The debate over which interdental cleaning tool is best comes up constantly in dental offices. Patients want a clear winner. The honest answer from the research — including a 2019 Cochrane systematic review and the ADA's own guidance — is that all three options can be effective, but no single method has been proven definitively superior for everyone.
Traditional string floss remains the most studied option. When used correctly, it removes plaque from between teeth and just below the gumline. The ADA recommends it as a standard, and the U.S. Department of Health and Human Services has reaffirmed interdental cleaning as an essential oral hygiene practice. The evidence shows that adding flossing to brushing reduces gingivitis more than brushing alone — though the effect is modest unless technique is good.
Floss picks — the Y-shaped plastic tools with a small piece of floss — are more convenient and easier to use one-handed, which makes them popular. They are less effective than string floss at getting below the gumline in tight spaces, but they are significantly better than nothing. For patients with limited dexterity, arthritis, or braces, picks can be the difference between cleaning interdentally and not doing it at all.
Water flossers (like Waterpik) use a pressurized stream of water to flush debris and bacteria from between teeth. Research shows they are particularly effective for people with gum disease, implants, crowns, or orthodontic appliances. They are not a replacement for string floss in all situations, but for the right patient they can be equally or more effective.
Interdental brushes — tiny cone or cylindrical brushes — are worth mentioning too. For patients with larger gaps between teeth, periodontitis, or implants, the ADA and research literature suggest these may outperform floss.
The bottom line: the best interdental cleaning tool is the one you will actually use consistently. If you hate flossing with string, you are better off using a pick or water flosser every day than using string floss twice a month. Talk to us at your next visit and we can help you find the right fit for your anatomy and habits.