Fingernails. Pieces of paper. Safety pins. Strands of hair.

When appropriate tools aren’t around, Americans resort to using some common, however unusual, items to remove that piece of food stuck between their teeth, according to a national survey conducted by Ipsos.

The survey of 1,005 adults, released in October, found that most Americans say they have used the following items to remove food between teeth: fingernails (61 percent), folder paper or cards (40 percent), cutlery (21 percent), safety pins (14 percent) and strands of hair (7 percent).

In addition, the survey, conducted on behalf of Waterpik and in consultation with the ADA, found that 63 percent of the surveyed adults admit they know better than to use those items in comparison to dental picks, interdental brushes, floss and water flossing tools. Also, 42 percent say they’ve felt pain as a result of removing something in their teeth when using those unusual items.

Additionally, results from a separate ADA member survey echoes the findings from the public survey. ADA member dentists reported that patients have told them they’ve used unsanitary - and unsafe - items to clean between their teeth, including: twigs, toenails, matchbooks, loose electrical wires, screwdrivers and pocket knives.

These findings highlight the importance of flossing and the need for ADA members to talk with their patients about cleaning between their teeth daily with appropriate items to remove food debris that can cause plaque build-up, which can lead to dental decay, gum sensitivity and bad breath.

“It’s really easy to use clean and safe items on-the-go and at home - like string floss, dental picks and water flossers,” said Dr. Brittany Seymour, ADA spokesperson and assistant professor at Harvard School of Dental Medicine, in a news release.

“The key is finding what works best for you to stick with every day,” she said. “If you’re not sure, start by looking for products with the ADA Seal of Acceptance. That way, you know it’s safe for your teeth and will get the job done, removing germs rather than introducing them.”

According to the survey of the public:

• Sixteen percent said they always floss at least once a day.
• Twenty percent said they only floss when they need to or when something is stuck in their teeth; and 8 percent said they simply never floss.
• The biggest reason reported for not flossing among those who do not floss at daily is because it’s too time consuming (55 percent). Another 16 percent said it was too painful and 9 percent said they find it gross.
• Forty-four percent of those surveyed admit they have exaggerated to their dentist about how much they floss when asked.

Dentists can recommend products with the ADA Seal of Acceptance to their patient because they have been shown to be both safe and effective. ADA-accepted manual interdental cleaners include traditional string floss and wooden plaque removers. Last February, Waterpik Water Flossers became the first powered interdental cleaner to earn the ADA Seal of Acceptance; and their battery operated lines earned the Seal earlier this month.