LORD OF THE FLOSS

Flossing is an annoying little habit that is so easy to do but so hard to do regularly. Most people would not think of going without brushing twice daily but those same people typically do not floss at all. Ever. Your mother was right. You should floss your teeth every day! Picture this - if you think about the shape of a tooth as a box – you can see that brushing only touches three sides of the box, the top and two of the sides. Flossing is the only way to clean the sides of the box that touch other boxes. Flossing is the only way to clean in between your teeth. Period. You can brush perfectly and use mouthwash and special toothpaste, it doesn’t matter. You will still have plaque and bacteria between your teeth. And between the teeth is where all the problems begin.


Without flossing the gums get red and inflamed, the condition dental personnel call gingivitis. This low grade inflammation causes levels of CRP (C-reactive protein) to increase in the bloodstream. CRP is a marker for inflammation in the body. High levels of this protein are associated with increased risks of premature birth, heart disease, strokes, and most recently, Alzheimer’s disease. The higher the CRP levels, the higher the risk. Of course, gingivitis isn’t the only cause of increased CRP levels. Smoking, high blood pressure, diabetes, and infections all contribute to raising CRP levels. Flossing is just one easy way for anyone to decrease the level of inflammation in the body.

Although the above is scary, most children and teens aren’t concerned with their CRP levels. But this does not mean that flossing isn’t important for them. The bacteria between the teeth can also cause cavities. Although decay is found most commonly on the pits and fissures on the biting surfaces of the back teeth, the second most common place for decay is in between the teeth, where the teeth contact each other. This decay doesn’t hurt and isn’t visible to the eye in the initial stages. It can only be seen on xrays. Without flossing, the contact points between the teeth are never cleaned. Add a little sugar to that bacteria sitting in the tooth and you have the recipe for decay.

When flossing, the floss shouldn’t “snap” between the teeth. Most people just snap the floss between and think the job is done. There is a little more to flossing properly. Wrap floss around your fingers and while moving the floss up, down, back, and forth wipe the side of each tooth in the contact. Angle the floss so it wraps around the tooth in a “C” shape and go below the gumline. Don’t forget to wrap the “C” around the other tooth too to make sure you floss both teeth that are touching. If you have the floss positioned properly, this will not hurt. Wind the floss so a fresh piece of floss can be used for each contact. Floss behind the last tooth too, this is an area that is difficult to reach with brushing. Once you get the hang of it, flossing is easy to do, even without looking in a mirror. Flossing should be a part of your regular hygiene, just like brushing.

     Many physically and mentally disabled people live in residential centers, cared for on a daily basis by people other than family. Even when residential staff is caring and compassionate, often training is not in place for daily dental care of patients.
     High levels of oral disease are present in these disabled populations due to lack of care. Many residents at these institutions cannot maintain any level of oral hygiene due to physical inability or mental incapacity. Having poor dental health can impact eating ability, diet, weight, speech, appearance and social interactions. Those living in residential care centers are completely reliant on their care givers to provide regular dental hygiene. It becomes necessary for family members to educate and discuss expectations with caregivers so that the disabled person's needs are met.
     For dependent and cognitively impaired adults, the provision of necessary daily hygiene can be challenging and daunting for care givers. It gets further complicated when patients have reduced dexterity, impaired sensory functions, cognitive problems and behavioral issues.

      Medications that are commonly used in these populations, like anti-depressants, blood pressure medications, diabetes medications and anti-psychotics often cause decreased salivary flow which in turn creates more dental problems. When salivary flow decreases, the amount of decay increases dramatically. Lowered salivary flow also creates an oral environment where dentures and partials can become uncomfortable, causing sores to develop.
     People with diabetes have a greater incidence of gum disease, which can in turn be associated with a greater risk of heart disease. In order to successfully manage overall health care in this population, attention to dental care becomes imperative. The following recommendations can be addressed by family members and caregivers.
- Assistance in daily oral hygiene, meaning daily plaque removal via brushing and denture cleaning. Ideally, brushing should be done twice daily. Dentures should be removed while sleeping. Flossing or use of floss aids can be implemented when physical skill allows.
- Regular dental examinations whether at the facility or at an outside dentist.
- Use of antimicrobial mouth rinses/sprays to decrease food debris, plaque and bacteria.
- Reducing intake of sugary foods.
     Poor oral health and dental pain can impact the disabled person's general well-being and quality of life. Regular oral health practices fall upon caregivers when disabled people cannot take care of themselves.
Family members can ask care givers what dental services are provided for residents and what kind of training they have had to provide those services. A consultation with a dentist can provide family members with the tools they need to make recommendations for their loved one's care.