What is the recommended sequence for flossing

What is the recommended sequence for flossing and brushing according to ADA and the Academy of Periodontology

The most up-to-date recommendations from the American Academy of Periodontology and recent studies suggest you should floss first, then brush your teeth. This sequence helps maximize plaque removal and enables fluoride from toothpaste to better reach between the teeth.

Evidence shows that flossing before brushing reduces interdental (between-teeth) plaque and increases the amount of fluoride retained in these areas, improving cavity prevention and gum health.^[2]^[4]^[1]
The ADA acknowledges that both sequences are effective as long as flossing is thorough, but multiple sources now advocate for flossing first to optimize results.^[5]
The key is to do both steps daily: flossing once and brushing twice per day with a fluoride toothpaste.^[6]
^[7]

References

1. https://www.perio.org/press-release/new-study-suggests-the-ideal-sequence-for-removing-plaque/

2. https://www.hamiltonhealthcenter.com/oral-hygiene-sequence/

3. https://aaoinfo.org/blog/should-i-floss-or-brush-first/

4. https://pubmed.ncbi.nlm.nih.gov/29741239/

5. https://adanews.ada.org/huddles/flossing-before-or-after-brushing-experts-weigh-in/

6. https://www.ada.org/resources/ada-library/oral-health-topics/floss

7. https://www.mouthhealthy.org/all-topics-a-z/flossing

Order of Oral Hygiene Steps:

Most authoritative recent sources and expert organizations now recommend to floss first and then brush your teeth. Flossing before brushing removes interdental debris and allows fluoride from toothpaste to reach between the teeth more effectively.^[6]^[2]^[7]^[8]
The full recommended sequence is:
- Floss (or use an interdental device or water flosser if preferred).^[2]^[9]^[6]
- Brush for two minutes with a soft-bristled toothbrush and fluoride toothpaste, twice a day.^[3]^[4]
- Rinse with mouthwash if desired, but ADA advises waiting 30 minutes after brushing to maximize fluoride contact with enamel.^[6]
- Scrape tongue to remove bacteria and freshen breath.^[1]
  ^[2]

Steps for Using an Electric Toothbrush (Philips Sonicare, Oral-B, etc.):

Use a brush head with soft bristles, replacing it every 3–4 months or sooner if frayed.^[4]^[1]
Hold the brush at a 45-degree angle to gums.
Move the brush slowly from tooth to tooth, letting the electric brush provide the cleaning action—do not scrub; use gentle guidance.^[1]
Spend 30 seconds on each quadrant of the mouth for a total of 2 minutes.
Cover all surfaces: outer, inner, and chewing surfaces.^[3]^[4]
Be gentle to avoid gum injury or enamel wear.

When and How to Use Water Flossers (e.g., Waterpik):

Water flossers are an ADA-accepted alternative to traditional floss, especially helpful for people with braces, implants, or dexterity difficulties.^[9]^[2]
Use a water flosser once per day, ideally before brushing, to dislodge food particles and disrupt plaque between teeth and below the gumline.^[2]^[9]^[6]
Begin at the lowest pressure setting.
Direct the stream at a 90-degree angle to the gumline and follow along all teeth, pausing between each tooth.

Done before brushing, this enables fluoride access to interdental areas.

Key Official Guidelines:

Brush twice daily for two minutes with a fluoride toothpaste.^[4]^[3]
Floss once daily, ideally before brushing.^[8]^[2]
Replace toothbrush or brush head every 3–4 months.^[4]
Consider additional aids (interdental brushes, water flossers, tongue scrapers) as needed for individual needs.^[9]^[2]^[1]
Schedule professional dental cleanings and check-ups every 6 months or as recommended.^[2]^[3]

These core habits, reinforced by both the ADA and the American Academy of Periodontology, are strongly associated with good oral and periodontal health and prevention of gum disease.^[10]^[5]^[2]