Probing the 'flossing surface'

June 1, 2001
Start your probing on brushing surfaces and then probe flossing surfaces.

Here's a great idea for jump-starting patient education. I wish I could pass this off as an original idea, but I can't. That doesn't matter. Just give it a try - it's an ingenious idea! Can you believe this idea comes from a family practice general dentist nearly 20 years my junior? Why didn't I think of this? OK, here it is.

Change what you say to patients so that you directly link gum disease and dental decay to prevention. I mean really link them. Instead of probing all around each tooth in the way we were all taught, probe only "brushing surfaces" and then probe only "flossing surfaces." It's so simple.

We probe six points around each tooth and announce the numbers to expedite the assistant's recording of them. Or, we do it that way because our dental hygiene instructors told us to do it that way. Whatever the reason, it makes more sense to give the patient valuable information as we call out the numbers.

If we can start probing all of the facial and lingual surfaces together, then we can tell the patient that we are probing all of the surfaces they reach with their toothbrush - the brushing surfaces. They will understand the effects of their brushing. Most facial and lingual surfaces measure 2 to 3 millimeters. They'll see that wherever they reach with their toothbrush, they don't have gum disease. Next, probe all of the mesial and distal surfaces and tell patients you are measuring the flossing surfaces. The probing and bleeding scores will tell you immediately if they're flossing or not.

Patients will get this message loud and clear, too. Are they reaching only the brushing surfaces and missing the flossing surfaces? The dramatic difference in flossing surface scores for someone who isn't cleaning between their teeth will be much more effective than all the lecturing we do.

Sure, we all tell patients that the deepest areas are between the teeth. But this simple change in routine dramatically distinguishes between brushing surfaces and flossing surfaces; it links infected areas with lack of adequate oral hygiene between the teeth. If they aren't flossing, it's time to start or to begin using some tool to reach between the teeth, either picks or oral irrigation. Patients will probably ask you how to clean between their teeth before you even finish probing.

What about the earlier reference to the link between dental decay and prevention? Instead of saying "occlusal decay," say "sealant cavities." Instead of saying "mesial decay" or "distal decay," say "flossing cavities." Can you believe how simple that is? Why don't we do this already? Sealant cavities happen to teeth that didn't receive a sealant. Flossing cavities occur because the patient didn't floss. Double-flossing cavities describe two cavities in the same interproximal area, both mesial and distal.

Even after the fact, this information clearly links flossing with interproximal decay or sealants with occlusal decay. Do patients have more sealant fillings or flossing fillings? Bring this to the attention of patients who already have lots of flossing cavities, so that they can stress the importance of flossing to their children. The hygienist is an oral hygiene trainer and coach. As the oral hygiene expert, hygienists are the best source for training and coaching kids in the fine art of flossing. That way, kids can avoid having the number of flossing cavities their parents have. The intraoral camera is perfect for showing a child the number of flossing cavities Mom has, thus motivating both the mother and child to floss daily. Flossing becomes a regular part of the routine, more important than brushing.

Are you curious about the source of this information? It comes from Dr. Howard Farran, a Phoenix family practice general dentist with a passion for dentistry and prevention. His commitment to prevention makes me think he's a hygienist caught in a dentist's body! He was instrumental in getting water fluoridation on the ballot and passed in several communities in Arizona. Those efforts were recognized when he received the Arizona Public Health Award. Dentists such Dr. Farran - who are committed to prevention and oral health - spend their time doing implants, ortho, tooth whitening, and cosmetic dentistry rather than chasing decay. They provide the services patients want and are willing to pay for out of their own pocket.

Howard, as he's known to his patients, is a real character. You may not like his style; it's a bit crass for some. But his ideas are fantastic, and he puts those ideas to work. Besides running an extremely successful practice called Today's Dental, Howard is the editor of Dental Town (dentaltown. com). He also recently completed an MBA degree, lectures all over the world, and consumes CE to the same extreme that some of our patients consume sugar and soda pop! His passion for oral health is contagious. His lectures and tapes are designed for the entire staff. If your dental team needs a jump-start or just a few new ideas, Howard is the ticket.

Tell your patients about sealant cavities and flossing cavities. Start your probing on brushing surfaces and then probe flossing surfaces. You're sure to have a lot of fun with this approach, so let me know how it works for you.

Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is She can be reached by phone at (800) 374-4290 and by e-mail at [email protected].