Dental floss

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A picture demonstrating the use of floss to remove dental plaque between the teeth Floss4.jpg
A picture demonstrating the use of floss to remove dental plaque between the teeth

Dental floss is a cord of thin filaments used in interdental cleaning to remove food and dental plaque from between teeth or places a toothbrush has difficulty reaching or is unable to reach. [1] Its regular use as part of oral cleaning is intended to maintain oral health.

Contents

Use of floss is recommended to prevent gingivitis and the build-up of plaque. [2] The American Dental Association claims that up to 80% of plaque can be removed by flossing, and it may confer a particular benefit in individuals with orthodontic devices. [3] However, empirical scientific evidence demonstrating the clinical benefit of flossing as an adjunct to routine tooth brushing alone remains limited. [3]

A Japanese macaque and long-tailed macaques have been observed in the wild and in captivity flossing with human hair and feathers. [4] [5] [6]

History

Dental floss (waxed) Dental floss (whole).jpg
Dental floss (waxed)

Levi Spear Parmly (1790-1859), [7] a dentist from New Orleans, is credited with inventing the first form of dental floss. [8] In 1819, he recommended running a waxen silk thread "through the interstices of the teeth, between their necks and the arches of the gum, to dislodge that irritating matter which no brush can remove and which is the real source of disease." [9] [10] He considered this the most important part of oral care. [8] Floss was not commercially available until 1882, when the Codman and Shurtleft company started producing unwaxed silk floss. [11] In 1898, the Johnson & Johnson Corporation received the first patent for dental floss that was made from the same silk material used by doctors for silk stitches. [11]

One of the earliest depictions of the use of dental floss in literary fiction is found in James Joyce's famous novel Ulysses (serialized 1918–1920), but the adoption of floss was low before World War II. During the war, nylon floss was developed by physician Charles C. Bass. [11] Nylon floss was found to be better than silk because of its greater abrasion resistance and ability to be produced in great lengths and at various sizes. [11]

Floss became part of American and Canadian daily personal dental care routines in the 1970s. [12]

Use

Dental professionals recommend that a person floss once per day before or after brushing to reach the areas that the brush will not and allow the fluoride from the toothpaste to reach between the teeth. [13] [14] Floss is commonly supplied in plastic dispensers that contain 10 to 100 meters of floss. After pulling out approximately 40 cm of floss, the user pulls it against a blade in the dispenser to cut it off. The user then strings the piece of floss on a fork-like instrument, or holds it between their fingers using both hands with about 1–2 cm of floss exposed. The user guides the floss between each pair of teeth and gently curves it against the side of the tooth in a 'C' shape and guides it under the gumline. This removes particles of food stuck between teeth and dental plaque that adhere to dental surfaces below the gumline. [3]

Types

Various dental flosses are commonly used in many forms, including waxed, unwaxed monofilaments and multifilaments. Dental floss that is made of monofilaments coated in wax slides easily between teeth, does not fray and is generally higher in cost than its uncoated counterparts. The most important difference between available dental flosses is thickness. Waxed and unwaxed floss are available in varying widths. Studies have shown that there is no difference in the effectiveness of waxed and unwaxed dental floss, [15] but some waxed types of dental floss are said to contain antibacterial agents and/or sodium fluoride. Factors to consider in choosing a floss include the amount of space between teeth and user preference. Dental tape is a type of floss that is wider and flatter than conventional floss. Dental tape is recommended for people with larger tooth surface area. [15]

The ability of different types of dental floss to remove dental plaque does not vary significantly; [16] the least expensive floss has essentially the same impact on oral hygiene as the most expensive.

Factors to be considered when choosing the right floss or whether the use of floss as an interdental cleaning device is appropriate may be based on: [15]

left: floss molded in disposable prongs, top: 135deg handle, bottom: 90deg handle Flossholders.jpg
left: floss molded in disposable prongs, top: 135° handle, bottom: 90° handle

Specialized plastic wands, or floss picks, have been produced to hold the floss. These may be attached to or separate from a floss dispenser. While wands do not pinch fingers like regular floss can, using a wand may be awkward and can also make it difficult to floss at all the angles possible with regular floss. These types of flossers also run the risk of missing the area under the gum line that needs to be flossed. On the other hand, the enhanced reach of a wand can make flossing the back teeth easier.

Dental floss is the most frequently recommended cleaning aid for teeth sides with a normal gingiva contour in which the spaces between teeth are tight and small. [15] The dental term 'embrasure space' describes the size of the triangular-shaped space immediately under the contact point of two teeth. [15] The size of the embrasure space is useful in selecting the most appropriate interdental cleaning aid. There are three interproximal embrasure types or classes as described below: [15]

The classification of the amount of gum that fills the spaces between the teeth Embrasure spaces.png
The classification of the amount of gum that fills the spaces between the teeth

The table below describes the types of interdental non-powered self-care products available. [15]

Interdental nonpowered self-care productsDescriptionIndicationsContraindications and limitationsCommon problems experienced during misuse of productNumber of times it can be used/duration of use
Waxed flossTraditional string floss, Nylon waxed Monofilament floss also available coated in polytetrafluoroethylene (PTFE), Does not frayType I embrasures, Floss cleans between the gum and toothType II and III embrasuresFloss cuts, Floss clefts, Circulation to fingers may cut off from wrapping floss too tight, Inability to reach back teeth due to spacing and dexterity difficultiesOne time use. Dispose after use
Unwaxed flossTraditional string floss, Unwaxed, multifilamentsType I embrasures, Floss cleans between the gum and toothType II and III embrasuresSee waxed flossOne time use. Dispose after use
Dental tapeWaxed floss that has a wider and flatter design to conventional flossType I embrasures, Floss cleans between the gum and tooth that may have large tooth surface areaType II and III embrasuresSee waxed flossOne time use. Dispose after use
Tufted/braided dental floss/ SuperflossRegular diameter floss, wider tufted portion looks like yarn. Tip of product also resembles a threaderType II and III embrasures. Under pontics of fixed partial denturesType I embrasuresTrauma from forcing threader into tissues. Yarnlike portion/fibers may catch on appliances or dental work (which may cause gum irritation/problem)One time use. Dispose after use
Continuous floss holderHandle with two prongs in Y or F shapeType I embrasures. Recommended where spacing or gag reflexes make finger-held flossing difficult. Floss holders may assist caregiversType II and III embrasuresUnable to maintain tension of floss against tooth and fully wrap around tooth side. Need to set a fulcrum/finger rest (e.g. cheek, chin) to avoid trauma to gums and floss cuts. Varied designs offer varied ease in repositioning floss.Can be used a number of times; long continuous floss is repositioned after each use.
Molded floss holder - two-pieceHandle with separable prongs in Y shapeType I embrasures. Recommended where spacing or gag reflexes make finger-held flossing difficult. Floss holders may assist caregiversType II and III embrasuresEases positioning and moving floss with tension, in tight spaces, and improves visibility.Handle is reused indefinitely. Prongs and molded-in floss are changed after each use, or when frayed.
Molded floss holder - one-pieceSmall handle with prongs in Y or F shapeType I embrasures. Recommended where spacing or gag reflexes make finger-held flossing difficult. Floss holders may assist caregiversType II and III embrasuresEases positioning and moving floss with tension, in tight spaces, and improves visibility.Pronged handle and molded-in floss are changed after each use, or when frayed.
Floss threaderA nylon loop designed to resemble a needle with large opening to thread floss. Tip of floss threader inserted and pulled through the space between two teeth to allow cleaning of the teeth sidesType I embrasures: tight contacts between teeth, floss between and under abutment teeth and pontics of fixed prosthesis (e.g. fixed bridges and dental implants), under orthodontic appliances such as wires and lingual bar, under bars for implantsType II and III embrasuresTrauma to gums from flossing threader into tissuesCan be used a number of times, however floss is to be changed after each use
Threader-tip flossA length of floss with an attached threader tipType I embrasures, Floss cleans between the gum and toothType II and III embrasuresSee waxed flossOne time use. Dispose after use

The table below describes the different types of Interdental powered self-care products available. [15]

Powered flosser Powered flosser.jpg
Powered flosser
Interdental powered self-care productsDescriptionIndicationsContraindications and limitationsCommon problems experienced during misuse of product
Power flossersBow type tip and single filament nylon tipType I embrasures: Individuals with physical challenges. Individuals who cannot master traditional string floss. Individual preference.Type II and III embrasures. Tight contacts between teeth or crowded teethFloss cuts or clefts with floss holder designs. Unable to maintain tension or wrap floss completely around tooth side.

Efficacy

Evidence

The American Dental Association has stated that flossing in combination with brushing of teeth can help prevent gum disease [17] and halitosis. [18]

However, evidence favoring commonplace use of floss remains limited. A 2008 systematic review concluded that adjunct flossing was no more effective than tooth brushing alone in reducing plaque or gingivitis. [3] The authors concluded that routine instruction of flossing in gingivitis patients as helpful adjunct therapy is not supported by scientific evidence, and that flossing recommendations should be made by dental professionals on an individual basis. [3]

A 2011 Cochrane Database systematic review identified "some evidence from 12 studies that flossing in addition to tooth brushing reduces gingivitis compared to tooth brushing alone", and "weak, very unreliable evidence from 10 studies that flossing plus tooth brushing may be associated with a small reduction in plaque at 1 and 3 months." [19] Studies of flossing behavior are based on self-report and many people do not floss properly. A 2006 review of 6 studies in which professionals flossed the teeth of school children over a period of 1.7 years showed a 40% reduction in the risk of tooth decay. [20]

More recently, a 2019 Cochrane Database systematic review compared toothbrushing alone to interdental cleaning devices, and also compared flossing to other interdental cleaning methods. [21] In all, 35 randomized control trials met the criteria for inclusion, with all but 2 studies at high risk for performance bias. The authors concluded that "overall, the evidence was low to very low certainty, and the effect sizes observed may not be clinically important."

As many authors note, the efficacy of flossing may be highly variable based on individual preference, technique, and motivation. [22] Moreover, flossing may be a relatively more difficult and tedious method of interdental cleaning compared to an interdental brush. [22]

Exclusion from US Dietary Guidelines in 2015

There was a controversy when the 2015 United States Dietary Guidelines for Americans [23] did not include a recommendation about flossing. The U.S. Department of Health and Human Services and the U.S. Department of Agriculture publish Dietary Guidelines for Americans every five years. [24] Guidelines published in 2000, 2005 and 2010 [25] recommended flossing as part of a combined approach to preventing dental diseases. The 2010 Guidelines [26] mention flossing once in 95 pages, in 2005 [27] the word also appears once in 71 pages and it appears twice in the 38-page 2000 document. [28]

In August 2016, an Associated Press (AP) article titled "Medical benefits of dental floss unproven" [29] reported on the omission of flossing from the 2015 document. The article tied the omission to the AP's Freedom of Information Request to the departments of Health and Human Services and Agriculture where it asked for the scientific evidence behind the Guidelines' flossing recommendation noting that "The guidelines must be based on scientific evidence, under the law." The story was picked up by other news organizations including The New York Times in an article entitled "Feeling Guilty About Not Flossing? Maybe There's No Need". [30]

The American Dental Association contacted the U.S. Department of Health and Human Services [31] [32] about the omission and reported that the omission of the flossing recommendation was due to the fact that the Dietary Guidelines chose to focus on diet and that the omission was not because the Department questions the efficacy of flossing. As reported by Medscape

An HHS spokesperson explained in an e-mailed statement that "since neither the 2010 nor 2015 Advisory Committees reviewed evidence on brushing and flossing teeth, the authors of the current edition decided not to carry forward the information on brushing and flossing included in past editions of the guidelines. By doing so, they were not implying that this is not an important oral hygiene practice. It is also important to note that, although dental floss was mentioned in past editions of the Guidelines, it was most likely identified as a supporting recommendation along with brushing teeth, with the primary emphasis being on the nutrition-based recommendation to reduce added sugars." The 2010 guidelines mention flossing only once, as one of the components of an oral health regimen. [33]

A website managed by a maker of dental floss referred to the entire episode as "Flossgate". [34]

Floss for orthodontic appliances

Orthodontic appliances, such as brackets, wires, and bands, can harbor plaque with more virulent changes in bacterial composition, which can ultimately cause a reduction in periodontal health as indicated by increased gingival recession, bleeding on probing, and plaque retention measurements. [35] Furthermore, fixed appliances makes plaque control more challenging and restricts the natural cleaning action of the tongue, lips, and cheek to remove food and bacterial debris from tooth surfaces, and also creates new plaque stagnation areas that stimulate the colonisation of pathogenic bacteria. [36]

Floss threader Floss Threader Picture.png
Floss threader

Patients undergoing orthodontic treatment may be recommended to maintain a high level of plaque control through not only conscientious toothbrushing, but also proximal surface cleaning via interdental aids, with dental floss being the most recommended by dental professionals. [35] Notably, small-scale clinical studies have demonstrated that dental floss, when used correctly, may lead to clinically significant improvements in proximal gingival health. [35]

Floss threader

A floss threader is loop of fiber that is shaped in order to produce better handling characteristics. It is (similar to fishing line) used to thread floss into small, hard to reach sites around teeth. [37] Threaders are sometimes required to floss with dental braces, fix retainers, and bridge.

Floss pick

Floss pick shapes
F-Shaped Floss Pick.jpg
F-shaped

A floss pick is a disposable oral hygiene device generally made of plastic and dental floss. The instrument is composed of two prongs extending from a thin plastic body of high-impact polystyrene material. A single piece of floss runs between the two prongs. The body of the floss pick generally tapers at its end in the shape of a toothpick. There are two types of angled floss picks in the oral care industry, the Y-shaped angle and the F-shaped angle floss pick. At the base of the arch where the "Y" begins to branch there is a handle for gripping and maneuvering before it tapers off into a pick.

Floss picks are manufactured in a variety of shapes, colors and sizes for adults and children. The floss can be coated in fluoride, flavor or wax. [38]

History of floss pick

In 1888, B.T. Mason wrapped a fibrous material around a toothpick and dubbed it the "combination tooth pick." [39] In 1916, J.P. De L'eau invented a dental floss holder between two vertical poles. [40] In 1935, F.H. Doner invented what today's consumer knows as the Y-shaped angled dental appliance. [41] In 1963, James B. Kirby invented a tooth-cleaning device that resembles an archaic version of today's F-shaped floss pick. [42]

In 1972, an inventor named Richard L. Wells found a way to attach floss to a single pick end. [43] In the same year, another inventor named Harry Selig Katz came up with a method of making a disposable dental floss tooth pick. [44]

See also

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Toothbrush</span> Oral hygiene tool

A toothbrush is an oral hygiene tool used to clean the teeth, gums, and tongue. It consists of a head of tightly clustered bristles, atop of which toothpaste can be applied, mounted on a handle which facilitates the cleaning of hard-to-reach areas of the mouth. They should be used in conjunction with something to clean between the teeth where the bristles of the toothbrush cannot reach - for example floss, tape or interdental brushes.

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities, gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

<span class="mw-page-title-main">Toothpick</span> A small stick for cleaning teeth

A toothpick is a small thin stick of wood, plastic, bamboo, metal, bone or other substance with at least one and sometimes two pointed ends to insert between teeth to remove detritus, usually after a meal. Toothpicks are also used for festive occasions to hold or spear small appetizers or as a cocktail stick, and can be decorated with plastic frills or small paper umbrellas or flags.

<span class="mw-page-title-main">Gums</span> Soft tissue surrounding the roots of the teeth

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

An electric toothbrush, motorized toothbrush, or battery-powered toothbrush is a toothbrush that makes rapid automatic bristle motions, either back-and-forth oscillation or rotation-oscillation, in order to clean teeth. Motions at sonic speeds or below are made by a motor. In the case of ultrasonic toothbrushes, ultrasonic motions are produced by a piezoelectric crystal. A modern electric toothbrush is usually powered by a rechargeable battery charged through inductive charging when the brush sits in the charging base between uses.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

<span class="mw-page-title-main">Oral irrigator</span> Dental care device

An oral irrigator is a home dental care device which uses a stream of high-pressure pulsating water intended to remove dental plaque and food debris between teeth and below the gum line. Regular use of an oral irrigator is believed to improve gingival health. The devices may also provide easier cleaning for braces and dental implants. However, more research is needed to confirm plaque biofilm removal and effectiveness when used by patients with special oral or systemic health needs.

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<span class="mw-page-title-main">Gingival recession</span> Exposure in the roots of the teeth

Gingival recession, also known as gum recession and receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting in adolescence, or around the age of 10. It may exist with or without concomitant decrease in crown-to-root ratio.

<span class="mw-page-title-main">Tooth brushing</span> Act of scrubbing teeth with a toothbrush

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<span class="mw-page-title-main">Oral hygiene</span> Cleaning the mouth by brushing the teeth and cleaning in between the teeth

Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Gingival disease is a term used to group the diseases that affect the gingiva(gums). The most common gingival disease is gingivitis, the earliest stage of gingival-related diseases. Gingival disease encompasses all the conditions that surround the gums, this includes plaque-induced gingivitis, non-dental biofilm plaque-induced gingivitis, and periodontal diseases.

<span class="mw-page-title-main">Angularis nigra</span> Small triangle-shaped gap which often occurs between the teeth, near the gums

Angularis nigra, Latin for 'black angle', also known as open gingival embrasures, and colloquially known as "black triangle", is the space or gap seen at the cervical embrasure, below the contact point of some teeth. The interdental papilla does not fully enclose the space, leading to an aperture between adjacent teeth. This gap has many causes including gingival recession, and gingival withdrawal post-orthodontic work. Interdental "black triangles" were rated as the third-most-disliked aesthetic problem below caries and crown margins. Treatment of angularis nigra often requires an interdisciplinary approach, involving periodontal, orthodontic and restorative treatment. Possible treatments to correct angularis nigra include addition of composite resin in the space, veneer placement, or gum graft. Angularis nigra is generally only treated based on the aesthetic preference of the patient.

Interdental cleaning or interproximal cleaning is part of oral hygiene where the aim is to clean the areas in between the teeth, otherwise known as the proximal surfaces of teeth. This is to remove the dental plaque in areas a toothbrush cannot reach. The ultimate goal of interproximal cleaning is to prevent the development of interproximal caries and periodontal disease. The combined use of tooth brushing, and mechanical and manual interdental cleaning devices has been proven to reduce the prevalence of caries and periodontal diseases.

References

  1. ↑ "How to Floss". Flossing Techniques-Flossing Teeth Effectively. Colgate. 2015. Retrieved 17 April 2015.
  2. ↑ Bauroth K, Charles CH, Mankodi SM, Simmons BS, Zhao Q, Kumar LD (2003). "The efficacy of an essential oil antiseptic mouthrinse vs. dental floss in controlling interproximal gingivitis". Journal of the American Dental Association. 134 (3): 359–365. doi:10.14219/jada.archive.2003.0167. PMID   12699051.
  3. 1 2 3 4 5 Berchier CE, Slot DE, Haps S, van der Weijden GA (2008). "The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review". International Journal of Dental Hygiene. 6 (4): 265–279. doi:10.1111/j.1601-5037.2008.00336.x. PMID   19138178. The dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal. In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence.
  4. ↑ "Monkeys 'teach infants to floss'". BBC News . 12 March 2009. Retrieved 23 November 2020.
  5. ↑ Jean-Baptiste Leca; Noëlle Gunst; Michael A. Huffman (10 July 2009). "The first case of dental flossing by a Japanese macaque (Macaca fuscata): implications for the determinants of behavioral innovation and the constraints on social transmission". Primates . 51 (13): 13–22. doi:10.1007/s10329-009-0159-9. PMID   19590935. S2CID   35199618 . Retrieved 23 November 2020.
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  11. 1 2 3 4 Kruszelnicki KS (30 March 2001). "Dental Floss 1". ABC Science. Retrieved 15 May 2015.
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  14. ↑ "Flossing & Brushing". Canadian Dental Association. 2015. Retrieved 17 April 2015.
  15. 1 2 3 4 5 6 7 8 Darby M, Walsh M. Dental Hygiene Theory and Practice. 3rd Ed. Saunders Elsevier; 2010. p.402-410
  16. ↑ Heasman P, ed. (2008). Restorative dentistry, paediatric dentistry and orthodontics (2nd ed.). Edinburgh: Churchill Livingstone. p.  37. ISBN   978-0-443-06895-9.
  17. ↑ American Dental Association, Accessed 28 November 2009. "ADA.org: ADA Seal of Acceptance: Floss and Other Interdental Cleaners". Archived from the original on February 9, 2009. Retrieved 2009-07-06.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  18. ↑ American Dental Association, "Bad Breath (Halitosis)". Accessed 28 November 2009. Archived March 6, 2008.
  19. ↑ Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV (2011). "Flossing for the management of periodontal diseases and dental caries in adults". Cochrane Database of Systematic Reviews (12): CD008829. doi:10.1002/14651858.CD008829.pub2. PMID   22161438. S2CID   70702223.
  20. ↑ Longbottom, Chris (2006). "Professional flossing is effective in reducing interproximal caries risk in children who have low fluoride exposures: Does dental flossing reduce interproximal caries incidence?". Evidence-Based Dentistry. 7 (3): 68. doi: 10.1038/sj.ebd.6400425 . ISSN   1462-0049. PMID   17003792.
  21. ↑ Worthington, Helen V; MacDonald, Laura; Poklepovic Pericic, Tina; Sambunjak, Dario; Johnson, Trevor M; Imai, Pauline; Clarkson, Janet E (2019-04-10). Cochrane Oral Health Group (ed.). "Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries". Cochrane Database of Systematic Reviews. 2020 (4): CD012018. doi:10.1002/14651858.CD012018.pub2. PMC   6457073 . PMID   30968949.
  22. 1 2 Imal P.; Yu X.; MacDonald D. (2012). "Comparison of interdental brush to dental floss for reduction of clinical parameters of periodontal disease: A systematic review". Canadian Journal of Dental Hygiene. 46: 63–78.
  23. ↑ 2015–2020 Dietary Guidelines for Americans (8 ed.). U.S. Department of Health and Human Services and U.S. Department of Agriculture. December 2015. Retrieved 16 January 2021.
  24. ↑ "About the Dietary Guidelines" . Retrieved 16 January 2021.
  25. ↑ "Previous Dietary Guidelines" . Retrieved 16 January 2021.
  26. ↑ Dietary Guidelines for Americans, 2010 (7 ed.). U.S. Department of Health and Human Services and U.S. Department of Agriculture. December 2010. p. 48. Retrieved 16 January 2021.
  27. ↑ Dietary Guidelines for Americans, 2005 (6 ed.). U.S. Department of Health and Human Services and U.S. Department of Agriculture. January 2005. p. 37. Retrieved 16 January 2021.
  28. ↑ Nutrition and Your Health: Dietary Guidelines for Americans, 2000 (5 ed.). U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2000. p. 32. Retrieved 16 January 2021.
  29. ↑ Donn, Jeff (2 August 2016). "Medical benefits of dental floss unproven". Associated Press . Retrieved 16 January 2021.
  30. ↑ Saint Louis, Catherine (2 August 2016). "Feeling Guilty About Not Flossing? Maybe There's No Need". The New York Times . Retrieved 16 January 2021.
  31. ↑ Manchir, Michelle (2 August 2016). "Government, ADA recognize importance of flossing". ADA News. Archived from the original on 21 January 2021. Retrieved 16 January 2021.
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