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Flossing frustrations

The most common answer to my question, “Do you floss?” is (verbatim), “Not as often as I should.” It seems like no matter how hard I try to instill in the patients the importance of flossing, only rarely does it ever sink into the patients’ heads. How do you motivate your patients to floss? Would you say the vast majority of your patients do not floss?



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19 Answers

You know what….this is similar to…do you excersise? …do you eat right?…they are all things that despite knowing its needed we all stink at doing something we should…I think in the 28 years I’ve been practicing I’ve realized people are people…Sure we have the flossing convo everyyyyy time because I feel obligated lol…but certain people I know are just not going to do it…we try and find other things like water picks, rubber tips, floss aides, etc etc etc to get in there even just a little bit if something else clicks with them more than floss…but then there’s my non flossers that dont have a speck of perio desease or barely a speck…sometimes we even laugh about their genetics out ranking my lecturing….or you have the dedicated flosser, picker, water pik’er that has advancing perio anyway…so we send him and his floss to the periodontist while the non flosser gives his floss sample away on the way home lol…

I find connecting with people is just the best for results for anything…get disgusted with them, lecture them, and their ears turn off…tell them they are risking their beautiful smile and wont need to see their lovely hygienist if they dont make the effort….sometimes the connection works….sometimes it just doesn’t…but all we can do is try and connect and actually care about their outcome…

I know hygienists that dont want to see elderly patients as tgeir personal hyg fails….give them to me…I care about the whole person while I’m caring for the teeth…a connection sometimes yields a change…and connecting makes my days enjoyable…even with those darn non flossers 😉 lol

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I have stopped asking that particular question, “Do you floss?” Instead I ask first if they use a regular brush or electric then I ask …”and how do you clean the in-between side of each tooth?” I feel this sounds less like a reprimand and more like the beginning of a conversation. There are other ways to clean interproximal surfaces and some work better for certain people than others.

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After 20 years, I’ve realized that people REALLY hate that question and the sometimes ‘scolding’ look or phrase that comes afterward. It really hit home recently when my friend’s husband ( talking about his hygienist not in my office) said…”I’m a grown man, and if I don’t want to floss, I won’t”. He didn’t say it with an attitude, or anything, but I could tell that he must have felt like she was his mom and scolding him, and that in turn made him feel badly and defensive. I really don’t want to make my patients fee bad, or like a little kid or patronized. Do you? I know we all get frustrated because we want health for our patients, but I’ve come to decide that I want them to feel respected and cared for and not dread coming in because they are going to get “yelled at” for not flossing. That being said… What I TRY to do ( and I do fall back into the lecture mode sometimes!) is record how often they floss, t.p., IP brush, whatever, and then refrain from any comments at all about it until I’m actually IN their mouths and can see what is going on. If patients are resistant to flossing, I show them or give them other options for cleaning IP. I really believe that floss is not always the very best way to clean interproximally, so if some other modality will work, and the patient is receptive to it, have at it! I really like GUM Soft-Picks. They are very easy to use and they feel nice, too! I wish they were a little more sturdy and more usable on the posterior teeth without bending, though. My motto is ‘anything is better than nothing’. I can always tweak their routine next visit to improve cleaning their problem areas, especially when the patient sees the improvement. They are more accepting of constructive comments after that happens. One last thing! I LOVE, LOVE, LOVE the POH black dental floss for patient education. I can easily say that at LEAST 85% of people that do floss, are doing it wrong, and the look on their faces when I take that black floss under their gum without discomfort is PRICELESS! Talk about a light bulb moment for them! Most patients have no idea that this is where the floss is supposed to go. When I explain that there is no way their tooth brush can get in that space to get the plaque, then they finally ‘get it’! Oh, the times I’ve heard ‘no one ever showed me that before’! I am guilty of thinking that patients understand, or know why and how to do home care effectively, but if no one ever shows them, how are they supposed to know? Hope this helps!

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I always suggest that the patient keep the floss or floss picks by their favorite chair where they sit while watching tv. Almost everyone watches at least one show/day, and flossing doesn’t have to be done in the bathroom. I have had a lot of success with this strategy.

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I teach them to Dry Brush. Try to get them to floss or at least use floss picks. Also try go between by butler gum. They can massage the gingiva with the brush. Dry Brushing works really well.

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I also recommend keep floss by their chair and floss while watching tv or put a sticky note on the bathroom mirror as a reminder. One other suggestion is start flossing a couple times a week and work up to daily.

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I love all of the above answers and do most of this techniques as well. I also just ask what their usual hygiene routine is throughout the day. Usually flossing isn’t listed and so I just go into education at that pout stating to ease into it with 2x a week and adding on from there. One of my patients said Maybe I will tape my floss container to my toothbrush!” Whatever works!

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There is much more to look at when articulating your dental hygiene diagnosis. Is the patient negligent in other personal care habits? Ask them about their diet. Do they exercise? Find what motivates them. Approach them from a holistic point of view. If you can motivate them to eat better, just doing that will yield a healthier mouth AND body. Do they smoke? Try providing smoking cessation tips. Attempt to broach the subject from a different angle.There are a slew of ways to motivate patients just as there are ways to clean in-between the teeth i.e., a water flosser or interdental picks. Our focus is providing patients with education that can help them achieve good oral health as well as optimal systemic health. Teach them why and let them make that shift for themselves. Sometimes it works and sometimes it doesn’t. It’s their life. If they choose to be unhealthy, too bad for them. Fortunately, you will find people who are inspired by you and those are the moments in a dental hygienists career that makes what we do so very rewarding. We might not be able to convert everyone but we can try. If they refuse, it’s their loss. Not ours. Move on and know that only about 2% of the population flosses and the majority of those are dental hygienist. Go to my weste and click on the producys page to view the studies on Waterpik’s water flosser. It provides a great alternative to those who refuse to floss. Or just go to Waterpik’s site and read all about the benefits of a water flosser. It certainly is worth perusing.

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I tell them they don’t have to floss all of their teeth, just the ones they want to keep. Usually this poses a question as to why flossing is THAT important, and I explain.

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I encourage my teenage patients to go home and google periodontal disease and perio pockets. With my adult patients I explain that if they don’t reverse the 4-5mm pockets that they have then then the perio disease process will progress and they can eventually loose their teeith because of the pocketing. I also explain that dentures change the taste of food. I actually told a patient she had chronic perio disease and that she needed treatment and to start flossing daily. She proceeded to ask if there was a pill she could take for it instead.

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I suggest they floss with floss picks while in their recliner or on the couch at the end of their day while watching the news. It’s how I got my own husband to floss more. Then I SHOW AND DO floss pick instructions.
Note: I personally prefer they use string floss, but frankly if picks motivate them b/c they’re “easy” that is just fine with me!

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You will run across people who’d rather swish for 20 minutes with coconut oil (or other) than floss for 1-2 minutes. Makes no sense.

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For my non-flossers with somewhat intact interdental papilla, I recommend soft picks. I advise patients that these can be purchased at the dollar tree and it usually grabs their attention. For those with loss of papilla, I recommend a proxabrush. I think something is better than nothing at all.

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Stimudents are another good option, especially if they are used to using a tooth pick… Flossing will always be a battle, and unfortunately we can’t win ’em all! As long as we’re doing our job, that’s all we can do. I feel like some people just don’t “get it” and that’s tough, but we can’t change everyone… If you can impact them at all, that’s a start!

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I think in 22 years of dental hygiene I have heard every excuse as to why people don’t floss. And I always have an answer or alternative for them. Tight teeth? Glide floss. Big spaces? Interdental brushes. Fingers don’t fit? Floss picks. Just don’t like it? Water pik. I have also done the start with 2 or 3 days a week and work up to every day, or start with the front teeth and work back one tooth on each side every week. I also have heard the “but my gums bleed every time I floss” I explain that if you were taking a shower and your arm started to bleed spontaneously while you washed it, would you not run screaming to the emergency room? Then why is it acceptable for your gums to bleed when you clean your mouth? That usually gets them thinking.
I also had a young patient who had such fantastic hygiene tell me “not flossing is like taking a shower and not washing in the cracks” There is a visual that gets them too.

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I always give them ideas on how to remember such as putting a floss holder in their books as bookmarks or by the remote. I also give them information on a scientific level. A lot of patients think that flossing is to get food out and if they never get food stuck, why do they need to floss? So I tell them the reason we need to floss is because we need to disturb the bacterial colonies that rebuild during the day around our teeth before they get a chance to cause gingivitis or periodontal disease. I also tell them that brushing alone cleans about 60% of their tooth surfaces.. Building a personal relationship with my patients is also key. It’s kind of like having a gym partner that you don’t want to let down. (:

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I agree and strategically use all of the above ideas! The wonderful thing about a multi-hygienist dental practice is that the non-compliant patient can be “rotated”, so the fun does not fall to the same hygienist each time! (lol) 🙂

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i never ask that question i always ask “hows flossing going?” usually i will ask that during the pxs so they sometimes feel obligated to tell me the truth since ive “already been digging around.” usually i get honest answers but…

i always say if someone isnt a regular flosser, you will not be able to snap your fingers and become one. i simply recommend either string floss or floss picks (with proper instruction) and suggest they try it 3-4x weekly to start the habit. a lot of my patients since ive started doing this have started flossing! i always say every day is ideal and we will start off slow to get you to that point. id rather have them flossing at least a few days weekly then not at all.

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I ask them “how are your flossing habits”. I also tell them that not flossing is like not washing their armpits!! And that’s just nasty leaving food to rotten in-between their teeth, leading to their “bad breath” they just complained to me about. Cut and dry…no preaching involved.

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