spaces, then springs back to its original thickness to trap plaque in its filament. ULTRA FLOSS is soft for sensitive gums, gentler on the fingers, and pre-measured into 18-inch (46 cm) segments, the length recommended by the American Dental Association.

John O. Butler Company introduced Butler-Weave, a dental floss that acts like dental tape. This smooth, shred-resistant floss spreads out when pulled between teeth, providing more surface contact with the tooth for effective plaque removal. In addition, its thin, flat profile glides easily between tight contacts.

Where To Learn More

Books

Foster, Malcolm S.Protecting Our Children's Teeth: A Guide to Quality Dental Care from Infancy through Age Twelve.Insight Books (a division of Plenum Publishing Corporation), 1992, pp. 186-90.

Holt, Robert Lawrence. Straight Teeth: Everything You Need to Know About Orthodontics, Including How to Avoid Costly Treatment for You and Your Children Through Preventive Care.William Morrow and Company, 1980, pp. 44, 121-35.

Siegel, Dorothy.The Encyclopedia of Health: Dental Health.Chelsea House Publishers, 1994, pp. 70, 75, 105-106.

Periodicals

Bedell, Thomas. "Looks: Floss, Anyone?"Men's Health, December 1991, pp. 20-21.

Sangiorgio, Maureen P. "Flossing Right: The Real Truth about the Most Underrated Tooth Saver." Prevention, June 1992, pp. 108, 135-36.

[Article by: Susan Bard Hall]

Waxed or plain thread of nylon or silk used to clean the interdental areas; an aid in oral physiotherapy.

Dental hygienist flossing a patient's teeth

Dental floss is either a bundle of thin nylon filaments or a plastic (teflon or polyethylene) ribbon used to remove food and dental plaque from teeth. The floss is gently inserted between the teeth and scraped along the teeth sides, especially close to the gums. Dental floss may be flavored or unflavored, and waxed or unwaxed.

History

Dental floss

Levi Spear Parmly, a dentist from New Orleans, is credited with inventing the first form of dental floss. He had been recommending that people should clean their teeth with silk floss since 1815.^[1]

Dental floss was still unavailable to the consumer until the Codman and Shurtleft company started producing human-usable unwaxed silk floss in 1882. In 1898, the Johnson & Johnson Corporation received the first patent for dental floss. Other early brands included Red Cross, Salter Sill Co. and Brunswick.

A character is depicted using dental floss in James Joyce's famous novel Ulysses (serialised 1918-1920) - an early mention of the practice in literary fiction.

The adoption of floss was poor before World War II. It was around this time, however, that Dr. Charles C. Bass developed nylon floss. Nylon floss was found to be better than silk because of its greater abrasion resistance and elasticity.

Dentists and dental hygienists urge the daily oral hygiene regimen of toothbrushing and flossing. Nearly all Americans brush their teeth. However, the ADA indicates that only about 12 percent of Americans floss daily, 39 percent floss less than daily, and 49 percent do not floss at all.^{[citation needed]}

Use

Dental floss is commonly supplied in plastic dispensers that contain 10 to 50 meters of floss. After pulling out the desired amount, the floss is pulled against a small protected blade in the dispenser to sever it.

The dental floss is held between the fingers. It can be difficult to grasp floss due to the tension required to push between certain teeth, and reducing friction as the fingers and floss become wet from saliva. To keep a hold, the floss can be wrapped around one or both fingers. Doing this on or above the first joint allows that finger to be used in conjunction with the thumb in a traditional pinch grip, to reduce excessive tension on the skin. Wrapping dental floss too tight as a tourniquet reduces circulation. So it is wise to loosen the wraparound when alternating to a fresh segment of floss. An alternative way to make the floss easier to handle is to make a loop and tie the ends together using a couple of knots. The resulting ring is easy to handle even in wet conditions and does not put as much tension on the skin as when wrapping it around the fingers.

F-shaped and Y-shaped dental floss wands

Specialized plastic wands have been produced to hold the floss. These may be attached to or separate from a floss dispenser. While not pinching the finger, it may be awkward and unable to floss at all the angles possible with a finger. At the same time, the enhanced reach can make flossing the back teeth easier, which are generally the more neglected teeth in dental care.

The floss is gently slid between the teeth. Dental floss is used to clear both particles of food stuck between teeth and dent-bacterial plaque adhered to such teeth surfaces. Ideally using a C-shape, when the floss is curved around a tooth and then moved away from the gumline, the floss scrapes the side of each tooth, and can also clean the front or back of the tooth. Gently moving the floss from below the gumline to away from the gumline removes dento-bacterial plaque attached to teeth surfaces above and below the gumline.

Occasional flossing and/or improper flossing can typically lead to bleeding gums. The main cause of the bleeding is inflammation of the gingival tissue due to gingivitis.

Directions

The American Dental Association (ADA) advises to floss once or more per day. It should be noted that overly vigorous or incorrect flossing can result in gum tissue damage. For proper flossing, the Association advises to curve the floss against the side of the tooth in a 'C' shape, and then to wipe the tooth from under the gumline (very gently) to the tip two or three times, repeated on adjacent tooth and on all other teeth too.

Vibration

Some flossing wands utilize vibration which transfers through the floss, originating from the ends. This is likely inspired by the similar use of vibration of the bristles in modern electric toothbrushes. As the vibration causes subtle movement, the floss will find the path of least resistance when pressed down. The movement would also help in temporarily separating tooth and gum for floss to get through.

This allows easier penetration under the gumline, with less force applied to push into the gap between teeth. With less force applied, more control of flossing is possible. In normal flossing, pressure may be applied until the floss 'pops' through the teeth, and the momentum can carry on and painfully impact the gum tissue. With more control, this can be reduced or avoided totally.

Many consider vibrations to be soothing, they are a common technique in massage and orthopedic devices. Much like electric toothbrushes are soothing to the teeth and gums, vibrating floss can sooth and massage the gumline.

Cuts become less likely as the floss will not press against as isolated an area, and less pressure is applied. Any abrasions to the gum would be more evenly distributed, leading to more equal adaptation of the tissue. ^{[citation needed]}

Benefits

Flossing in combination with toothbrushing can prevent gum disease, halitosis, and dental caries.^[2].

Branded products

• Colgate Total floss
• Crest Glide dental floss and dental tapes (acquired "Glide" from W. L. Gore and Associates)
• Johnson & Johnson flosses and dental tapes
• Oral-B flosses and dental tapes

See also

• Gingiva
• Toothbrush
• Toothpaste
• American Dental Association

References

1. ^ Sanoudos M, Christen AG. (1999). Levi Spear Parmly: The Apostle of Dental Hygiene. Journal of the History of Dentistry. 47(1): 3-6.
2. ^ Cleaning your teeth and gums

External links

• Great Moments in Science: Dental Floss

Periodontology and Implant Dentistry
Tissues of the Periodontium and their physiologic entities	Alveolar bone - Biologic width - Cementum - Free gingival margin - Gingiva - Gingival fibers - Junctional epithelium - Mucogingival junction - Periodontal ligament - Sulcular epithelium - Stippling
Pathogenesis	A. actinomycetemcomitans - B. forsythus - Capnocytophaga sp. - F. nucleatum - P. gingivalis - P. intermedia - T. denticola
Pathologic entities	Calculus - Edentulism - Fremitus - Gingival enlargement - Gingival pocket - Gingivitis - Horizontal bony defect - Occlusal trauma - Periodontal pocket - Periodontal disease - Plaque - Recession - Vertical bony defect
Diagnosis, Treatment planning, Prevention and Chemotherapeutic agents	Brushing - Bleeding on probing - Chlorhexidine gluconate - Flossing - Hydrogen peroxide - Mouthwash - Oral hygiene - Tetracycline - Triclosan
Periodontal armamentarium	Currette - Membrane - Probe - Scaler
Conventional Therapy	Debridement - Scaling and root planing
Surgical Therapy and Periodontal surgery	Apically positioned flap - Bone graft - Coronally positioned flap - Crown lengthening - Flap debridement - Free gingival graft - Gingivectomy - Guided bone regeneration - Guided tissue regeneration - Implant Placement - Lateral pedicle graft - Pocket reduction surgery - Sinus lift - Subepithelial connective tissue graft
Other specialties	Endodontology - Orthodontology - Prosthodontology

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