Interdental cleaning is the mechanical removal of plaque and debris from the small spaces between teeth. This step is necessary because toothbrush bristles cannot effectively reach the approximately 40% of tooth surface area located in these tight gaps. The specific practice of using a thin string, or floss, is deeply ingrained in the public consciousness, particularly in the United States. This has led many to question if this habit is primarily an American cultural phenomenon.
The Origin and Early Commercialization of Dental Floss
The concept of using a thread to clean between teeth was introduced in the United States in the early 19th century. In 1815, a New Orleans dentist recommended that his patients use a thin silk thread to remove food particles and plaque from interdental spaces.
The commercialization that followed firmly established the product in the American market. In 1882, the Codman and Shurtleff company began mass-producing unwaxed silk floss in Massachusetts, making it available to the public. Later in 1898, Johnson & Johnson secured the first patent for dental floss, utilizing the same silk material used for surgical stitches. The material later shifted to more affordable and durable nylon in the 1940s, which increased accessibility and lowered manufacturing costs.
Global Prevalence of Interdental Cleaning
While the invention and early marketing of string floss were American, the practice of interdental cleaning is recommended globally, though the preferred tool often differs. In many parts of Europe, dental professionals frequently recommend interdental brushes as the first-choice cleaning aid. The European Federation of Periodontology (EFP) suggests that interdental brushes are generally more effective at plaque removal than floss, particularly where spaces between teeth are open enough to accommodate them.
In the United Kingdom, for example, a survey found that the use of interdental brushes had surpassed traditional string floss as the most common interdental cleaning method. Traditional floss is often reserved for individuals with very tight contacts where a brush cannot be safely inserted. Australian dental authorities, like their European counterparts, emphasize daily interdental cleaning but recommend various tools, including floss, interdental brushes, and water flossers, depending on the individual’s needs.
Why Flossing Is Highly Emphasized in American Dentistry
The perception of flossing as a universal standard in the US stems largely from its institutional backing and decades of consistent consumer messaging. Organizations like the American Dental Association (ADA) have historically promoted flossing as the primary standard for interdental plaque removal. The ADA continues to recommend cleaning between teeth once a day with an interdental cleaner, with floss often listed prominently.
This message has been powerfully reinforced by US consumer culture and advertising since the mid-20th century. Floss was one of the first interdental tools to be widely advertised and associated with the ideal of a healthy smile, leading to its deep cultural penetration. The result is a public health message in the US that uses the word “flossing” as a shorthand for all interdental cleaning, even though other tools may be recommended for specific patient needs.