Flossing involves using a thin filament or specialized device to remove food debris and bacterial plaque from between the teeth and along the gum line. This practice is a necessary complement to toothbrushing, which is generally unable to reach the approximately 35% of tooth surfaces located in these tight spaces. Skipping this step allows a sticky film of bacteria to remain in areas that account for a significant portion of the mouth’s surface area.
Plaque Buildup and Halitosis
The immediate consequence of not flossing is the rapid accumulation of dental plaque in the interdental regions. Plaque is a colorless, sticky biofilm composed of bacteria, food particles, and saliva that constantly forms on the teeth. If this film is not mechanically removed from the spaces between teeth, it begins to mature and harden within 24 to 36 hours into calculus, or tartar, which cannot be removed by brushing alone.
The trapped bacteria in this accumulating plaque begin to break down leftover food particles, particularly proteins, through a process of fermentation. This bacterial activity produces foul-smelling waste products, primarily volatile sulfur compounds (VSCs). The resulting persistent bad breath, medically known as halitosis, is often the first noticeable sign that interdental spaces are not being properly cleaned.
The rough, porous surface of tartar provides an ideal environment for more bacteria to multiply, protecting them from normal cleaning efforts. This cycle intensifies the halitosis and sets the stage for more serious health problems.
The Onset of Gum Inflammation
When plaque is allowed to remain along the gum line, the body responds by initiating an inflammatory process known as gingivitis. Gingivitis is the earliest and mildest form of gum disease, characterized by inflammation that is confined to the soft tissues of the gums, or gingiva. The inflammation is a direct response to the toxins and irritating substances released by the bacteria in the dental plaque.
A healthy gum is typically firm and pink, but with gingivitis, the gums become noticeably red, swollen, and tender. A hallmark symptom is bleeding, which can occur easily when a person brushes, eats hard foods, or attempts to floss. Despite these symptoms, gingivitis often goes unnoticed because it can cause little to no discomfort in its early stages.
Gingivitis is a reversible condition because it has not yet caused permanent structural damage. With the removal of the bacterial biofilm through professional cleaning and the resumption of thorough at-home oral care, the inflamed tissues can return to a healthy state. If the plaque is not removed, however, the inflammation becomes chronic and the condition can quickly progress to a more destructive form of periodontal disease.
Progression to Severe Oral Disease
If gingivitis is ignored, the chronic inflammation can progress to periodontitis, which involves the destruction of the tissues and bone that support the teeth. In periodontitis, the bacterial plaque spreads and grows below the gum line, where the body’s sustained inflammatory response begins to break down the periodontal ligament and the alveolar bone. This structural damage distinguishes periodontitis from the earlier, reversible stage of gingivitis.
As the supporting structures are destroyed, the gums separate from the teeth, creating small spaces called periodontal pockets that become reservoirs for bacteria and debris. These pockets deepen over time, leading to the resorption of the underlying bone.
This bone loss causes the gums to recede, making the teeth appear longer, and eventually leads to tooth mobility and potential tooth loss. Beyond the mouth, the chronic infection and inflammation associated with severe periodontitis have been linked to systemic health issues. Bacteria and inflammatory mediators from the infected gums can enter the bloodstream, contributing to the body’s overall inflammatory burden.
This systemic inflammation is associated with an increased risk of cardiovascular diseases, including heart attacks and strokes. Furthermore, a bidirectional relationship exists with conditions like diabetes, where periodontal disease can complicate blood sugar control, and uncontrolled diabetes can worsen gum disease.