A recent article from the Associated Press has stimulated much interest about whether flossing really works.
Can we finally stop doing what our dentists and hygienists have been nagging us about all this time?
Well, it turns out there really isn’t that much scientific evidence to support flossing directly.
However, our focus should actually be on removing plaque. There is an extremely strong body of evidence that plaque contributes to both tooth decay and periodontal disease, or bone loss. When we look at the effectiveness of floss, toothbrushes, regular professional cleanings and so on, we have to think about it in the context of plaque removal and keeping teeth and other oral structures clean.
Bacteria, some of which damage teeth and the supporting structures, live in dental plaque. If we reduce the amount of plaque, we reduce the total numbers of potentially pathological bacteria. So when we keep our mouths as clean as possible, we are much less likely to suffer from oral disease.
To do this effectively, sometimes we need to use all the tools in the toolbox — including floss.
Suggesting that floss is always good for everyone, or always bad for everyone, can never be accurate. Everyone is different. Our oral health care providers should give us individualized recommendations based on our unique oral conditions.
Students and faculty at the Oral Health Center, UNE College of Dental Medicine’s clinical facility, treat thousands of patients of all ages with very different needs. For example, a 3-year-old child with crowded teeth would need help from her parents to floss because teeth that are tight together trap food and plaque more easily. Another 3-year-old child who has spaces or gaps between the teeth may be able to remove most plaque with simply a toothbrush. An older or special needs patient with limited movement may struggle to use floss or a toothbrush, so occupational therapists often assist dentists to devise ways to help them clean their teeth.
We also must remember that a lack of scientific evidence does not necessarily equate to a lack of effectiveness.
The Associated Press article implies that the U.S. government no longer supports flossing and has removed flossing from the 2015 U.S. Dietary Guidelines because of a lack of evidence. The Dietary Guidelines have no bearing on the longstanding recommendations from the Surgeon General, the CDC and other health agencies to continue regularly using floss. In fact, the U.S. Department of Health and Human Services reaffirmed the importance of flossing in an Aug. 4 statement to the American Dental Association.
“Flossing is an important oral hygiene practice,” it states. “Tooth decay and gum disease can develop when plaque is allowed to build up on teeth and along the gum line. Professional cleaning, tooth brushing and cleaning between teeth (flossing and the use of other tools such as interdental brushes) have been shown to disrupt and remove plaque.”
We strongly advocate for the use of all proven and effective methods for removing disease-causing plaque. That includes the regular use of floss. Ask your oral health care provider what they recommend for you.
Jon S. Ryder, DDS MS, is dean of the College of Dental Medicine at the University of New England.