Some thoughts about educating patients about how to floss...

Let's face it, The majority of the population don't floss daily. I would go so far as to say the majority never floss. Of those who floss regularly, many are not performing the task optimally. I myself was pushed to floss without knowing why but it was just something I did. It wasn't until I was educated as a dentist that my technique had logic behind it. However, in the end, any kind of mechanical cleansing action interdentally is better than no cleaning. Below are some points I consider when educating patients to floss:

-Any cleaning is better than nothing. The most superior method of cleaning interdentally is one that the patient will actually do. Don't overcomplicate things and confuse them or they'll lose the motivation to pick up the habit

-That's exactly what it is: a habit. Habits are something that have to be trained into you and once they're ingrained in your mind, you won't feel comfortable unless you've flossed your teeth. This is good. At the start, patients need a kick in the backside to develop the habit, they can put the floss near their brush, set reminders on their phone, place a post it note in the bathroom etc.

-There are many ways to clean interdentally, floss is ideal as it enters the gingival sulcus but flossetes may be easier for the patient to use. Recession allows the use of interdental brushes which can expand into interdental grooves and fissures. Air flossers and interdental irrigators such as the waterpik can be an alternative for poor manual dexterity patients or those who really can't be bothered. Like I said, anything is better than nothing. I also consider the waterpik and interdental brushes useful in patients with food packing as it actually has a lateral force to push food out of the embrasure. This is possible with floss of curse but is more manually challenging.

-Patients will get to know their own mouths. They need to set aside enough time to complete the task and not rush it at first. Focus on the technique first and develop speed later (sounds like all of dentistry). If they rush then it will be more sore and they will give up. Before long they will be speeding through the flossing.

-If you notice any tight or sharp contacts you must inform the patient. If they keep shredding the floss this is not normal. There may be recurrent caries, subgingival calculus, sharl restorative margins, overhangs etc that we can correct. Patients will be disheartened by shredded floss. If it is an issue that you cannot correct they need to either start or end flossing at the problem contact or use a tougher floss like gorilla floss that won't shred as easily. This has the disadvantage of being thicker and more difficult to fit between tight contacts.

-Show them on a model, then demonstrate in the mirror for them and finally get them to do it themselves. Basic tell show and do works very well with any age.

-The floss has to be perpendicular to the arch at the point they are flossing. This is a key point as patients often come in at an odd angle which makes it difficult to pass the contact. They need sufficient light and have to be looking in the mirror as they are learning,

-Patients will often click the floss straight down and hit the papilla. This is very painful especially in gingivitis patients. They will not notice a complete resolution in bleeding over time as they are not clearing subgingival plaque and are causing gingival trauma. Be sure to educate them that they are to move the floss against the teeth either side of the pink gingival triangle. Show them in the mirror that there is a lot of space under the gum that isn't being reached with their toothbrush,

-Unfortunately, they will have to get their hands dirty and put their fingers in their mouth. Eww right? Unfortunately, many patients have never been educated to floss and don't know even this basic. They are very hesitant to put their fingers in their own mouth to clean their teeth. There is no other way to clean back past the canines without doing this. They can wash their hands before and after and won't die of they touch their own saliva for a few minutes.

-Ensure they understand that their gums will bleed and this is normal. We would expect that with good technique this should improve after 2 weeks after the resolution of inflammation. If it does not they should feel free to return for a review. perhaps we have missed calculus in a certain area. This highlights the need for review to the patient.

-They are in charge of their own oral hygiene. We are only in their mouths for a few hours a year. The rest of the time it is their responsibility to take care of what nature has given them. We can't be cleaning their teeth every day.

In the end it is important for us to realise that the majority of patients haven't had the fortune of oral hygiene education that we have had. the generation before them and before that didn't have the same emphasis on oral hygiene that our tertiary degree has taught us. However it is us to us to educate the public and break this generational cycle. Misconceptions and poor technique are rife and we have to keep a patient mind about this. We did not learn these techniques overnight and neither will they. Constant positive reinforcement and encouragement are essential to empower these people to take care of their own health.