Better to Floss Before or After Brushing?

Did you know that taking good care of your teeth and gums can not only add years to your life, but also lowers risk for heart disease, stroke, diabetes—and even memory-robbing disorders like Alzheimer’s disease?  A new study of nearly 5,000 older adults found that those who brushed their teeth less than once a day were up to 65 percent more likely to develop dementia than those who brushed daily.

And here’s even more motivation to brush and floss: A new CDC study reports that nearly 65 million Americans—one out every two adults ages 30 and older—have gum disease, a far higher rate than has previously been reported. That’s dangerous, since a 2012 American Heart Association scientific statement reports that periodontal (gum) disease is a strong, independent risk factor for cardiovascular disease (heart attacks and stroke).

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A Surprising Dental Controversy

What’s the best way to keep your teeth and gums healthy? While everyone agrees that brushing at least twice a day is crucial, there’s hot debate online right now about whether it’s preferable to floss before you brush (as I do) or afterwards. Here’s a look at surprising flossing recommendations from five leading dentists:

“I’ve always advised patients to floss before they brush to break up and remove the plaque matrix between the teeth before going in with the toothbrush to sweep away the bacteria and debris they’ve dislodged with flossing.”--Mark Barry, DDS, associate dean for clinical affairs and professor, division of oral medicine, Medical University of South Carolina.

“It makes more sense, particularly for kids, to floss after brushing so you can see what you’ve missed with the toothbrush. Also, if you floss first, debris might get pushed back between the gums when you brush. It’s also important to use the right flossing technique: make a C-shape with the floss and wrap it around each tooth to clean the surface, rather than just snapping the floss up and down, which doesn’t clean the structures properly."--Mary Hayes, DDS, American Dental Association spokesperson.

“It doesn’t matter whether you floss first or brush first, because you are cleaning different surfaces of the teeth. That’s why flossing is crucial: It’s the only way to clean between the teeth, since a toothbrush can’t reach these crevices.”--Ruchi Sahota, DDS, American Dental Association spokesperson and general dentist in Fremont, CA

“The biggest thing is to remember to brush twice a day and floss once, spending several minutes removing plaque and debris between the teeth. It takes 24 to 48 hours for oral bacteria to organize into plaque, so as long as you dislodge the plaque at least once a day by flossing, you’re protecting your oral health.”--Ron Burakoff, DDM, MPH, DMD, MPH, Chair & Professor, Department of Dental Medicine, Hofstra North Shore-LIJ School of Medicine

“Either order is OK. My recommendation is to floss at night, before you go to bed. When you’re sleeping, you produce less saliva to clean your teeth and gums, so oral bacteria are free to do more damage. Therefore, it’s important to brush, floss and scrape your tongue every night to get rid of bacteria and go to bed with your mouth as clean as possible.”--Ronald M. Goodlin, DDS, President, American Academy of Cosmetic Dentistry

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What’s the Bottom Line on Flossing?

The American Dental Association reports brushing or flossing first are both fine, as long as you do a thorough job. However, the ADA adds that a benefit of flossing first is that fluoride from toothpaste is more likely to reach between your teeth when you brush, which may help reduce cavities.

As all of the dentists interviewed for this article agree, flossing once a day is crucial to avoid having the film of bacteria between the teeth harden into plaque and then tartar, a hard mineral deposit that can cause gums to become swollen and inflamed, leading to the earliest stage of gum disease: gingivitis.

For more tips on flossing—including a how-to video from the ADA—click here.

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