To floss or not to floss? Dentists weigh in
A report stating that there’s evidence that flossing is not an effective oral hygiene technique has annoyed many in the dental community.
For those in the medical community, there are some things you just accept without question.
“If someone comes into an emergency room and they’re bleeding heavily, you don’t need research to tell you that you need to stop the bleeding,” says Dr. William Nash, a dentist in Fairfield.
Among those in the dental profession, advising patients to regularly floss their teeth isn’t as much of a no-brainer as staunching a bleeding wound, but it’s close, says Nash, immediate past president of the Connecticut State Dental Association. “I’ve seen the positive results that come from good oral hygiene again and again and again,” he says.
That’s why he was floored by a recent Associated Press report that stated there was not enough evidence that flossing works. According to the report, last year the AP asked the departments of Health and Human Services and Agriculture for proof of flossing’s effectiveness.
Eventually, representatives of the federal government sent the news organization a letter acknowledging there was no research into whether flossing works. The government also removed a recommendation on flossing from its latest dietary guidelines.
The American Dental Association quickly responded to the report, with a statement saying that “a lack of strong evidence doesn’t equate to a lack of effectiveness. As doctors of oral health, dentists are in the best position to advise their patients on oral hygiene practices because they know their patient’s oral health status and health history.”
The association statement also took issue with the implication that removing the flossing recommendation from the dietary guidelines meant the government has changed its stance on flossing, saying, “this is simply not the case. The Dietary Guidelines Advisory Committee made a deliberate decision to focus on food and nutrient intake.”
Flossing — the act of threading a piece of string called floss between the teeth to remove plaque, stuck food and bacteria — has been recommended by the federal government for more than 40 years. The American Dental Association maintains cleaning between teeth removes plaque that can lead to cavities or gum disease.
The AP report looked at 25 studies that compared the benefits of toothbrushing alone with the benefits of brushing combined with flossing. Investigators reportedly found evidence that flossing works was weak in most of the research they examined. The report has irked many dentists, including Nash, who fear the possible impact. “People may use it as an excuse not to floss,” he says.
Nash admits good research on flossing’s benefits isn’t abundant, but he’s seen plenty of evidence with his own eyes to believe it works.
Another expert had a more pragmatic reaction to the report. Marcia Lorentzen, dean of the University of Bridgeport Fones School of Dental Hygiene, calls the flossing report “a shocker.” However, she says even dental professionals know flossing is not the be-all and end-all of dental care.
“A piece of string can get between teeth, but it can’t get everything,” Lorentzen says. “The spaces between people’s teeth are different, and the lengths of their teeth are different,” so flossing likely won’t work equally well for everyone.
Despite flossing’s limitations, Lorentzen does advocate cleaning between the teeth, using either floss or another method. “Some of my patients say, ‘I don’t want to put my fingers in my mouth. Can I do something else?’” she says.
Both she and Nash say yes. Waterpicks will work, as will an interproximal brush, a tiny brush with rounded bristles that can fit between teeth. Both are widely available. “Basically, almost anything that gets between the teeth is going to help,” Nash says.