Are you deciding the order of brushing your teeth just "somehow"?

Brushing your teeth after waking up in the morning or before going to bed at night is a daily habit for many. However, surprisingly few people consciously consider whether to perform interdental care before or after brushing. Some people use interdental brushes or dental floss as a finishing touch after brushing, while others prefer to remove debris between the teeth first before using a toothbrush.

In response to this simple question, a study introduced by the German health information site aponet.de provides a fairly clear answer. In conclusion, "interdental care first, then brushing" was found to be more advantageous, at least under the study conditions.

Of course, this alone won't change dental guidance worldwide overnight. The study was small, involving 25 dental students, whose age, interest in dental care, and precision in technique may differ from the general population. Nonetheless, it's an interesting opportunity to reconsider daily oral care.

A toothbrush alone has difficulty reaching between teeth

Why is interdental care necessary in the first place? The reason is simple: a toothbrush alone has difficulty adequately reaching between teeth, especially in the gaps between molars and areas close to the gums.

Plaque that adheres to the surface of teeth is not just food debris. It is a biofilm containing bacteria, which, if left untreated, can lead to cavities, periodontal disease, and bad breath. While the outer surfaces and chewing surfaces of teeth are relatively easy to brush, the areas where teeth touch each other and the gaps near the gum line are difficult for the bristles to reach.

This is where dental floss and interdental brushes come in. Floss is often suitable for those with narrow interdental spaces, while interdental brushes may be appropriate for those with wider gaps or after periodontal treatment. The best choice depends on the alignment of your teeth and the condition of your gums, so ideally, you should confirm the right tools and sizes for you at a dental clinic.

The benefits of "floss first" as shown by research

In the study introduced by aponet.de, 25 dental students were divided into two groups. One group brushed their teeth first and then used floss, while the other group used floss first and then brushed their teeth. The study compared plaque removal and fluoride retention for each sequence.

As a result, the group that used floss first showed better plaque removal in both the interdental areas and the entire oral cavity. Additionally, the fluoride concentration remaining in the interdental biofilm was higher when floss was used first.

This result is intuitively understandable. By loosening debris and fine particles between the teeth with floss first, the ingredients in toothpaste can reach more easily during subsequent brushing. If you're using fluoride toothpaste, it's more likely that fluoride will reach the interdental areas. Conversely, if you brush first and then use floss, you may move debris between the teeth after having prepared them with toothpaste.

To borrow a common expression from social media, it's like "sweeping the floor with a broom after mopping." While this is an extreme analogy, the idea of removing debris from gaps first and then brushing the entire area does sound rational.

However, the study is small-scale and not an "absolute answer"

It's important to note that this study alone doesn't mean "everyone must follow this order."

Firstly, the study involved only 25 participants. Moreover, since they were dental students, they might have been more accustomed to brushing and flossing techniques than the general public. The results may differ between those who can use floss correctly and those who rush through it without experience.

Additionally, there isn't just one type of interdental care tool. There are various tools used at home, such as string floss, floss with a holder, interdental brushes, rubber picks, and water flossers. The most suitable tool can vary depending on tooth alignment, prosthetics, or the presence of orthodontic appliances.

Therefore, while this study offers a strong hint that "using floss first seems beneficial," it is not a definitive conclusion for everyone. What is more important is to make interdental care a daily habit and to use the tools that suit your mouth correctly.

What do professional organizations say?

Dental professional organizations widely recognize the importance of interdental care. The American Dental Association recommends brushing your teeth twice a day and cleaning between your teeth with floss or other tools once a day. However, regarding the order, they also state that "as long as thorough cleaning is achieved, either order is fine." In other words, it's more important to perform interdental care at a time that's easy to maintain as a habit rather than being overly concerned with the order.

On the other hand, the UK's NHS recommends using floss before brushing. Furthermore, UK preventive dental materials explain that performing interdental cleaning with tools like interdental brushes before brushing is desirable from a habit-forming perspective.

The German Federal Dental Association also explains that cleaning interdental areas is important for preventing cavities and periodontal disease, recommending floss for narrow gaps and interdental brushes for wider gaps or in cases of periodontal disease.

In summary, the practical answer is this: Ideally, perform interdental care first, then brush with fluoride toothpaste. However, if being too concerned with the order makes it cumbersome and you stop, it's more important to do it daily at a time that's easy for you to continue.

On social media, the "floss first" group seems dominant, but the "continue" group is also strong

This topic is frequently debated on social media and forums. Particularly on overseas forums like Reddit, the question "Do you use floss before or after brushing?" is repeatedly posted.

The dominant group is the "floss first" group. Common reasons include "removing debris from gaps first makes it easier for the toothbrush and toothpaste to reach," "dental clinics sometimes treat interdental areas before cleaning," and "food particles loosened by floss can be washed away by subsequent brushing."

Conversely, there are also many who say, "I use floss after brushing." They feel it provides a "finishing touch" and allows them to check for remaining debris between teeth after brushing. Some even practice "brushing, flossing, and then lightly brushing again."

A more common reaction is, "The important thing is to floss, regardless of the order." In reality, many people don't have the habit of using floss or interdental brushes daily. Considering this, it's more beneficial to continue daily, even if the order isn't perfect, rather than searching for the perfect order and giving up after a few days.

Typical social media reactions include comments like "I've been doing it the opposite way all along," "It's different from what my dentist told me," "Flossing before brushing makes my mouth feel refreshed," and "I was praised at a dental check-up after starting to do it at night." While health information on social media tends to lead to extreme conclusions, this topic seems to have a relatively shared understanding that "doing it first seems good, but continuing is the priority."

"Rinsing thoroughly with water at the end" can sometimes be counterproductive

Along with reviewing the order of interdental care, it's worth reconsidering how you rinse after brushing. In Japan, many people rinse their mouths multiple times with water after brushing. However, if you're using fluoride toothpaste, rinsing too vigorously may wash away the fluoride left in your mouth.

The NHS and others recommend spitting out excess toothpaste after brushing and not rinsing thoroughly with water immediately. This is to keep fluoride on the tooth surface longer. Fluoride helps with the remineralization of teeth and increases resistance to acids.

So, if you're aiming for greater effectiveness, the flow should be as follows:

First, clean between your teeth with floss or an interdental brush. Next, brush the surface of your teeth carefully for about two minutes with fluoride toothpaste. Finally, spit out the foam and excess toothpaste from your mouth. If you rinse with water, don't rinse too vigorously or too often.

This sequence is not just about feeling "clean," but also a method to make the most of the ingredients in your toothpaste.

Should you use floss or an interdental brush?

When it comes to interdental care, many people first think of dental floss. However, floss is not necessarily the best option for everyone.

If the gaps between your teeth are narrow and an interdental brush won't fit, floss is suitable. The basic technique is to curve the floss into a C-shape along the tooth surface and move it up and down without pressing it too hard into the gums. Inserting it with too much force can injure the gums, so it needs to be passed through slowly.

On the other hand, for people with some space between their teeth, those with receding gums due to periodontal disease, or those who want to clean around bridges or implants, an interdental brush may be suitable. Choosing the right size is crucial; if it's too large, it can injure the gums, and if it's too small, it may not effectively remove debris.

On social media, there is also debate between the "floss group" and the "interdental brush group," but this is not a matter of winning or losing. The correct answer varies depending on the condition of your mouth. Some people have different interdental widths on the left and right sides, so it's not uncommon to use both floss and interdental brushes depending on the location.

Should you stop if you experience bleeding?

One thing that often surprises people new to flossing or using interdental brushes is bleeding from the gums. When blood appears, some people worry that they have injured themselves and stop.

Of course, if you're pressing too hard and causing injury, you need to review your technique. However, if there's inflammation in the gums, bleeding can occur even with gentle cleaning. If plaque remains in the interdental areas and gingivitis occurs, bleeding may be more likely in the early stages of cleaning.

In some cases, it may settle down after gently continuing for a few days to one or two weeks. However, if bleeding persists for a long time, if there is pain, swelling of the gums, strong bad breath, or loose teeth, it's better to consult a dental clinic. It's safer to have a professional check the size and usage of the tools rather than scrubbing too hard on your own.

If you're going to change, starting "before night brushing" is easier

So, when is the best time to incorporate this into your life? The most recommendable time is before night brushing.

Nighttime is also the time to remove the debris accumulated from the day's meals. During sleep, saliva secretion decreases, and the mouth tends to dry out. Saliva helps wash away and neutralize acids in the mouth, so cleaning between the teeth before bed is significant.

The procedure is not difficult. First, use floss or an interdental brush. Don't worry about the food particles or plaque that come out, and then brush your teeth. Brush for about two minutes with fluoride toothpaste, and finally, spit lightly. Don't rinse too much with water. That's it.

You don't need to aim for perfection from the start. If doing it every day is difficult, start with a few times a week. Once you get used to it, make it a nightly habit. Placing floss on the sink, lining up interdental brushes next to your toothbrush, or doing it before looking at your smartphone are effective ways to lower the hurdle of the action.

Conclusion: "Interdental care first" is ideal, but "continuing" is most important

The point highlighted by this study is very simple. Performing interdental care first makes it easier to remove plaque between the teeth and allows fluoride to reach more effectively during subsequent brushing. This is easy to understand logically, and it's understandable why the "floss first" group is supported on social media.

However, the study is small-scale, and the best solution varies depending on the interdental care tools and individual oral conditions. Even looking at the opinions of professional organizations, the stance of emphasizing continuity over order is strong.

Therefore, if you're going to start practicing today, the answer is this:

If possible, use floss or an interdental brush before brushing. Then, brush carefully with fluoride toothpaste. Finally, don't rinse too vigorously. And most importantly, continue doing it.

Dental health is protected by small daily efforts rather than perfect care in one go. Changing the order of brushing slightly doesn't increase cost or time significantly. You might want to start by picking up a piece of floss before brushing tonight.

Source URL

aponet.de "Erst Zahnseide oder erst Zähneputzen? Studie liefert eine klare Antwort." An article introducing a study on the order of flossing and brushing.
https://www.aponet.de/artikel/erst-zahnseide-oder-erst-zaehneputzen-studie-liefert-eine-klare-antwort-12014

Research paper: "The effect of toothbrushing and flossing sequence on interdental plaque reduction and fluoride retention" published in the Journal of Periodontology. A study examining the impact of the order of flossing and brushing on plaque removal and fluoride concentration.
https://pubmed.ncbi.nlm.nih.gov/29741239/

Research paper DOI: DOI page for the same study.
https://doi.org/10.1002/JPER.17-0149

American Dental Association: General explanation about the frequency and order of flossing and interdental cleaning.
https://www.ada.org/resources/ada-library/oral-health-topics/floss

NHS: Public health information on how to brush teeth, use floss, and rinse after brushing.
https://www.nhs.uk/live-well/healthy-teeth-and-gums/how-to-keep-your-teeth-clean/

GOV.UK / Delivering Better Oral Health: Materials on performing interdental cleaning before brushing and the concept of preventive dentistry.
https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-8-oral-hygiene

Bundeszahnärztekammer: Explanation by the German Federal Dental Association on interdental cleaning, floss, and interdental brushes.
https://www.bzaek.de/service/positionen-statements/einzelansicht/zahnseide.html

Reddit: Example of general user reactions on whether to use floss before or after brushing.
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