Interdental Cleaning: Floss, Brushes and Which Works Better
For adults: why cleaning between the teeth matters, brushes versus floss, sizing, technique, water flossers and bridges. The takeaway from NHS, Delivering Better Oral Health and Cochrane evidence: clean between your teeth daily, before brushing, with a snug-fitting interdental brush where the space allows and floss or tape where it does not.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
This page is reviewed by Dr Ibraheem Ijaz, the practice's principal dentist and a General Dental Practitioner (GDC 301711). His qualifications are BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
Why does cleaning between your teeth matter?
Plaque and food debris collect between the teeth, where a toothbrush cannot remove them, a Leeds Teaching Hospitals NHS Trust gum disease leaflet explains.
The NHS says gum disease is caused by a build-up of plaque, and plaque not removed by brushing and cleaning between the teeth irritates the gums. Delivering Better Oral Health (DBOH), the UK prevention toolkit, says healthy gums also need plaque removed between the teeth, and recommends doing this daily, to below the gum line.
On tooth decay the sources differ: the NHS says regular flossing “may also reduce” tooth decay, while DBOH says there is “no evidence to determine whether interdental cleaning aids reduce caries or not, when compared with toothbrushing alone”.
Are interdental brushes better than floss?
Interdental brushes may be more effective than floss, the evidence suggests, though its certainty is low.
A 2019 Cochrane review (35 trials, 3,929 adults) found, in nine trials comparing the two, low-certainty evidence that interdental brushes may reduce gingivitis (gum inflammation) more than floss at one and three months, though no difference in pocket depth was shown and plaque results were inconsistent. Its authors concluded that floss or interdental brushes with toothbrushing may reduce gingivitis or plaque more than brushing alone, but the evidence was low to very low certainty and effects may not be clinically important.
DBOH advises an interdental or single-tufted brush wherever there is space, and floss or tape for small spaces. For people with, or treated for, periodontitis, whose spaces are generally larger, it says interdental brushes are more effective than floss or tape.
How do you find the right interdental brush size?
An interdental brush should fit snugly between the teeth, the NHS says.
Leeds Teaching Hospitals' gum disease leaflet advises the largest size that fits snugly without getting stuck, and a range of sizes, because not all spaces are the same size.
The Leeds leaflet adds that brushes should be changed when the bristles become worn or the wires distorted, usually every few days.
For gaps too small for a brush, the Leeds leaflet says floss may be needed.
How do you use floss and interdental brushes?
For floss or dental tape, the NHS gives these steps:
- Take 30cm to 45cm and hold it so that 3cm or 4cm is taut between your hands.
- Slip it between the teeth and into the area between your teeth and gums, as far as it will go.
- Curve it into a C-shape and gently slide it up and down each tooth.
For an interdental brush, Leeds Teaching Hospitals' leaflet advises placing it between the teeth and using a forwards-backwards and rotating movement.
The NHS advises against wooden toothpicks for trapped food, as they may damage your gums, which could lead to an infection.
Questions about this treatment? Book online or call the practice.
Is a water flosser worth it?
Evidence does not clearly show that a water flosser is worth it. Delivering Better Oral Health calls the evidence for oral irrigators, which include water flossers, limited and inconsistent.
In the 2019 Cochrane review, very low-certainty evidence suggested oral irrigators may reduce gingivitis at one month compared with toothbrushing alone, but not at three or six months. Low-certainty evidence suggested they did not reduce bleeding or plaque more than toothbrushing alone. Compared with floss, low- to very low-certainty evidence suggested less gingivitis at one month.
How do you clean around a bridge?
Clean carefully around a bridge and its gum line, and under the false tooth with special floss or cleaning aids, the Oral Health Foundation advises.
Cleaning around dental implants is covered in our guide on how to clean dental implants.
How do you make cleaning between your teeth a habit?
Clean between your teeth every day, before brushing: DBOH says doing it first may help link the two habits and build regularity.
Our page on how to brush your teeth properly covers the brushing half of the routine.
Inflamed gums may bleed when you first clean them properly. Leeds Teaching Hospitals' leaflet says this comes from the inflammation, not damage, and reduces if you keep cleaning. The NHS advises seeing a dentist if your gums bleed when you brush your teeth or eat hard foods.
DBOH says that after treatment for gum disease below the gum line, the patient's own plaque control remains central to their gum care. Brushing, mouthwash and tartar are covered when you browse the gum disease prevention section.
When should you speak to a dentist?
If you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online. NHS guidance gives these actions:
- Gums that bleed when you brush or eat hard foods, or that are painful and swollen: see a dentist.
- Gum disease with other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip: ask for an urgent dentist appointment.
- Toothache that lasts more than 2 days, does not go away with painkillers, or comes with a high temperature, pain when you bite, red gums, a bad taste or a swollen cheek or jaw: see a dentist. While you wait, the NHS suggests a soft toothbrush and avoiding flossing around the sore tooth.
- Toothache with swelling around your eye or neck, or swelling in your mouth or neck that makes it difficult to breathe, swallow or speak: go to A&E or call 999 for an ambulance, and do not drive yourself.
Frequently asked questions
At what age should you start cleaning between your teeth?
By 18, or younger with inflamed gums, Delivering Better Oral Health advises. See a dentist, the NHS says, if gums bleed when brushing or eating hard foods, or are painful and swollen. Gum disease with very sore, swollen gums, loose teeth, ulcers, red patches or mouth or lip lumps needs an urgent dentist appointment. If none is available, call 111.
Can cleaning between your teeth damage your gums?
Wooden toothpicks may damage your gums, the NHS warns. In Cochrane's 2019 review, studies measuring harms found no severe events caused by interdental cleaning devices, and no evidence of a difference between groups in minor effects such as gum irritation. If your gums bleed when you brush or eat hard foods, the NHS advises seeing a dentist.
Can mouthwash replace cleaning between your teeth?
No. Leeds Teaching Hospitals' gum disease leaflet says mouthwash is not a substitute for toothbrushing or cleaning between the teeth, because it does not physically remove plaque. The NHS adds that mouthwash should not be used straight after brushing, as it washes away the fluoride left by toothpaste, and suggests another time, such as after lunch.
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