Water Flossing vs Dental Floss vs Interdental Brushes

Interdental cleaning means cleaning between your teeth. There are many different tools available, but in this article I am going to compare:

• Traditional floss and floss picks
• Water flossers
• Interdental brushes

They have varying results in cleaning the spaces between your teeth.

Going by the evidence, interdental brushes are the gold standard for interdental cleaning.

But some people are more suited to one technique or tool than another. 

Using the right tool will get the most effective clean and help you build a flossing habit for life. 

In the sections below I will explain the pros and cons of each type of tool, and then compare them against one another, based on the evidence from clinical studies.

I’ve also put together a brief guide on how you can choose the option that’s best suited to you.

And for even more information on technique and common issues, see our how to floss hub page.

Why is interdental cleaning important?

Dentists normally recommend some sort of daily interdental cleaning as well as your brushing routine. 

It’s not just us. The National Health Service (NHS) also recommends regular interdental cleaning. 

This is because brushing your teeth only cleans 60% of the tooth surface. This means that 40% of your tooth remains uncleaned unless you partake in interdental cleaning.

Despite this, only 31% of British adults are flossing on a daily basis.

Interdental cleaning in addition to brushing will remove plaque from a greater amount of tooth surface.

It cleans the side of teeth, including the area hidden under the gumline. It removes plaque and bacteria, along with food particles that build up on these surfaces.

There has been plenty of research, which you can find out about below. The known benefits of interdental cleaning include:

• stops your gums bleeding and prevents gum disease.
• slows down advanced gum disease.
• prevents tooth decay.
• prevents bad breath.
• prevents tooth loss.

Floss — Evidence, Pros & Cons

Flossing is the act of cleaning between the teeth using a tape or string known as floss.

Floss is made up of strands of fibre woven or wrapped together,looking very much like a piece of string. 

The floss is pulled over the outer surface on the tooth. This physically removes the plaque that it comes into contact with.

The thin profile will glide between two teeth. Floss reaches underneath the gum and into the gingival sulcus, an area where plaque builds up.

Floss has many different varieties. This versatility means that it can be suitable for lots of different people.

What Are The Pros And Cons of Floss?

There is a lot of variety within floss. Floss can vary depending on:

• The material it is made with: Nylon multifilament (floss), PTFE monofilament (tape), or plant based materials.
• Whether it is waxed or unwaxed.
• If it comes pre-cut with special features.
• Tools available, and whether these are single use or reusable.

Traditional floss is made of multiple strands of fibre woven together. This is “multifilament” floss. These fibres are most commonly made of nylon, but more environmentally friendly options are available. 

Tape is a monofilament floss, typically made from polytetrafluoroethylene (PTFE). It is wider and flatter than multifilament floss. The tape has a larger surface area as it passes over the tooth surface. It is less prone to shredding.

With floss and tape there is also the option of whether or not it is waxed. The wax coating helps the floss glide over the tooth surface, making the process easier. The wax coating does increase the thickness of the floss and might not fit in the tightest of gaps. The waxed floss tends to be stronger than the unwaxed, but is also more expensive.

Floss can also come pre-cut with special features. These types of floss have three parts: a stiff reinforced end, an expanding or spongy section, and a regular floss section. The stiff section acts a little like a guide wire. This area does not bend or flex and is pushed through gaps. These are designed to be used around appliances such as braces or bridges.

Environmentally friendly alternatives to traditional floss or tape are available. They use natural ingredients or plant based materials. Examples include threads made from bamboo, silk or other plant derived materials. They are normally biodegradable or compostable.

Pros Of Flossing

• Cheap – Very cost effective as one reel will last months. Reels of floss can be picked up for under £2.
• Travel friendly – Compact packaging and can be completed anywhere. Whilst a mirror and a bathroom might be handy, it is not essential to allow you to floss.
• Availability – Easy to source from grocery stores and pharmacies.
• Hygienic – Disposing of the floss after use ensures the bacteria is removed. No rinsing  or cleaning of floss involved.
• Quick and easy to do – Relatively speaking, it is not the most difficult task to complete and can be learnt quickly.
• Good option for small gaps and crowded teeth, where interdental brushes cannot reach.
• Threaded floss can be used for bridges and braces

Cons Of Flossing

• Difficult technique– Getting the floss in between the teeth and cleaning effectively can be very awkward, particularly for rear teeth and those with limited dexterity.
• Painful – Can cut into the gums and be unpleasant to use.
• It takes a good few minutes – To do it properly, takes time.
• You need the right technique to be effective – Simply putting the floss in between teeth is not enough.  You need to cup around each tooth and move the floss for it to work.
• Not effective in larger gaps.
• Difficult to complete if you have restricted dexterity. 
• Traditional floss not suitable for bridges and braces due to obstruction at contact point.
• Smallest evidence base for use (versus interdental brushes and water flossers).

Pros And Cons Of Floss Tools

The floss you use can also be attached to a device to hold the floss. These are most commonly called floss picks, but there are different options:

• Floss holder/floss harp – pre cut floss is held between two arms. Helps position the floss.
• Floss picks/flossette – floss holder with a pick on the other end. Helps position the floss.
• Floss threader – a handle in the shape of a small plastic needle, with an eye for fitting floss through. Good for getting around devices like braces or bridges.

Many options are disposable after one use. There are also options where you just replace the floss after use, keeping the holder. 

You can pick your type of floss or tape depending on your preferences, out of the categories I described above.

The same as floss, the benefits are mostly around removing plaque and food from areas that the toothbrush can’t reach. There are additional pros and cons to the use of flossing tools though.

Pros Of Flossing Tools 

• Same cleaning benefits of floss but better reach – maneuverability comes from the length/height of the floss holder.
• Flossing tools are a good option for those with limited dexterity.
• Flossing tools are less awkward than floss.
• Flossing tools add pressure to help move the floss into the tightest of gaps.
• Don’t need to put fingers in mouth – Better for gag reflex or limited mouth opening.
• Travel friendly – Compact packaging and can be completed anywhere. Whilst a mirror and a bathroom might be handy, it is not essential to allow you to floss.
• Cheap – Very cost effective whether you use single use products which come in large packets, or reusable handles where floss is replaced each time.
• Hygienic – Disposing of the floss after use ensures the bacteria is removed. No rinsing  or cleaning of floss involved.
• Good option for small gaps and crowded teeth, where interdental brushes cannot reach.
• Quick and easy to do – Relatively speaking, it is not the most difficult task to complete and can be learnt quickly.
• Floss picks – two products in one. Has floss on one end and a toothpick on the other.
• Floss holders and floss threaders – enables better dexterity but can still pick the best floss for you.
• Reusable floss holders and floss threaders – reusable handle more environmentally friendly.
• Floss threaders can be used for bridges and braces as an alternative to threaded floss.

Cons Of Flossing Tools 

• Disposable devices have an environmental impact.
• Availability – Limited options in most grocery stores and pharmacies.
• Painful – As with normal floss, can cut into the gums and be unpleasant to use.
• It takes a good few minutes – To do it properly, takes time.
• You need the right technique to be effective – Simply putting the floss in between teeth is not enough.  You need to cup around each tooth and move the floss for it to work.
• Not effective in larger gaps.
• Flossettes and floss picks – not suitable for bridges and braces due to obstruction at contact point

What Is The Evidence For And Against Floss?

Floss is the most widespread method for interdental cleaning.

It is generally considered to be safe. Reversible damage to the gums is possible with incorrect use. These problems usually heal quickly.

Evidence supporting the use of floss for plaque removal is low quality. A review paper by Ng and Lim compared different types of interdental cleaning. They say flossing is of no benefit compared to only brushing.

A reason for the lack of effectiveness of floss is that it is difficult to get the correct flossing technique. Ineffective use of floss is no better than using a toothbrush with no interdental cleaning. 

More recently, The European Federation of Periodontology (EFP) conducted a review. They produced the first evidence based guideline for managing gum disease and periodontitis. Within this, they give advice on how patients should manage their condition at home. Their 2020 Guidelines advise dental floss has no positive effect compared to toothbrushing only.

Despite lack of evidence for removing plaque, a Cochrane Review and Sälzer et al support floss for improving the signs of gum disease. But, they do say that it is not the most effective method.

A study by Terézhalmy et al confirmed the benefits of flossing. They compared 3 types of traditional floss and found that they all remove the same amount of plaque. They report no evidence to support one type of floss over another. 

This means more expensive floss is unlikely to bring you any better oral health benefits.

Floss holders are of some benefit. Ng and Lim report that floss holders encourage a long term habit.

When it comes to how often you should floss, the evidence is contradictory. A 2017 research paper studied the association between how often you floss and whether or not you have periodontal disease. They confirmed the benefits of flossing for gum health. They also concluded that “flossing 2–4 days a week could be as beneficial as flossing more frequently”. 

As you can see, the evidence around flossing is complicated.

Floss is historically the go to recommendation for interdental cleaning. But the evidence now leans towards interdental brushes as being more effective at cleaning.

Who Should Use Floss And Floss Picks

Floss should not be the default interproximal cleaning tool.

Floss should be used in gaps where interdental brushes just don’t fit. 

As recommended by the EFP in their Evidence based guidelines:

“flossing cannot be recommended other than for sites of gingival and periodontal health, where interdental brushes will not pass through the interproximal area without trauma”.

To see what is available and help you pick the best options for you, go to our pages for the best dental floss and flossing tools.

Are There Any Other Alternatives To Flossing? 

Yes, there are alternatives to using floss.

We will discuss other interdental cleaning aids such as water flossers and interdental brushes further down the page.

There are also powered flossers available. Although the most widely known, the Hummingbird has been discontinued, but is still available from some places like ebay. With these tools the floss/pick is a piece of soft rubber that essentially wiggles between the interdental space.  Moving thousands of times per minute, the rubber flosser makes regular contact with the teeth and gum surfaces to remove debris and lift plaque.

There are also some new product types in development, which we write about on our toothbrush technology page.

Water Flossers — Evidence, Pros & Cons

Water flossers use a stream of pressurised water to clean the interdental regions. 

Water flossers are almost synonymous with Waterpik, a popular brand of water flosser. Other names include oral irrigators, electric flossers, water jet flossers or water toothpicks.

The water is pulled from a water reservoir. 

The water is sometimes combined with air. It can also be switched with mouthwash.

It is then pushed through a nozzle towards the area you want to clean. The stream dislodges plaque, bacteria and food debris from between teeth and under the gumline. 

This stream can be continuous or intermittent.

The pulsating action of an oral irrigator creates a small-scale compression and decompression on the gums. This creates an effect of forcing bacteria out from deep underneath the gum line. This effect can go deeper than where the water reaches.

What Are The Pros And Cons Of Water Flossers?

Using a water flosser can help you to improve your oral health. Water flosser options include:

• Countertop: requires a mains power supply during use. These are larger and less portable. They have a larger water reservoir and a choice of power settings. To give you an idea of size, they typically take up a surface area similar to a kettle.
• Cordless (portable): powered by batteries. The device is smaller and has the water tank built into the handle.
• Water flossing vs combination of water and air.

Pros Of Water Flossers

• Easy to reach the back teeth – The nozzles reach into the mouth and can be angled in the right direction. 
• Comfortable on gums – Water is typically softer on the gum tissue and stimulates blood flow.
• Control of pressure – Variable pressure settings allow you to control how powerful the flow of water is on the teeth and gums.
• Quick and easy to do – Once technique is perfected, it is often quicker than regular flossing.
• Hygienic – water flow is used instead of reinserting interdental brush or floss.
• Technique doesn’t rely on manual dexterity.
• Cleans under the gumline.
• Enjoyable to use.
• Designed to last for a couple of years or more.
• Good for braces and appliances.
• Good for cleaning around implants.
• Good for limited dexterity – The handle shape and electronic assistance gives an effective clean. May be more suitable if you have limited hand movement, e.g arthritis.
• Good option for small gaps and crowded teeth, where interdental brushes cannot reach.

Cons Of Water Flossers

• Cost – Expensive to buy and heads need replacement. But consideration needs to be made for the ‘lifetime’ value as over time versus regularly buying a reel of floss.
• Requires access to a sink – You generally need to be leant over a sink to drain away the water.
• Requires power – Many require mains power and this can limit where they are positioned as a sink is also needed. For those with no mains power in a bathroom the cordless options exist.
• Requires water to refill the reservoir.
• Size of device – Countertop flossers are about the size of a kettle. Water tank makes device bulky.
• Not travel friendly – Even the portable options are larger than might be ideal for a weekend travel bag for example. 
• Lack of availability – Most stores won’t stock a range of options, if any. Not as easy to source as standard floss or interdental brushes.
• Messy to use.
• Ineffective plaque removal.
• Produces noise when in use.

What Is The Evidence For And Against Water Flossers?

Water flossers are one of the less common forms of interdental cleaning.

They are safe, with little ability to cause damage to the gums.

It seems that water flossers do not effectively remove plaque. But can still have a positive effect on the gums.

Waterpik has listed a large amount of clinical research on its website. Some people could perceive this as biased. But it is worth noting that it is independently scrutinised to be published in peer-reviewed journals. This means that you can discount any obvious problems with their data. However, do consider that they are unlikely to promote data that doesn’t support their hypotheses (read: advertising claims). Many of the articles are not available in full online, only the Waterpik summary or the paper abstracts.

Highlights from their research are (the link will lead you to the journal article, not the Waterpik page):

• Using a water flosser in addition to toothbrushing reduces bleeding gums and plaque levels. Lyle et al. compared bleeding scores and plaque levels in two groups: those using only an electric toothbrush; those using an electric toothbrush + water flosser. They found that the group who used the water flosser had decreased levels of bleeding gums. The plaque levels were also lower in those using the water flossers, although these results were of less statistical significance.
• Waterpiks reduce gingival inflammation more than flossing does. Barnes et al. 2005 study that found a Waterpik to be more effective than string floss in reducing gingival bleeding. This study compared manual toothbrush + floss to manual toothbrush + water flosser and sonic toothbrush + water flosser. They miss out a key comparison group: sonic toothbrush + flossing. This makes the evidence is somewhat skewed in favour or the waterflosser as much of the benefit of switching to a powered brush is presented as being the waterflosser, but there is no way to compare.
• Water flossers are effective and safe for implants. Kotsakis et al. showed that water flossers are as effective as interdental brushes and more effective than chlorhexidine mouthwash. They reduce the amount of bacteria on implants, without damaging the implant surface. 

Independent reviews and papers support most of these claims. 

Independent reviews by Ng and Lim as well as Worthington et al  showed that water flossers do not reduce plaque levels. This is also shown in Waterpik’s own study in 2011. 

Water flossers might not reduce levels of plaque, but it is thought they do disrupt forming plaque from above and below the gum level. It is thought that this changes the structure of plaque. If the plaque structure is altered, it may cause less inflammation in the gums. But at present, this is only a theory.

They also flush out food debris.

Despite ineffective plaque removal, water flossers do reduce inflammation of the gums. They reduce bleeding from the gums, an indicator for active gum disease.

The 2015 review by Sälzer et al also supports water flossers for improving gingival health versus no interdental cleaning aid. The EFP also recommends water flossers for interdental cleaning in their evidence based guidelines.

Can A Water Flosser Replace Traditional Flossing? 

Yes.

The reviews already mentioned do show support for water flossers. Floss is also ineffective in most cases.

The limited evidence available does say water flossers are more effective than flossing.

But interdental brushes are more effective at cleaning than water flossers.

Go to the section “Is One Type Of Cleaning Recommended Over Another” for a more detailed look at this.

Who Should Use a Water Flosser?

Overall, water flossers are not the most effective at plaque removal. But they still show benefits for gum health.

They are a good option for someone who has tried and failed to use interdental brushes.

Water flossers are a good option for:

• Someone with limited hand and finger mobility.
• Someone with braces, to help clean around the brackets.
• Someone with dental work such as bridges and crowns, who struggle with cleaning in that area.
• Anyone who wants to use them in addition to either floss or interdental brushes.

See our post on the best water flossers for guidance on choosing one.

Interdental brushes — Evidence, Pros & Cons

An interdental brush is a small brush designed for cleaning between your teeth. It has three parts: a handle, a wire core, and fibre bristles. 

Newer all rubber version styles are available too.

The bristles have a large surface area which contacts the teeth on either side of the gap. This action physically removes plaque and food debris. 

Interdental brushes are also known as ‘interproximal brush’ or ‘rubberpick’. TePes are the most famous brand of interdental brushes, so much so that the name is almost synonymous now.

Our video below demonstrates how to use them properly.

How To Use Interdental Brushes

What Are The Pros And Cons Of Interdental Brushes?

Interdental brushes come in various different sizes and styles. To get maximum benefit, you need the correct size for the gap. The options available include:

• Bristle diameter and length – this is the most common variable. Most brands will label the diameter in mm, but also colour code the handle. The colour code is not the same across brands. The bristles can be tapered, straight or even hourglass shaped to clean around the contact point between teeth.
• Handle material – the bit you grip is usually made of plastic. Some companies are developing environmentally friendly materials for the handle such as bamboo or plant derived materials. 
• Handle length – most interproximal brushes come with a short handle. Some companies offer a longer handle to make it easier to reach the back teeth. Handles can be angled to make it easier to reach back teeth.
• Reusable handles – where you only replace the bristle part, reducing waste.
• Bristle hardness and material – the bristles are normally an artificially made fibre which can come in a range of hardnesses. Newer options include wire free silicone brushes.

Pros Of Interdental Brushes

• Most effective option for removing plaque from in between the teeth.
• Most effective option for reducing gum inflammation.
• Travel friendly – Compact packaging and can be completed anywhere. Whilst a mirror and a bathroom might be handy, it is not essential to allow you to floss.
• Wide variety of sizes – something for different size gaps.
• Availability – Easy to source from grocery stores and pharmacies.
• Quick and easy to do – Relatively speaking, it is not the most difficult task to complete and can be learnt quickly.
• Affordability – not as cheap as floss, but can be bought relatively cheaply. And one brush can last a week.
• Easy to reach the back teeth – handles and bending tips help with access to back teeth.
• Can be used with one hand.
• Handles make this a good option for limited dexterity.
• No need to put hands in mouth.
• Good option for large gaps, e.g. where teeth are missing.
• Good option for braces – can clean around the brackets and in between the teeth.
• Good for cleaning around dental appliances e.g. implants and bridges.
• Smaller silicone based brushes can be used in smaller gaps.

Cons Of Interdental Brushes

• Disposable plastic handles – thrown away after only a few uses.
• Different sized brushes for different sized gaps in the teeth – Not a one size fits all approach like floss. Need for more than one size brush.
• Different colour schemes and sizes between brands available can be confusing – need to know diameter
• More expensive than floss.
• Can irritate gums – If used aggressively and incorrectly the wire can cause damage.
• Bacteria build up – Whilst they can be rinsed off and reused for about a week, bacteria can build up on the bristles.
• It takes a good few minutes – To do it properly, takes time.
• Not suitable for very crowded teeth.

What Is The Evidence For And Against Interdental Brushes?

Interdental brushes are the gold standard for interdental cleaning.

Interdental brushes are effective at removing plaque from between the teeth. They have been proven to reduce signs of gum disease, such as bleeding and swelling.

They are safe to use. Rarely, they can cause reversible damage to the gums if used incorrectly.

Rubberpicks, or silicone based interdental brushes, are no less effective than traditional interdental brushes (Ng and Lim). A 2022 study into the use of interdental brushes and rubber interdental picks yet again confirmed that they are effective and cleaning. This new study focussed on onlt patients who have more advanced gum disease (periodontitis) and found both types of cleaner to be better than toothbrushing alone or toothbrushing and flossing.

The following literature reviews rate interdental brushes as the best form of cleaning:

• Richards
• Ng and Lim
• Graziani et al
• Sälzer et al
• European Federation of Periodontology 2020 Guidelines.

Read on to find out more about comparing interdental brushes with floss and water flossers.

Who Should Use Interdental Brushes?

Interdental brushes should be the first option tried for interdental cleaning.

They are suitable for most people and most size gaps.

When it comes to floss vs interdental brushes, use floss if the gaps are too small for interdental brushes.

See our post on the best interdental brushes for guidance on choosing some.

Comparing Floss vs Water Flossers vs Interdental Brushes

So far, I have talked about the pros and cons of each type of interdental cleaning. Read on to find out:

• The reasons why interdental cleaning is important.
• The best method for interdental cleaning.
• How to find the best interdental cleaning product for you.

Do I Need To Do Interdental Cleaning?

Yes. Normal brushing does not clean all of the tooth surface.

Interdental cleaning gets the areas between the teeth and under the gumline. It reaches areas that regular brushing does not. The benefits of this include:

• Dislodging trapped food debris.
• Removing plaque and bacteria.
• Reducing the risk of gum disease.
• Making your mouth feel more clean.
• Preventing tartar (calculus) build up.

The majority of evidence does support the use of interdental cleaning aids in addition to brushing, as opposed to only brushing. 

Reviews, including by Marchesan et al, Ng and Lim, and Worthington et al all discuss the advantages of interdental cleaning. They also go on to compare different types of interdental cleaning.

Is One Type Of Cleaning Recommended Over Another?

Yes.

Interdental brushes should be the first option for interdental cleaning.

Water flossers have some evidence to support their use, but are not as good as interdental brushes.

Flossing is the least effective type of interdental cleaning.

There is a but…

Even with evidence pointing towards one particular type of cleaning, the most important thing is developing a regular habit. The most effective type of interdental cleaning is the one that you will actually do.

There is a small amount of evidence to support all of the cleaning methods. Even the perceived “least” effective forms of interdental cleaning are shown to have some benefit over tooth brushing alone.

Chief Executive of the Oral Health Foundation, Dr Nigel Carter OBE summed this up nicely:

“For some time the recommendation in the UK has been to use interdental brushes rather than floss as the evidence for their effectiveness is stronger.

While there is no suggestion that flossing can be damaging to oral health, there is limited evidence as to its effectiveness. If you are flossing, and flossing well, it will cause no harm and it is probably not advisable to give up but you might want to try interdental brushes as an alternative.”

What Is The Evidence For The Best Form Of Interdental Cleaning?

When considering evidence, reviews have the highest standard of evidence. Reviews compare individual studies and research papers. Reviews collaborate the evidence to make statements. 

There is some difficulty directly comparing different types of interdental cleaning. This is because of differences in methods during studies. The result of this is low quality evidence. The term “low quality” is actually a technical term used within science. Low quality does not equate to the method of interdental cleaning being ineffective.

As reviews are considered the highest levels of evidence, many clinicians will turn to for evidence based practice. 

Interdental brushes are more effective than water flossers and traditional floss. They are easier to use than traditional floss, and more accessible than water flossers. Cost wise, they are a middle ground between traditional floss and water flossers. People tend to prefer using interdental brushes over floss. People are more likely to develop a regular cleaning habit with interdental brushes compared to traditional floss (no evidence yet regarding water flossers).

The “effectiveness” applies to the amount of plaque removed. Interdental brushes are the best for removing plaque whether or not you have gum disease. They are also shown to have the best improvements in people who do have periodontitis. 

When considering all the available evidence, interdental brushes also show the greatest improvement in the signs of gum disease. This includes the amount of bleeding coming from the gums, as well as swelling in the gums.

The following reviews all support interdental brushes over other forms of interdental cleaning: 

• Richards
• Ng and Lim
• Worthington et al 
• Graziani et al
• Sälzer et al
• Kotsakis et al

The European Federation of Periodontology 2020 Guidelines and British Society of Periodontology both advise the use of interdental brushes for interdental cleaning. This is due to their effectiveness and ease of use. 

Water flossers have some evidence to support their use. Reviews comparing water flossers to other forms of interdental cleaning promote their use over flossing. But they are not as effective as interdental brushes (Ng and Lim, Worthington et al). Kotsakis et al found water flossers (and interdental brushes) to be more effective than flossing.

Water flossers are not effective at removing plaque, yet still have some positive effects on signs of gum disease. They are easier to use than floss.

Floss should only be used in the smallest of gaps. Flossing is easily accessible and affordable for most people. Traditionally, it is the most commonly recommended method. Despite this, flossing is less effective at cleaning compared to interdental brushes. People find it hard to develop a habit using floss due to difficulty getting the right technique. Interdental brushes and water flossers are generally easier to use. 

Flossing is largely ineffective at plaque removal, unless done with correct technique (Sälzer et al). The majority of studies show that flossing has limited effects on plaque scores. It ranks worse than interdental brushes. In direct comparison with water flossers, there is no evidence about which is more effective. Generally water flossers have better results than floss for improving gingival inflammation. 

Flossing shows some improvements in bleeding for patients with early stages of gum disease. The European Federation of Periodontology (EFP) 2020 Guidelines advise flossing provides no benefit to patients with periodontal disease.

Flossing is difficult to do and has poor patient compliance. Correct technique for flossing is very important for it to have a positive effect on gum health and reducing risk of decay. Unfortunately this proper technique is difficult to achieve at home. This probably explains lack of success in real world applications (Kotsakis et al, Ng and Lim). 

The one advantage of floss is that it can fit in the very tightest of gaps. The EFP say “flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes will not pass through the interproximal area without trauma”. 

What Is The Take Home Message?

If you already have perfect gum health (as diagnosed by your dentist or hygienist) there is no need to change what you use for interdental cleaning.

If you need to start interdental cleaning, interdental brushes are the most effective option.

But you need to choose a tool which you feel happy using. Very often, floss is not what people feel happiest using.

It is best for you to go to your own dentist or hygienist. They will make you your own personalised plan that is unique for your mouth.

I believe Dr Terri Tilliss summaries the situation best.  “To achieve optimal oral hygiene, the key is an effective device that people will use long-term… since traditional string floss has negative associations, patients are often receptive to learning about alternatives. It seems futile to continue to hope for floss compliance in patients who have never developed daily flossing behaviors.”

Is One Choice More Eco-friendly Over Another? 

I have reviewed the scientific evidence for each method of interdental cleaning. 

When picking the best option for you, the environment might also be a concern.

At Electric Teeth, we like to give you options and let you make your own decision. We are investigating environmentally friendly options and will let you know when we can give more advice about it.

In the meantime, things to consider about environmentally friendly options include:

• What materials are used – new plastics, recycled materials, plant based materials?
• Is the product vegan or cruelty free?
• Is the product single use or reusable?
• Can the product be recycled?
• Is the product compostable?
• What packaging is used?

Sign up here to be informed about the latest developments. 

How Can I Find The Right Product For Me?

Choosing the right product is very personal.

See below for a quick comparison of the different methods of interdental cleaning. This is in a simple traffic light system (red – amber – green). Red is comparatively worse rated than green. This is just rough guidance as there is variety within each category!

As always, see a dental professional for tailored advice.

	Floss	Flossing Tool	Water flosser	Interdental brushes
Cost	🟢	🟠	🔴	🟠
Availability	🟢	🟠	🔴	🟢
Ease of use	🔴	🟠	🟠	🟢
Environmental Impact	🟠	🟠	🟠	🟠
Cleaning Effectiveness	🔴	🔴	🟠	🟢
Good for small gaps	🟢	🟢	🟢	🟠
Good for big gaps	🔴	🔴	🟠	🟢
Good for crowns and bridges	🔴	🟠	🟢	🟢
Good for braces	🔴	🟠	🟢	🟢
Good for implants	🔴	🔴	🟢	🟢
How long each bit lasts for	One reel – months. Floss itself single use	Single use piece of floss. Reusable handles	Years, nozzle changed every few months	One brush lasts about a week

Conclusion

Interdental cleaning is recommended for everybody. 

Your teeth and gums will be cleaner using some form of interdental cleaning.

Interdental brushes are the most effective at cleaning and are the easiest to use. They are normally reuseable for up to a week, but do cost more than floss. 

Water flossers are not as effective as interdental brushes, but are an alternative.

Traditional floss is the least effective form of interdental cleaning. Tools are available, which can make them easier to use. Floss should only be used in the tightest of gaps where interdental brushes do not fit.

FAQ

Does dental floss expire?

It depends on the brand and type of floss, so check the container/packaging. If the product does expire, avoid using after this time. Often the expiry date is a long time in the future, giving you many months between purchase and the time it must be used by. If you like to bulk buy, in many instances you can do this without fear of it being out of date, but do double check. Biodegradable products, in particular, are more likely to have an expiration date as after this time the strength, taste and general use may be compromised.

Waxed v unwaxed floss – which is best?

It is a choice based on personal circumstances. There is no evidence to support using one over the other. Unwaxed floss can often reach or fit in tighter gaps, is cheaper and just as effective. The waxed floss, on the other hand, may be more enjoyable to use and work better for some.  Find what works for you.

Floss vs tape

The flatter profile of tape can be more enjoyable to use for some as it often glides with more ease. Tape is easier to hold compared to string floss. Neither is more effective than the other in plaque removal.

What’s the difference between a water flosser and oral irrigator?

Nothing aside from the name. These are two terms often used interchangeably, but they describe the same sort of device. You may also see them referenced as water irrigators or a water jet flosser.

Do I need to use toothpaste with interdental brushes?

No, you do not have to. Some dentists do advise using it though to coat the areas with fluoride but also ease the movement or gliding of the brush into what can be quite tight spaces. Interdental brushes can also be used to deliver special gels, such as chlorhexidine gels, into areas between the teeth, to help manage advanced gum disease.

How often do interdental brushes need replacing?

The general recommendation is that an interdental brush can be reused for about a week or when the bristles become worn, wires buckled or distorted. You do not need to replace after every use unless they are damaged or worn. If they become buckled with each use, you are probably using the wrong size.

Why are my gums bleeding?

Bleeding gums can be a sign of gingivitis (gum disease). Diseased gums can bleed very easily and regular cleaning will result in healthier gums. If there is only a small amount of bleeding continue to brush for a few days and the bleeding should reduce. Should the bleeding continue beyond two weeks, or if the bleeding does not stop shortly after brushing, seek advice from a dental professional.