Floss
Dental floss is a thin, cord-like filament, typically composed of nylon, polytetrafluoroethylene (PTFE), or other synthetic fibers and often coated with wax, used in oral hygiene to remove dental plaque, food debris, and bacteria from the interdental spaces and below the gumline where toothbrushes cannot reach.[1][2] The origins of flossing trace to 1815, when American dentist Levi Spear Parmly published a guide advocating the use of waxed silken thread passed between teeth to prevent decay and maintain gingival health, marking the first systematic recommendation for interdental cleaning as a preventive measure.[3][4] Commercial manufacturing emerged later in the 19th century, with unwaxed silk floss produced starting in 1882 and Johnson & Johnson patenting a silk-based version in 1898 after introducing it to consumers around 1896, transitioning from artisanal to mass-produced hygiene products amid growing awareness of oral disease causation.[4][5] Regular flossing, when combined with brushing, demonstrably reduces interdental plaque accumulation and gingival inflammation, as evidenced by clinical trials showing supplementary benefits in plaque index scores and bleeding on probing, though self-reported adherence often limits population-level outcomes and some systematic reviews highlight variability in study quality.[6][7] Over time, innovations like PTFE floss for smoother gliding and floss picks for ease have expanded accessibility, while debates persist on alternatives such as water irrigators, which show comparable short-term plaque reduction in certain contexts but lack long-term superiority in randomized comparisons.[8][9] Despite these evolutions, flossing remains a cornerstone of evidence-based preventive dentistry, endorsed by professional bodies for mitigating risks of periodontitis and interproximal caries through direct mechanical disruption of biofilm.[1]Oral Hygiene
Definition and Usage
Dental floss is a thin cord or filament, typically composed of nylon, polytetrafluoroethylene (PTFE), or other synthetic polymers, designed for interdental cleaning to remove food debris and plaque from spaces between teeth that toothbrushes cannot reach.[1][10] It functions by mechanically scraping surfaces along the tooth sides and below the gumline, where bacterial biofilm accumulates and contributes to gingivitis and caries if untreated.[1][11] The American Dental Association endorses daily use of dental floss or equivalent interdental cleaners as a core component of oral hygiene routines, recommending it once per day to complement twice-daily brushing.[2][1] To employ it correctly, dispense about 45 centimeters (18 inches) of floss and wrap most around one middle finger while securing the remainder on the opposite middle finger, leaving 2–5 centimeters (1–2 inches) taut between the thumbs and index fingers.[12] Gently guide the floss between each pair of teeth using a sawing motion to avoid snapping against the gums, then form a C-shape around one tooth's base and slide it upward toward the gumline while angling slightly under the margin, repeating on the adjacent tooth before advancing to fresh floss sections.[12][13] This technique ensures thorough cleaning of proximal surfaces, including the distal aspects of the most posterior teeth.[13]Historical Development
Levi Spear Parmly, a dentist in New Orleans, is credited with inventing modern dental floss in 1815, recommending that patients use a thin silk thread coated with beeswax to clean between teeth and remove food debris.[14] This innovation stemmed from Parmly's observations of interproximal decay and was detailed in his 1819 book A Practical Guide to the Management of the Teeth, where he emphasized the thread's role in preventing plaque accumulation.[15] Commercial production began in the late 19th century, with the Codman and Shurtleft Company of Randolph, Massachusetts, marketing unwaxed silk floss in 1882 as the first mass-produced version available to consumers.[16] Johnson & Johnson secured the first U.S. patent for dental floss in 1898, producing it from high-quality silk thread similar to that used in surgical sutures, which facilitated wider distribution through pharmacies and marked the transition from artisanal advice to standardized consumer product.[15] During World War II, silk shortages due to wartime rationing prompted the development of nylon floss in the 1940s, which proved more durable and less shred-prone than silk, leading to its dominance in the market by the postwar period.[15] Innovations like the floss pick emerged in 1963, invented by James B. Kirby, offering a disposable plastic handle for easier use, particularly for those struggling with traditional string floss.[17] Earlier precedents trace to prehistoric times, where archaeological evidence suggests ancient peoples used fibrous materials such as horsehair or plant strands for interproximal cleaning, though these lacked the refinement of 19th-century developments.[15]Scientific Efficacy and Empirical Evidence
Dental floss, when used adjunctively with toothbrushing, has been evaluated in multiple randomized controlled trials and systematic reviews for its ability to reduce interdental plaque accumulation, a primary precursor to gingival inflammation. A 2011 Cochrane systematic review of 12 trials involving over 500 participants found low-quality evidence that flossing plus brushing reduced gingival bleeding compared to brushing alone, with a mean difference of -0.12 (95% CI -0.18 to -0.06) on the Gingival Index, though evidence for plaque reduction was unreliable due to high risk of bias and inconsistency across studies. Similarly, a 2008 systematic review of five trials concluded that flossing provided a small but statistically significant reduction in plaque scores (mean difference 0.26, 95% CI 0.00 to 0.52) and gingival inflammation parameters when added to brushing, yet emphasized the limited number of high-quality, long-term studies.[18] For gingivitis prevention and management, evidence indicates modest benefits, particularly in short- to medium-term interventions. The 2019 Cochrane review, analyzing 35 trials with over 5,000 participants, reported very low-certainty evidence that floss plus brushing may reduce gingivitis scores by 0.08 to 0.13 points on standardized indices over 1-6 months, with unclear effects on plaque due to imprecision and heterogeneity. Clinical trials, such as a 2022 randomized controlled study of 60 adults, demonstrated that daily flossing alongside brushing significantly lowered gingival index scores from 1.12 to 0.45 over 4 weeks (p<0.001), outperforming brushing alone, attributed to mechanical disruption of interdental biofilms.[6] However, real-world adherence remains low, with self-reported flossing frequency often underestimating actual use, potentially diminishing population-level efficacy.[19] Longer-term outcomes, including periodontitis progression or caries prevention, lack robust support from high-quality evidence. No large-scale, longitudinal trials definitively link routine flossing to reduced tooth loss or advanced periodontal disease incidence, though observational data suggest associations with lower systemic inflammation markers potentially tied to cardiovascular risk.[20] A 2024 preprint analysis of child cohorts found self-flossing ineffective at preventing gingivitis, highlighting technique dependency and developmental factors.[21] Mechanistically, flossing targets inaccessible interdental spaces where plaque harbors anaerobes causing host-mediated tissue destruction, yet studies consistently show only partial plaque removal (e.g., 13% reduction post-habitual use in proximal sites).[19] Comparisons to alternatives reveal floss's relative efficacy. Interdental brushes may outperform string floss for plaque removal in wider embrasures (mean reduction 0.48 vs. 0.13 on plaque index), per the 2019 Cochrane synthesis, while water flossers show comparable gingivitis reductions in orthodontic patients but require device access.[8] Overall, while professional bodies like the American Dental Association endorse daily flossing based on cumulative evidence of adjunctive benefits, the evidence base is graded as low certainty, with calls for better-powered trials addressing compliance and technique.[1]Types, Innovations, and Criticisms
Dental floss is primarily categorized by material and design. Traditional floss consists of multifilament nylon strands, either waxed to reduce shredding or unwaxed for greater plaque removal through its textured surface.[22][23] Polytetrafluoroethylene (PTFE) floss, such as Gore-Tex-based products, offers a smooth, low-friction glide suitable for tight contacts but may leave behind residue.[24] Other variants include dental tape, a wider, flat ribbon for broader surfaces; super floss with stiff-end threads for bridges and orthodontics; and natural options like silk or bamboo-derived floss marketed as biodegradable alternatives to synthetic polymers.[25][23] Innovations in flossing technology emphasize ease of use and enhanced cleaning. Electric flossers, such as the Flaus device introduced around 2023, employ up to 18,000 sonic vibrations per minute to dislodge plaque and navigate tight spaces without manual threading.[26] Water flossers, or oral irrigators like Waterpik models, utilize pressurized water jets—often combined with sonic action in hybrid devices—to flush interdental debris, with studies indicating superior efficacy over string floss for certain users, particularly those with dexterity issues.[27] Emerging smart floss systems, prototyped by Tufts University researchers in 2025, integrate sensors into floss picks to measure salivary biomarkers like cortisol for real-time stress monitoring, potentially extending to diabetes or cardiovascular tracking.[28] Criticisms of dental floss center on efficacy, methodological flaws in supporting research, and environmental impacts. Systematic reviews, including a 2019 Cochrane analysis, have rated evidence for flossing's adjunctive benefits over brushing alone as low quality, citing short-term studies with modest plaque reduction but inconsistent long-term data on gingivitis or caries prevention, often hampered by self-reported compliance and skill variability.[29][30] Environmentally, conventional nylon and PTFE flosses contribute to microplastic pollution, with non-biodegradable single-use picks exacerbating waste; additionally, some PTFE variants contain per- and polyfluoroalkyl substances (PFAS), "forever chemicals" linked to absorption via oral mucosa and potential health risks like endocrine disruption when gums bleed.[31][32] Biodegradable alternatives mitigate some concerns but face scalability and cost barriers.[33]Dance and Culture
The Floss Dance Move
The Floss dance move involves rapid, alternating swings of the arms from side to side, passing them behind and in front of the body, while the hips thrust in the opposite direction to create a counter-rhythmic motion.[34] This back-and-forth arm action, combined with hip rotation, mimics the repetitive threading motion of dental flossing, from which the dance derives its name.[35] Performers typically maintain a steady stance with feet shoulder-width apart, executing the sequence at high speed for an energetic effect, often as a solo routine or celebratory gesture.[36] The move was devised by Russell Horning, a dancer from Lawrenceville, Georgia, who gained online recognition under the moniker "Backpack Kid" for incorporating it into his performances.[37] Horning first shared a video demonstrating the Floss on Instagram on August 18, 2016, which amassed tens of thousands of views and laid the groundwork for its recognition as a distinct dance.[38] Initially unnamed, it was dubbed "the Floss" by observers noting the arm-swing resemblance to floss thread.[35]Origins, Viral Spread, and Cultural Impact
The floss dance originated with Russell Horning, a teenager from Lawrenceville, Georgia, known online as "The Backpack Kid," who first demonstrated the move in social media videos around 2016.[36] Horning, then about 14 years old, created it as part of his self-choreographed routines filmed in his bedroom, involving rapid swinging of the arms side-to-side while twisting the hips in opposition, mimicking a flossing motion.[39] Although similar arm-swinging gestures appeared earlier—such as in Nathan Barnatt's "No Bones" dance from around 2009—Horning's version gained distinct recognition for its rhythmic, exaggerated execution popularized on platforms like Instagram.[40] Its viral spread accelerated in early 2017 after Horning's appearance on Saturday Night Live during Katy Perry's performance of "Swish Swish" on February 18, where he performed the floss live, exposing it to millions.[41] The move's popularity exploded further in September 2017 when Epic Games incorporated it as a limited-time emote in Fortnite Battle Royale, a battle royale video game that had reached over 10 million players by mid-2017; this integration turned it into a celebratory gesture within the game's community, amplifying its reach through user-generated content and streaming.[42] By late 2017, floss challenges proliferated on YouTube and emerging platforms like TikTok, with compilations garnering millions of views and participation from celebrities, athletes, and ordinary users, particularly children and teens.[43] Culturally, the floss symbolized a lighthearted, accessible entry into internet meme culture, fostering intergenerational interactions as parents attempted the move in response to children's challenges, often leading to humorous family bonding documented in viral videos.[44] It infiltrated schools, where teachers reported its use during breaks to energize students, and sporting events, though some venues discouraged it as disruptive.[45][46] The dance's integration into Fortnite highlighted gaming's role in mainstreaming youth trends, influencing subsequent emote-based dances and contributing to the platform's cultural dominance, with floss emotes viewed billions of times in-game. Horning's claim to its invention led to a 2018 lawsuit against Epic Games for unauthorized use, seeking compensation for the emote's $800 in-game purchase price multiplied by usage, though the case underscored challenges in copyrighting simple dance sequences.[40][35] By 2018, its peak waned amid newer trends, but it endured in pop culture references, music videos, and as a nostalgic staple for Gen Alpha and millennial youth.[47]Criticisms and Decline
The Floss dance faced criticism primarily for its association with Fortnite, a battle royale video game featuring graphic violence, which prompted several schools to ban the move in 2018 out of fears it could normalize or encourage exposure to such content among children. For instance, a primary school in Devon, England, prohibited flossing during assemblies and breaks, citing the dance's prominence in Fortnite as a potential influence on disruptive behavior. Similar bans occurred in Australian and U.S. schools, with parents and administrators arguing the trend distracted from learning and linked innocuous physical activity to a game involving simulated shootings and eliminations.[48][49][50] Public perception often highlighted the dance's repetitive nature as grating or juvenile, with observers noting its overuse in social settings led to annoyance, particularly when performed excessively by young children or awkwardly by adults lacking the requisite coordination. Russell Horning, known as Backpack Kid and the move's popularizer, remarked in 2018 that adults attempting the Floss typically failed due to insufficient flexibility, rendering their efforts embarrassing rather than engaging. Online discussions echoed this, describing the dance as "cringeworthy" for its mechanical simplicity and lack of expressive depth compared to prior trends like twerking.[47][51] Legal controversies further tarnished the trend's image, as Horning's mother filed a $3 million copyright infringement lawsuit against Epic Games in December 2018, alleging Fortnite's emote version appropriated the dance without permission or compensation. This suit, part of a wave including claims over other emotes like the Milly Rock, highlighted tensions between viral creators and commercial platforms but ultimately faltered; it was withdrawn in 2019 following a U.S. Supreme Court ruling affirming that short social dance routines generally lack copyright protection as fixed choreographic works.[52][37][53] The Floss peaked in popularity from mid-2017, gaining traction after Horning's appearance on Saturday Night Live during Katy Perry's May 20, 2017, performance of "Swish Swish," and exploding globally via Fortnite's inclusion as a purchasable emote in 2018, which drove millions of in-game uses and social media videos. By late 2018, however, signs of decline emerged through oversaturation, as ubiquitous performances eroded novelty, prompting backlash against its persistence in outdated contexts. Internet trend cycles, characterized by rapid adoption followed by fatigue from algorithmic amplification on platforms like YouTube and Instagram, accelerated the fade, with the dance supplanted by subsequent TikTok-driven moves such as the Renegade by early 2019.[54] Horning's personal trajectory mirrored the trend's ebb; after initial fame, his pivot to music with the 2018 single "Too Lit" underperformed, and the unresolved Fortnite disputes failed to yield financial or reputational gains, contributing to his reported irrelevance by 2020 as public interest shifted. By 2023, retrospective analyses framed the Floss as a fleeting meme emblematic of 2010s youth culture, with sporadic nostalgic revivals but no sustained revival, underscoring how viral dances derive longevity from scarcity rather than repetition.[53][55]Textiles and Fibers
Embroidery and Craft Floss
Embroidery floss, commonly referred to as stranded cotton, is a loosely twisted thread composed of six separable strands, typically made from mercerized cotton to achieve a smooth, glossy surface that enhances stitch visibility and durability.[56] This construction allows embroiderers to adjust thickness by using one to six strands, providing versatility for fine detail work or broader coverage in techniques like cross-stitch and satin stitch.[57] Craft floss shares this stranded format but is often applied in non-embroidery crafts such as friendship bracelets or knotting projects, where the separability facilitates varied tension and color blending without requiring the sheen optimized for fabric decoration.[58] Primary materials include long-staple cotton for the standard floss, which undergoes mercerization—a process involving sodium hydroxide treatment to increase strength, luster, and dye affinity—resulting in threads approximately 8.7 yards long per skein.[59] Alternative compositions encompass silk for a luxurious sheen and finer texture, rayon (viscose) for vibrant color saturation and slight elasticity, linen for a matte, textured effect in rustic designs, and metallic variants incorporating polyester or lurex for reflective accents.[60] Pearl cotton, a related but non-stranded type, features higher twist for a cord-like structure, used in outlined or textured embroidery rather than separable strand work.[61] In embroidery, floss enables precise decorative applications on fabrics like cotton or linen, with stitches such as backstitch or French knots relying on its splitability for depth and shading; a single skein typically yields 12 to 18 inches of stitching per strand depending on fabric count.[62] For crafts, it supports projects requiring colorfastness and flexibility, such as beaded weaves or simple tapestries, though non-stranded craft cords may substitute in knot-heavy applications for reduced fraying.[63] Leading producer DMC maintains over 500 standardized colors via numbered charts, ensuring consistency across global patterns since the late 19th century.[64] The modern stranded floss emerged in the 19th century alongside industrialized textile production, with DMC—founded in 1746 in Mulhouse, France—pioneering mercerized cotton variants by the 1890s using Egyptian long-staple fibers dyed in controlled batches for uniformity.[65] Production involves spinning, mercerizing, and skein-winding in facilities like DMC's French plant, where threads achieve a denier of about 25 per strand, prioritizing colorfastness tested to withstand 40-50 wash cycles without fading.[59] This standardization addressed pre-industrial variability in hand-spun silks and wools, enabling reproducible designs in both professional embroidery and amateur crafts.[66]Natural and Industrial Floss Materials
Natural embroidery floss materials are derived from plant or animal fibers, prized for their tactile qualities and historical use in handcrafting. Cotton floss, the most prevalent type, consists of six loosely twisted strands of mercerized cotton fibers, which undergo a chemical treatment with sodium hydroxide to enhance strength, luster, and dye affinity, making it suitable for detailed stitching on natural fabrics.[57] Silk floss, sourced from mulberry silkworm cocoons, offers exceptional smoothness and natural sheen due to its protein-based filament structure, enabling fine, lustrous effects in heirloom projects, though it requires careful handling to avoid fraying.[67] Linen floss, made from flax plant stems, provides a rustic, textured appearance from its cellulose fibers, which are processed through retting and spinning for durability in surface embroidery, particularly on heavier weaves.[68] Wool floss, derived from sheep fleece via carding and spinning, imparts a soft, matte finish with slight elasticity, ideal for textured stitches but prone to felting if overworked.[69] Industrial floss materials, designed for machine embroidery and high-volume production, predominantly feature synthetic polymers for enhanced performance under mechanical stress. Polyester floss, composed of 100% polyethylene terephthalate filaments, exhibits superior tensile strength, abrasion resistance, and colorfastness, with high tenacity ratings enabling speeds up to 1,200 stitches per minute in industrial machines without breakage.[70] Rayon floss, a regenerated cellulose from viscose derived from wood pulp or bamboo, mimics silk's sheen through its filament extrusion process but offers better affordability and uniformity for synthetic fabrics, though it is less durable in humid conditions due to moisture absorption.[71] These synthetics outperform naturals in scalability and consistency, as polyester's chemical stability resists shrinking and fading under UV exposure, supporting applications in apparel manufacturing since the mid-20th century.[72] Nylon, another filament-based synthetic, appears in specialty floss for its elasticity and knot resistance but is less common due to potential yellowing over time.[69]| Material Type | Examples | Key Properties | Primary Uses |
|---|---|---|---|
| Natural | Cotton, Silk, Linen, Wool | Organic fibers; variable sheen and texture; biodegradable | Hand embroidery on natural fabrics; artisanal crafts |
| Industrial/Synthetic | Polyester, Rayon, Nylon | Filament-based; high strength, uniform dye uptake; synthetic durability | Machine embroidery; commercial production; synthetic textiles |