Brush or Floss? Which Comes First?

By Dr. Mercola

Nearly 70 percent of Americans brush their teeth at least twice a day, but only 40 percent floss at least once daily. Twenty percent of Americans say they never floss, and although a Delta Dental survey found a strong association between daily flossing and good oral health,¹ other sources are not so clear-cut.

One systematic review found, for instance, that while flossing in addition to brushing may reduce gingivitis compared to toothbrushing alone, there is only “weak, very unreliable” evidence that flossing plus toothbrushing may be associated with a small reduction in plaque.²

Dr. Philippe Hujoel, a professor of oral health sciences at the University of Washington in Seattle, advises his patients to floss, even though he says, “Self-flossing clinical trials have failed to show a benefit in the reduction of dental decay.”³

What has shown a clear benefit is getting your teeth flossed by a professional. Children who had their teeth professionally flossed daily for 1.7 years had a 40 percent lower risk of cavities.⁴ So perhaps flossing your teeth properly holds the secret. With that in mind, does it matter whether you floss before or after brushing your teeth?

Brush or Floss: Which Should Come First?

Regularly brushing and flossing are the basics when it comes to dental care, but does it matter which comes first? It depends who you ask. Some dentists recommend flossing first simply because it gets it out of the way and lessens the risk that you’ll simply skip it once you’re done with brushing.

Others recommend flossing first because you can then brush away any plaque particles or food debris that have been removed. Still others advise brushing your teeth and then flossing before you rinse, as you’ll pull some of the toothpaste between your teeth as you floss.

Then there are those who say flossing first is better for this, as it “opens” the areas between your teeth for the toothpaste to enter… As for the American Dental Association (ADA), they say “Either way is acceptable as long as you do a thorough job.”⁵ In short, if you prefer one way over the other, it’s fine to keep doing it that way.

In case you were wondering, an ADA poll found 53 percent of Americans brush before they floss, while 47 percent floss before they brush .⁶

How to Floss Like a Pro

The method you use to floss may be more important than the timing. The ADA recommends the five steps that follow for a flawless floss:⁷

• Start with about 18 inches of floss. Wind most of it around one middle finger and wind the remaining floss around the middle finger of your other hand.
• Hold the floss tightly between your thumbs and forefingers.
• Guide the floss gently between your teeth using a rubbing motion. Do not snap the floss into your gums.
• At the gum line, curve the floss using a “C” shape against your tooth. Slide the floss between the gum and tooth.
• Hold the floss tightly against the tooth, gently rubbing the side with up and down motions. Repeat on the rest of your teeth, including the back side of your last tooth.

It’s recommended that children floss, too, as soon as they have two teeth that touch. Most children cannot floss well by themselves until the age of 10 or 11, however, so a parent will need to do the job for younger children.

If You Want Healthy Teeth, Be Sure You’re Eating Right

Alan Cooper, director of the Australian Center for Ancient DNA,⁸ and his team looked at calcified plaque on teeth from prehistoric skeletons and revealed that changing diets lead to detrimental shifts in oral bacteria.

The two greatest culprits as far as dietary shifts and dental health go was the introduction of carbohydrate-rich farming diets in the Neolithic period (about 10,000 years ago) followed by the more recent introduction of industrially processed flour and sugar (around the mid 1800s).

The calcified dental plaque offered researchers a “detailed genetic record” that showed a transition from a hunger-gatherer diet to farming “shifted the oral microbial community to a disease-associated configuration.”

Cavity-causing bacteria became dominant, likely during the Industrial Revolution, and the oral microbiotic ecosystems also had “markedly less” diversity, which the researchers said “might be contributing to chronic oral (and other) disease in postindustrial lifestyles.”⁹

In the 1900s, Dr. Weston A. Price also found, and documented in his classic book Nutrition and Physical Degeneration, that native tribes who were eating their traditional diet had nearly perfect teeth and were almost 100-percent free of tooth decay.

But when these tribal populations were introduced to sugar and white flour, guess what happened… their health, and their perfect teeth, rapidly deteriorated. So clearly, one of the keys to oral health is eating a traditional diet rich in fresh, unprocessed vegetables, nuts, and grass-fed meats that are in line with your genetic ancestry.

Vitamin K2 for Oral Health

Research shows that when vitamin K2 is administered, it reduces bacterial counts in the saliva. Specifically, vitamin K2 reduced the concentration of a bacteria involved in tooth decay, Lactobacillus acidophilus, from a count of 323,000 to 15,000.¹⁰

It’s clear that vitamin K2 plays a role in oral health, although its exact mechanisms are not well understood. The second highest concentration of vitamin K2 in your body is in your salivary glands, and vitamin K is secreted in saliva. It’s likely that vitamin K2 works in concert with other vitamins, like vitamin D, to boost your oral health. According to the Weston A Price Foundation:¹¹

“There are three calcified tissues of the teeth: the cementum forms the roots, the enamel forms the surface, and the dentin forms the support structure beneath it. Cells called odontoblasts lining the surface of the pulp just beneath the dentin continually produce new dentin material.

If a cavity invades the dentin and reaches these cells they can die. The pulp tissue, however, contains stem cells that can differentiate into new odontoblasts that could regenerate the lost dentin if the right conditions were present.

Dentin is unique among the tissues of the teeth for its expression of osteocalcin, a vitamin K-dependent protein better known for its role in organizing the deposition of calcium and phosphorus salts in bone.

In the infant rat, whose teeth grow very rapidly, dentin manufactures much more osteocalcin than bone does, suggesting that osteocalcin plays an important role in the growth of new dentin. Matrix Gla protein (MGP), which is required for the mineralization of bone, is also expressed in dentin.

Vitamins A and D signal odontoblasts to produce osteocalcin, and probably regulate their expression of MGP as well. Only after vitamin K2 activates these proteins’ ability to bind calcium, however, can they lay down the mineral-rich matrix of dentin.”

This is intriguing, since fermented vegetables, which are loaded with friendly flora that improve digestion, alter the flora in your mouth as well. And when made using the proper culture, fermented vegetables are an excellent source of vitamin K2. Since the addition of fermented vegetables to my diet, my plaque has decreased by 50 percent and is much softer.

Other Nutritional Factors for Healthy Teeth and Gums

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Proper dental hygiene is important for optimal health in your mouth and in the rest of your body, as discussed by Dr. Bill Osmunson in the interview above. The key is your diet and proper dental care: good old brushing and flossing.

By avoiding sugars and processed foods, and eating fermented vegetables, you help prevent the proliferation of the bacteria that cause decay while promoting protective varieties. Contrary to popular belief, antimicrobial agents and alcohol mouthwashes designed to "kill bad bacteria" actually do far more harm than good.

The oral microbiome, while connected to the gut microbiome, is quite unique. Most importantly, it has a protective component that protects you from deadly viruses and bacteria in the environment. In addition to consuming foods that are part of the "traditional diet" and avoiding processed foods and refined sugar, make sure you are getting plenty of omega-3 fats. The latest research suggests even moderate amounts of omega-3 fats may help ward off gum disease.

My favorite source of high-quality omega-3 fat is krill oil. A particular type of honey from New Zealand called Manuka honey has also been shown to be effective in reducing plaque. Researchers found Manuka honey worked as well as chemical mouthwash — and better than the cavity-fighting sugar alcohol xylitol — in reducing levels of plaque.

Remember, Your Oral Health Impacts Your Systemic Health

Thousands of studies have linked oral disease to systemic disease. Inflammation is well known as a "ravaging" and disease-causing force, and gum disease and other oral diseases produce chronic low-grade inflammation in your body. When the bacteria that cause tooth decay and gum disease enter into your circulatory system, it causes your liver to release C-reactive proteins, which has inflammatory effects in the entire circulatory system. Advanced periodontal disease or gum disease can raise your risk of a fatal heart attack up to 10 times.

According to Dr. Gerry Curatola, founder of Rejuvenation Dentistry, if you get a heart attack related to periodontal or gum disease, nine times out of 10 it will actually kill you. There's also a 700 percent higher incidence of type 2 diabetes among those with gum disease, courtesy of the inflammatory effects of unbalanced microflora in your mouth. So while your toothbrush and toothpaste are important, don’t be misled by thinking they’re the only options for sound dental health. Many natural substances, like the foods you eat, also have the power to drastically improve the health of your teeth and gums, and thereby the health of the rest of your body, too.

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