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As if flossing your teeth wasn’t hard enough, braces add an additional challenge in accessing areas not properly cleaned by brushing alone, while also creating new areas for bacteria to settle and build up. Additionally, the hardware of braces is relatively delicate and must be handled with care to avoid loosening or breakage that could put your treatment plan behind schedule. Luckily, with a little practice in proper technique, and/or exploring different methods of flossing that are better suited for people with braces, you can reap the benefits of regular flossing and avoid extra trips to the orthodontist for reparative work.

While traditional wax string is the most common method of flossing used today, it is arguably not the best method for cleaning between teeth when you have braces. For instance, other methods like an interproximal brush or water flosser have become the best way to floss your teeth with braces. However, if you choose to stick to the traditional dental floss method, you’ll need to carve out a little more time in your morning routine – about 10-15 minutes — to ensure you are flossing your teeth properly while working around your braces with care.

How to Floss with Dental Floss When You Have Braces

  1. Cut a piece of wax string — generally about 18 inches long. Wrap one end of the string around the index finger of one hand.

  2. Thread the other end of the string between the connective wire of your braces and front surface of your teeth. Then wrap that end around the index finger of your other hand.
    Tip: Dental threaders were designed specifically to assist this process. A dental threader is a generally inexpensive and disposable tool that can be found at most supermarkets and retailers. Dental threaders are most commonly made of flexible plastic and shaped like a large sewing needle. The user threads the floss through the ‘eye’ of the dental threader, then uses the straight end of the threader to guide the floss through the wiring of braces.
  3. Work the string between your teeth, gently scraping the underside surfaces of your teeth around 8-10 times each as well as along the gum line between your teeth. 
    *Remember that the idea is not to snap the floss between the teeth, but to remove any plaque or build-up on the surfaces that enclose the spaces between teeth. If you aren’t gentle enough, you might experience bleeding gums.
  4. Unwrap one end of the string from around your index finger and slide that end of the string back out from between your teeth and braces. If you used a dental threader, you can gently pull the string out from between your braces and teeth as one end of the string is not fastened to
  5. Repeat this process between the next set of teeth.
  6. Continue this process for each pair of teeth, working your way along your jawline for both your top and bottom rows of teeth.
  7. Once you’ve completed both rows, thoroughly brush the front and backside surfaces of your teeth with a toothbrush. To ensure you clean the brackets and wires of your braces as well, angle your brush into a 45-degree angle and gently go over the top and bottom sides of your braces to cleanse any bacteria that may have settled there.

This process is more involved than flossing without braces, even with the assistance of the dental threader, and generally requires between 10–15 minutes per session when done properly. If you still find that you are having trouble doing it correctly, ask your dentist to walk you through how to floss and how often to floss with braces.

Because of the additional challenges introduced by your braces’ infrastructure to the process of flossing, other methods are available that are less time-intensive but just as effective in removing debris and build up. They are also less likely to damage the brackets and wiring of braces.

Flossing Alternative: Water Flossing

Water flossing is different from regular flossing in that rather than using the solid, physical object to scrape the plaque and debris from the sides of your teeth, it uses the pressure from a focused stream of water to rinse the surfaces between teeth and along the gum lines. Water flossers are a great alternative to string flossing, particularly for those who have braces or other types of dental hardware such as implants or other forms of dental hardware.

Among the many benefits of using water flossers is that generally, there’s less room for user error (unlike string flossing, the effectiveness of which is heavily reliant on proper user technique). Water flossers are gentler on the gums and braces. They are gaining acceptance in the periodontal professional community as an equally effective alternative to string flossing. In 2017, the American Dental Association gave its first endorsement to a water flosser. 

Additionally, many water flosser models include replaceable attachments that are specifically designed for folks with braces. Many models include dials that adjust the water’s pressure, allowing you to clean not only the areas and surfaces between teeth but also the brackets and wiring of the braces themselves. 

How to Use a Water Flosser with Braces

  1. Lean over a sink so that the angle of your mouth is sloped downwards. Keep your mouth open in this position as you go to allow the water to drain into the sink as you go.

  2. Position the water flosser toward the back area of your mouth near the molars, choosing a side or row to start with.

  3. Flush the backside of the starter molar.

  4. Begin tracing the water stream along the gumline, flushing out the area where it meets the tooth. 
    *Remember: Where gum lines meet the teeth from a visual perspective is not where they are physically attached. There’s generally a small flap of the gum line that covers a portion of the bottom of the tooth. Be sure to rinse this fold to ensure bacteria and plaque are flushed away. Spit out excess water when needed.
  5. Once you’ve traced the flosser around the tooth’s gum line, you’re ready to move on to the space between teeth. Hold the water pick so that the stream is focused on this space for several seconds. Angle the pick slightly to get the surfaces of the interior sides of the teeth.

  6. Flush the gum lines between teeth. Because teeth taper inward as they approach the gum line, the space between increases relative to the space between the crowns of teeth. This forms an inverted, downward-facing triangle of space between each pair of teeth, with one surface from each tooth composing two sides of the triangle, and the gumline forming the third. Outline the full perimeter of this triangle between every pair of teeth.
    Note: Interdental brushes are also an effective means of cleaning all three surface areas of this inverted triangle. They are generally simple to use even with braces. They specifically target the area that is not obstructed by the dental hardware.
  7. Work your way around the U shape of your jawline.

  8. Repeat this process, but this time, on the interior gumline to ensure you clean the areas along the backsides of your teeth as well.

  9. Once you’ve traced both the front and backsides of your teeth along the gum lines and thoroughly flushed the spaces between teeth, position the water flosser to face the brackets and wire of your braces with a gentle, low-pressure stream. This step will clean any plaque or food particles that could otherwise end up on your teeth.

It may sound like a lot, but compared to dental string flossing, water flossing is a time-saver, as each of these steps only requires a few seconds. The full water flossing process should net about five minutes total, compared to the 10–15 minutes needed to thoroughly floss with wax string.

An Oral Hygiene Routine with Braces: Make it Stick

Whether you floss with string or with a water flosser, keep these flossing techniques in mind and spend a little extra time on teeth that have crowding issues as the spaces between them are generally smaller and not as easily accessed. Additionally, it never hurts to follow up with mouthwash to rinse your mouth and dispose of any particles that may have been dislodged in the flossing process. Then, seal the deal by brushing the surfaces of your teeth and braces with a good toothbrush and toothpaste as you normally would. Surely, you know how important it is to brush your teeth twice a day, but completing your dental hygiene routine with regular proper flossing will ensure good oral hygiene and prevent possible periodontal diseases like gum disease. 

A consistent oral hygiene routine that includes proper flossing is essential for braces care. However you decide to do it, should any part of your braces become loose or break at any point during your treatment plan, schedule an appointment with your orthodontist to have the issue repaired immediately to avoid having additional time added to your treatment plan.

While braces may add an extra challenge in cleaning hard-to-reach areas between teeth, cleansing these spaces is an integral part of a comprehensive oral hygiene care routine. If you’ve already committed to the process of having braces, whether your goal is to improve your oral health or for cosmetic reasons (or both), it wouldn’t make sense to allow other periodontal issues to arise by neglecting to floss properly. Keep your eyes on the prize: the beautiful, healthy smile you’ll have at the end of the process will be worth the hassle and investment of the braces and braces care.

Sources:

  1. Christin Frank, DDS. How to floss with braces. Healthline, 2018. https://www.healthline.com/health/how-to-floss-with-braces
  2. Reviewed by Michael Friendman, DDS: Caring for teeth and braces and retainers. WebMD Medical Reference, 2019.
    https://www.webmd.com/oral-health/guide/care-of-braces-retainers#1
  3. American Dental Association: How often should I floss my teeth? Mouth Healthy.
    https://www.mouthhealthy.org/en/az-topics/f/flossing
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