“Do I really need to floss?”

It is one of those dental questions that sounds as though it should have a simple yes-or-no answer.

My answer is slightly different:

You need to clean between your teeth. Dental floss is one very good way to do it—but it is not the only way.

A toothbrush does an excellent job cleaning many of the accessible surfaces of your teeth, but toothbrush bristles cannot predictably clean the tight spaces where neighboring teeth touch. The American Dental Association recommends cleaning between the teeth daily and recognizes floss, interdental brushes, water flossers, and other interdental cleaners as possible options depending on an individual’s needs.

That distinction matters. The goal isn’t to become a perfect flosser. The goal is to regularly disrupt the plaque that your toothbrush leaves behind.

“I care much less about whether a patient loves traditional dental floss than I do about whether we’re finding an effective way to keep the spaces between their teeth and gums clean.”

— Marielaina Perrone, DDS

Why Brushing Alone Doesn’t Clean Everything

Dental plaque is a sticky bacterial biofilm that continuously develops on teeth. When plaque accumulates along and between the teeth, it can contribute to gingival inflammation. Over time, plaque that isn’t removed can mineralize into calculus, or tartar, which cannot simply be brushed or flossed away at home.

The National Institute of Dental and Craniofacial Research explains the purpose of flossing quite simply: it cleans between teeth where brushing cannot reach effectively and helps disrupt plaque before it calcifies into calculus.

That is the fundamental reason dentists recommend interdental cleaning. Think about each tooth as having multiple surfaces. Brushing the front, back, and chewing surfaces while consistently ignoring the areas between teeth means part of the tooth is routinely being missed.

But Didn’t Research Say Flossing Doesn’t Work?

This is where the story becomes more interesting. You may remember headlines several years ago questioning whether there was sufficient scientific evidence supporting flossing. Those headlines were based partly on an important limitation in dental research:

There isn’t a large body of high-certainty, decades-long randomized clinical research proving that traditional flossing prevents cavities, periodontitis, or tooth loss.

That is true. But it does not mean research demonstrated that flossing is useless. Those are very different conclusions.

A major Cochrane systematic review evaluated 35 randomized controlled trials involving 3,929 adults and examined floss, interdental brushes, wooden cleaning sticks, rubber/elastomeric cleaners, and oral irrigators used in addition to toothbrushing.

The researchers concluded that adding floss or interdental brushes to toothbrushing may reduce gingivitis, plaque, or both compared with toothbrushing alone. However, the overall certainty of the evidence was low to very low, and most studies were relatively short.

Importantly, none of the included studies evaluated interdental tooth decay as an outcome, and few adequately evaluated periodontitis.

So a scientifically accurate interpretation isn’t:

“Flossing doesn’t work.”

It’s:

“The available clinical-trial evidence suggests benefits, particularly for gingivitis, but long-term evidence for outcomes such as cavities and periodontitis remains limited.”

That is considerably less exciting than the old headlines—but much more accurate.

Why Is Flossing So Difficult to Study?

Imagine designing the ideal flossing study.

You would need thousands of people randomly assigned to different oral-hygiene routines.

You would need to know that they actually followed those routines correctly.

You would potentially need to follow them for many years because periodontitis and tooth decay can take considerable time to develop.

You would also need to account for differences in:

• Diet
• Fluoride exposure
• Smoking
• Genetics
• Diabetes and other health conditions
• Saliva
• Dental visits
• Brushing habits
• Existing periodontal disease
• Dental restorations
• Individual susceptibility to cavities and inflammation

The NIDCR specifically points out that large, long-term studies of an at-home behavior such as flossing are difficult and expensive and that absence of such studies should not be interpreted as evidence that cleaning between the teeth has no value. That nuance is important whenever we talk about evidence-based dentistry.

What Does the Research Say About Gum Disease?

The evidence is strongest for gingival health rather than prevention of advanced periodontal disease.

In the Cochrane review, adding floss to toothbrushing was associated with reduced gingivitis at one, three, and six months, although the evidence was considered low certainty. There is also observational evidence.

An analysis of 6,939 adults from the U.S. National Health and Nutrition Examination Survey found that people reporting flossing more than once per week had modestly lower odds of periodontitis after adjustment for several factors, including age, smoking, income, alcohol use, and dental visits.

But because this was an observational, cross-sectional study, it demonstrates an association—not proof that flossing caused the difference.

That distinction is important.

We should neither exaggerate the evidence nor dismiss a biologically sensible, low-risk method of removing plaque from an area a toothbrush has difficulty reaching.

Does Everyone Have to Use Traditional Dental Floss?

No.

And I think this is one of the most useful changes in how we talk about home dental care.

Instead of asking:

“Did you floss today?”

a better question may be:

“How are you cleaning between your teeth?”

The ADA specifically describes flossing as a shorthand term that can sometimes be problematic because patients may not realize other interdental cleaning methods are available.

Depending on your mouth, alternatives can include:

Traditional dental floss — often appropriate where teeth have tight contacts.

Interdental brushes — small brushes designed to pass through spaces between teeth. These can be particularly useful with larger interdental spaces and for some periodontal patients.

Water flossers/oral irrigators — use pulsating water to clean around and between teeth and can be helpful for patients who struggle with conventional floss.

Interdental picks or cleaners — may be easier for some patients to manipulate consistently.

In fact, the Cochrane review found low-certainty evidence suggesting interdental brushes may reduce gingivitis more effectively than floss in some circumstances.

The ADA likewise notes that the appropriate device should reflect the individual patient: floss may work well in tight spaces, while interdental brushes can be useful for people with periodontitis or more open spaces between teeth.

The Best Interdental Cleaner Is the One That Fits Your Mouth

This is where personalized dentistry matters.

Someone with tightly positioned healthy teeth has very different needs from someone with:

• Gum recession
• Periodontal bone loss
• Dental implants
• Bridges
• Orthodontic appliances
• Large spaces between teeth
• Limited hand dexterity
• Extensive dental restorations

There isn’t necessarily one tool that is ideal for every person—or even every area of the same mouth.

“Home care shouldn’t be an exercise in guilt. If traditional floss isn’t working for someone, I’d rather help that patient find another effective interdental cleaner than repeatedly tell them to use something they aren’t going to use.”

— Marielaina Perrone, DDS

What About Dental Implants?

Interdental cleaning becomes especially important when maintaining dental implants and implant restorations.

An implant cannot develop a cavity, but the tissues surrounding it can develop inflammation and disease. The objective is therefore not simply protecting the restoration. It is maintaining healthy tissues around the implant.

Depending on the implant restoration, anatomy, and available space, appropriate home care might involve floss, an interdental brush, an oral irrigator, or another device recommended by your dental team.

Implants eliminate cavities in the implant itself. They do not eliminate the need for oral hygiene.

If My Gums Bleed When I Floss, Should I Stop?

Not automatically. Bleeding can be a sign of gingival inflammation, particularly when plaque has accumulated along the gumline. But bleeding can have multiple causes, and persistent bleeding deserves evaluation rather than self-diagnosis.

If you haven’t cleaned between your teeth regularly and suddenly begin doing so, inflamed tissues may initially bleed.

However, persistent bleeding, swelling, tenderness, gum recession, bad breath, loose teeth, or changes in your bite should not simply be attributed to “flossing too hard.”

Those findings may warrant a periodontal examination.

The NIDCR notes that gingivitis represents inflammation associated with plaque and can progress to more serious periodontal disease in susceptible patients if disease is not appropriately managed.

Can You Floss Too Aggressively?

Absolutely. More pressure isn’t better.

Snapping floss forcefully through a tight contact and repeatedly traumatizing the gum tissue isn’t the objective.

For conventional floss, gently guide it between the teeth, curve it around the side of one tooth in a C-shape, move it along the tooth surface and slightly beneath the gum margin, and then repeat against the neighboring tooth.

You are cleaning the sides of the teeth, not sawing through the gums.

If you’re uncertain about your technique, ask your dentist or hygienist to demonstrate it in your own mouth. A thirty-second demonstration can sometimes be more useful than years of being told simply to “floss more.”

How Often Should You Clean Between Your Teeth?

The ADA recommends cleaning between the teeth once a day as part of a home oral-care routine that also includes brushing twice daily with fluoride toothpaste. I wouldn’t become overly focused on whether interdental cleaning happens before brushing, after brushing, in the morning, or immediately before bed.

Consistency matters more. Choose a routine you are actually likely to maintain.

For many people, that means cleaning between their teeth once each evening and then brushing before bed.

For someone else, another time of day may work better.

“But I’ve Never Flossed and My Teeth Are Fine”

Some people can neglect interdental cleaning for years without obvious symptoms. That doesn’t necessarily mean everyone can.

Risk for cavities and periodontal disease varies substantially between individuals. Genetics, bacterial composition, saliva, smoking, diabetes, diet, medications, fluoride exposure, previous disease, tooth anatomy, restorations, and home care can all influence risk.

There is another important issue:

Early gum disease doesn’t necessarily hurt.

A person can feel perfectly fine while inflammation or periodontal changes are occurring.

That’s one reason professional examinations, periodontal measurements, appropriate dental X-rays, and regular preventive care matter. Home symptoms alone don’t tell us everything.

So, Do You Really Need to Floss?

Here is the answer I give my patients:

You need to clean between your teeth regularly.

For many people, dental floss is an inexpensive and effective way to accomplish that.

For others, an interdental brush, water flosser, or combination of methods may be more practical or appropriate.

The scientific evidence for flossing isn’t as perfect as some people assume. The Cochrane review rates much of it as low or very low certainty, particularly when we ask whether flossing prevents long-term outcomes such as periodontitis and cavities. But that uncertainty shouldn’t be confused with evidence that interdental cleaning has no value.

The ADA recommends daily interdental cleaning, and the NIDCR describes it as a low-risk, low-cost way to clean surfaces a toothbrush cannot effectively reach.

For me, that’s the important takeaway.

“The goal isn’t perfect flossing. The goal is a healthy mouth. Find an interdental cleaning method that fits your teeth, your hands, and your routine well enough that you’ll actually use it.”

— Marielaina Perrone, DDS

Flossing and Preventive Dentistry in Henderson, NV

At my Henderson dental practice, serving Green Valley, Anthem, Seven Hills, Summerlin, and patients throughout the Las Vegas Valley, home care recommendations are individualized.

If your gums bleed, traditional floss constantly shreds, you have larger spaces between your teeth, dental implants, bridges, periodontal disease, or simply cannot make flossing work, tell us. There may be a better option for your particular smile.

Good preventive dentistry isn’t about making patients feel guilty for what they haven’t done. It’s about identifying risk early, preserving healthy teeth and gums, and finding realistic habits that can protect your smile over a lifetime.

And sometimes that means floss.

Sometimes it means an interdental brush.

Sometimes it means a water flosser.

What matters most is that the spaces your toothbrush misses aren’t forgotten.

Frequently Asked Questions

Do dentists still recommend flossing?

Yes. The ADA continues to recommend cleaning between the teeth daily. Traditional floss is one option, but interdental brushes, water flossers, and other interdental cleaners may be appropriate depending on the patient.

Is flossing scientifically proven?

Research suggests adding floss to toothbrushing may reduce gingivitis, but the certainty of evidence is relatively low, and long-term evidence for preventing periodontitis and interdental cavities is limited. That does not mean flossing has been shown to be ineffective.

Is a water flosser as good as regular floss?

There isn’t enough high-certainty evidence to declare one method universally superior. Oral irrigators may improve gingival health in some circumstances, while conventional floss can work well in tight contacts. The appropriate choice depends on the individual.

Are interdental brushes better than floss?

For some patients, potentially. A Cochrane review found low-certainty evidence that interdental brushes may reduce gingivitis more than floss at short follow-up periods. They can be especially useful where spaces between teeth are sufficiently open.

Why do my gums bleed when I floss?

Bleeding commonly occurs when gums are inflamed, although technique and other conditions can also contribute. Persistent bleeding should be evaluated by a dentist rather than assumed to be normal.

Should I floss if I have dental implants?

The tissues around implants still require careful plaque control. The ideal cleaning method depends on the implant restoration and surrounding anatomy, so your dentist or hygienist can recommend the appropriate floss, brush, irrigator, or combination.

Research & Authoritative Resources

The most useful sources I’d actually link from the article are:

American Dental Association — Dental Floss/Interdental Cleaners
ADA: Dental Floss and Interdental Cleaners

National Institute of Dental and Craniofacial Research — “Do I Really Need to Floss?”
NIDCR: Ask the Expert—Do I Really Need to Floss?

Cochrane Systematic Review — Home Use of Interdental Cleaning Devices
35 randomized trials involving 3,929 adults; useful because it presents both the potential benefits and the limitations of the evidence.
Cochrane: Interdental Cleaning Systematic Review

National Institute of Dental and Craniofacial Research — Periodontal Disease
NIDCR: Periodontal (Gum) Disease

Journal of Clinical Periodontology — Flossing/Interdental Cleaning and Periodontitis
NHANES analysis of 6,939 U.S. adults; useful as observational evidence, with the important limitation that association does not establish causation.
Full Research Article: Flossing and Periodontitis

About the Author

Marielaina Perrone, DDS, is an award-winning cosmetic, restorative, and implant dentist serving Henderson, Las Vegas, and the surrounding communities. With more than 25 years of clinical experience, she is dedicated to helping patients achieve healthy, natural-looking smiles through personalized, evidence-based care. Dr. Perrone combines advanced technology with an artistic eye to provide comprehensive preventive, restorative, cosmetic, and implant dentistry, along with conservative facial aesthetic treatments that support confidence, oral health, and lifelong well-being. A graduate of Stony Brook School of Dental Medicine and Advanced Education in General Dentistry (AEGD), she is a published dental author and recognized advocate for the connection between oral health and healthy aging.

Medically Reviewed by Marielaina Perrone, DDS

This article has been medically reviewed by Marielaina Perrone, DDS, an award-winning cosmetic, restorative, and implant dentist in Henderson, Nevada. Dr. Perrone has more than 25 years of clinical experience and reviews all educational content for clinical accuracy, relevance, and consistency with current evidence-based standards of dental care before publication.

Updated: September 2026