Brushing your teeth, rinsing with mouthwash, and flossing daily have been the cornerstones of the dental home care regimen, preached by dentists and hygienists to their patients for years and years.
Despite this, over a third of Americans say that they never floss! According to a study reported by CNN, 37.3% say that they only floss occasionally and about 30% of people say that they flossed in the past week.
A new report, released by the Associated Press, stated that there is no evidence that flossing has any effect on oral health. The report further states that there has never been a peer-reviewed study that definitively proves that flossing matters!
The study most often cited by both critics and skeptics about the effectiveness of flossing and toothbrushing is the Cochrane Study of 2011. This study did credit floss with a slight reduction in gum inflammation (3-5%), which can sometimes develop into full-fledged gum disease. The authors’ conclusions were as follows:
“There is some evidence from twelve studies that flossing, in addition to toothbrushing, reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.”
The admitted “downfall” of the study was the limited sample size used in the 12 studies under the Cochrane Report. The total sampling for flossers and brushers was 512 people, while the total sampling pool for the brushers was only 501 people. Spread out over 12 different studies, the true sampling, though interesting, has really been deemed to be too small of a sample to be statistically significant. Even the American Academy of Periodontics (AAP) said that
“most of the current evidence fell short because researchers had not been able to include enough participants or examine gum health over a significant amount of time.”
Regardless, dentists and hygienists remain adamant that all Americans should floss daily. Just going a couple of days without flossing will cause enough plaque buildup between the teeth, and over time, the plaque hardens into tartar, which can only be removed by a dental hygienist or dentist. Brushing and rinsing with mouthwash can only remove a fraction of the plaque buildup on teeth, and very little between the teeth, which is where decay and gum disease problems start and flourish.
Most other studies have only been “short-term” tests, similar to the Cochrane results with small sample sizes, and are far too brief for a cavity or gum disease to develop.
“If you use your toothbrush with floss, it’s not more effective than toothbrushing alone,” said Fridus Van Der Weijden, a University of Amsterdam dental school professor who focuses on the prevention of periodontal infections and co-authored two of five often cited reviews on flossing research.
ADA spokesperson Dr. Matthew Messina acknowledged the poor quality of the research supporting dental floss; however, he maintains that flossing is still an effective way to remove food from between the teeth.
“We need to remove bacteria from the teeth, from the gums, and from in between the teeth.”
Messina went on to point out that there aren’t a lot of research dollars allocated for preventative measures that doctors already know are effective.
“There’s only so many research dollars and so much research effort. So not a lot of effort has been put into the study of dental flossing, just simply because there are other more important things for us to do.”
“Nobody’s done a study to say that using a parachute jumping out of an airplane is safer than not using a parachute. I’m still going to use a parachute because we just know that that’s going to work. It’s all about putting it into perspective.”
Bacteria that cause gum disease and cavities hide in the area between the teeth and under the gums. Your toothbrush can not reach between teeth, and can only extend a small amount under the gums. Flossing is the best way to get between your teeth and under the gum, what the dentist calls “the sulcus.”
If the plaque hardens in the sulcus, it becomes tartar, or what dentists call “calculus.” This isn’t the same calculus you may have struggled with in high school. But it is a struggle to remove from your teeth. It harbors bacteria and causes the gum to be irritated and then infected.
This infection causes the gums and bone to recede around the teeth, teeth to become loose, and your breath to become noticeably bad.
But there are other diseases that are associated with gum disease. Did you know Alzheimers’, heart disease, and diabetes are all associated with and worsened in patients with gum disease? In pregnant women, gum disease is linked to preterm labor and low birth weight.
The bacteria in the plaque and tartar harbored in the mouth has appeared in the patient’s bloodstream and attached to heart lining. This is just one example of how gum disease can cause other diseases to worsen!
So, what is a dental patient to do?
Dentists have always preached regular dental hygiene appointment. For many people, especially younger folks, twice a year is a good regimen to visit the hygienist. But for many older patients, or patients who have a lot of dental work (crowns, bridges, fillings, or implants), a more frequent re-care regimen is best—maybe every three months, to keep from developing problems. Most people who have had a history of gum problems and treatment really need to visit the hygienist every three months.
But no matter how often you visit the dentist and hygienist, what you do at home in between appointments is more important. Your daily regimen!
And your daily regimen has to include complete cleaning and plaque removal between your teeth at least once a day. You see, plaque hardens in your mouth over a period of 24 hours. Then, only the hygienist can remove the tartar from your teeth. So, expert flossing once a day is mandatory to remove the plaque between your teeth.
When we say “expert flossing” we mean using the proper technique. Wrapping the floss around the teeth, and manipulating the floss under the gums is the correct way to do this.
Are there any alternatives to flossing?
Waterpiks are a pretty good alternative. We all remember Waterpiks—given to kids who had braces “back in the day.” Still a great tool for kids with braces, but it can be an important adjunct to your homecare regimen. Dr. Messina, from the ADA, agrees that using Waterpiks can be a good adjunct to oral care.
Sonic toothbrushes say that they can clean between teeth, too. Like Waterpiks, they can be a good adjunct to a home care regimen, especially for younger people.
But the gold standard is still flossing, regardless of what the AP, the government, or even Hillary or Donald say!
Here are some dental hygiene products you may find helpful (being listed below is not an endorsement – The TDWI Team):