Who ties dental floss after it is inserted into the inter-proximal spaces?

Dental floss is typically tied by the person using it, often the patient or their dental hygienist. After inserting the floss into the inter-proximal spaces between teeth, it may be tied in a knot or loop to help facilitate cleaning. This technique can enhance the effectiveness of plaque removal in hard-to-reach areas. However, many people simply use dental floss without tying it, relying on the tension and maneuverability of the floss itself.