These small, textured brushes made for cleaning between teeth can be easier to hold and maneuver than floss. The Cochrane Review found that such tools can reduce gingivitis symptoms and plaque in the short term, and a 2015 review of nearly 400 studies, published in the Journal of Clinical Periodontology, found “moderate” evidence that interdental brushes reduce plaque and gingivitis symptoms. People with tightly spaced teeth may have trouble using them, and according to the A.D.A., people with electronic implants in their mouths should avoid interdental brushes with an exposed metal wire.
Like interdental brushes, some toothpicks (usually made of wood, rubber, or plastic) may be easier to hold than a strand of floss. The toothpicks you might pick up at your local diner are probably not A.D.A. approved, but you can find wooden “plaque removers” with the A.D.A. Seal of Acceptance. The Cochrane Review found that wooden “cleaning sticks” can help reduce gingivitis but not plaque, whereas those made of synthetic materials can help reduce plaque but not gingivitis symptoms.
A floss pick is a disposable tool with a toothpick on one end and a bit of floss held taut on the other. A 2007 study published in the Journal of Clinical Dentistry found that floss picks are “at least as good as” regular dental floss when it comes to removing plaque. Reusable floss holders are also available — some are just a plastic handle that you can string floss onto, and others have disposable floss cartridges that you have to buy separately — but none of these tools have the ADA Seal of Acceptance, and a 2011 study published in Clinical Oral Investigations found that many reusable floss holders are difficult to maneuver.
According to the A.D.A., your flossing technique and frequency are more important than what your floss is made out of — nylon, plastic, waxed, or unwaxed. Some people find that a wide, flat, tape-style floss (rather than a strand of fibers woven together) is more comfortable and easier to slide between tightly spaced teeth.
Some things just can’t take the place of flossing, according to the A.D.A. Charcoal, for example, wears away at tooth enamel. Tongue scrapers don’t work. Oil pulling doesn’t improve oral health — and, according to the British Dental Journal, harmful side effects such as upset stomach have been reported.
Do you have to floss if you use an electric toothbrush?
Regardless of what kind of toothbrush you use — and how good your brushing technique is — it can’t replace flossing. A 2014 Cochrane Review found that electric toothbrushes are generally more effective than manual brushes at reducing plaque and gingivitis symptoms. But even the best toothbrushes clean only the top, front, and back surfaces of the teeth. Unless you use an interdental cleaner, you’re leaving the side surfaces exposed.
“Cleaning in between our teeth is one of the best things we can do to prevent cavities, bleeding, gum disease, and infection,” Dr. Sahota said.