No matter how busy life gets, people always remember to brush their teeth.
Most people brush, floss and then use mouthwash. And some just brush, skipping the other two steps. As it turns out, it’s actually more effective to floss, use mouthwash, then brush, according to dentists — and they don't recommend skipping any steps.
Why floss, rinse with mouthwash, then brush?
Dr. Todd Shatkin, a dentist based in Amherst, New York, said cleaning sessions should always begin with flossing to remove any obvious pieces of food and debris first. He recommends spending at least five minutes thoroughly flossing between each tooth.
“Typically, you want to clean the teeth first,” Shatkin told TODAY Health in a Zoom interview. “So you're going to use the floss. You're going to get rid of any plaque or calculus in between the teeth. And you can do that on every tooth and you have to go slow. You don't want to rush through it. It's not just up and down. You want to take that floss, go around the tooth, up and down a little bit and then take it in and out of each space between each tooth.”
After finishing this prep work, it’s not quite time to brush yet. Dr. Vanessa Creaven, a dentist based in Ireland and England, said using mouthwash should always come before brushing. The process of brushing distributes active ingredients from toothpastes to teeth and rinsing with mouthwash after that would wash away those ingredients, Creaven said.
“You don't want to ever rinse your mouth after brushing because you don't want to ever rinse away your active ingredients,” Creaven said. “Active ingredients in your toothpaste are really going to help remineralize and protect your teeth for up to four hours.”
So sequentially flossing, using mouthwash and then brushing your teeth is the best order to follow for maximum results. But Dr. Catrise Austin, a dentist based in New York City, said she’d rather people regularly clean their teeth in any order than skip it because they don’t know which order to follow.
“I don't care what order you do it, just do it,” Austin said.
The importance of a three-step dental routine
Austin said flossing, brushing and using mouthwash are equally as important as each can only do so much individually, but together they clean the entire mouth. She said a lot of people skip flossing.
"I know it seems like an extra step, but it's so key because there are parts of your mouth that the brushing does not get," Austin said. "So flossing allows you to get that bacteria from underneath the gums so that you don't get gum disease. You're cleaning the sides of the teeth so the plaque doesn't stick and you can get the acids and the sugars that also may be sticking to your teeth. This is key, just as important as brushing."
Mouthwash catches what brushing does not, she said. "A lot of people don't know that brushing only cleans about 25% of your mouth. So the rest of your mouth has bacteria sugars lurking around. That's where I recommend Listerine antiseptic, cool mint mouth rinse. It is great for removing that bacteria, giving you a full mouth clean and 24-hour protection."
How to choose a toothpaste
These days, the dental hygiene aisle rivals the cereal aisle with so many different brands for sensitivity, fighting bad breath and cavity prevention.
The goal is to select a toothpaste based on specific needs at the time, the dentists said.
“Often when we choose our toothpaste, we should choose it with the ethos in mind that we are choosing a health product," Creaven said. “People are so invested in their skin care regime, but they're picking up any which toothpaste and they're not actually considering, ‘What's the cause that I want to treat?’ And so I often say, sit down and think about what are your biggest concerns in your mouth?”
From there, Creaven and Austin recommend choosing a toothpaste that targets those specific concerns and meeting with a dentist who can recommend products after performing evaluations.
“If you happen to be cavity prone, then you may want to use a fluoride-based toothpaste,” Austin said. “If you are a coffee drinker or smoker, then you may want to use a product that has baking soda. If you have gum disease, then you may want to choose a product that has hydrogen peroxide.”
Creaven said toothpastes with fluoride are overall the best way to go and no-fluoride toothpastes do not perform as well.
“When you're choosing your oral care products, you need to look for active ingredients, and that has to be the No. 1,” she said. "So fluoride needs to be in your toothpaste. I know it's controversial. But ... we see time and time again the massive benefits for your oral health long-term. And I would even go as far as to say when my patients use fluoride-free toothpaste, I can tell at their next checkup.”
Creaven said to avoid products with sodium lauryl sulfate because it’s linked to ulcers and cold sores
“For me, it's really important my patients use a sodium lauryl sulfate-free toothpaste because I think a lot of my patients suffer from ulcers, and they suffer from cold sores very often,” Creaven said. “And when you have SLS or sulfates or sodium lauryl sulfate, in your toothpaste, it can increase the frequency of your ulcers and can increase the longevity or the time that they spend there.”
In between cleaning sessions, Creaven and Austin recommend rinsing throughout the day so there are always active ingredients fighting oral bacteria.
Creaven said, “It’s really helpful to use mouthwash throughout the day. Not only does it keep your breath fresh, but it also rebalances the pH within your mouth and it remineralizes and it reinforces and reintroduces active ingredients.”