The Flossing Debate and Why There Shouldn't Be One

The Flossing Debate and Why There Shouldn’t Be One

The debate about the merits of flossing all started last August with The New York Times. The prestigious paper ran a story that implied that it might not be necessary to floss to prevent tooth decay, gum disease, and bone loss. The dental community responded with a unified and resounding, “Yes, it is.”

The NY Times article referred to the latest dietary guidelines published by the Departments of Agriculture and Health and Human Services that excluded flossing in their recommendations. The Associated Press reported that the government agency dropped flossing because officials had never researched whether flossing truly helped in upholding dental health.

The American Academy of Periodontology (AAP) responded the same day. In their statement, they said:

“The American Academy of Periodontology recommends daily flossing as one part of a regular oral hygiene routine, which also includes brushing your teeth twice a day and ensuring you receive a comprehensive periodontal evaluation every year. The accumulation of plaque bacteria beneath the gum line may cause an inflammatory response which ultimately leads to gingivitis, a mild form of periodontal disease. If left untreated, periodontal disease can worsen, leading to tooth loss and increased risk for other systemic disease such as diabetes and heart disease. Flossing allows for the removal of plaque bacteria and debris from areas in the mouth that brushing alone cannot reach.”

The AAP went on to explain that flossing is a key element of an overall oral health plan, which includes brushing twice a day and a comprehensive dental evaluation at least once a year with a dental professional trained to diagnose and treat gum disease.

The AAP further addressed the reason there isn’t evidence to support the claims that flossing does benefit patients. The evidence needed would take a long time to gather, as gum disease progresses slowly over many years with other factors that influence its progression. Furthermore, legitimate evidence would require a sample from a vast and varied population with suitable indications of periodontal health.  None of the available evidence available today meets these requirements. However, the AAP also said that people should floss even without evidence of its benefits if for no other reason than it wouldn’t hurt.

The American Dental Association (ADA) also addressed the issue immediately after the NY Times article ran. On whether dental professionals should recommend flossing to their patients despite substantial evidence that proves it is effective, they said the following:

The first is to recognize that even in the absence of strong evidence, patients often look to the professional for guidance.  In this case, while the average benefit is small and the quality of the evidence is very low (meaning the true average benefit could be higher or lower), given that periodontal disease is estimated to affect half of all Americans, even a small benefit may be helpful.  The other side of the benefit-risk analysis is an absence of documented harms as well as minimal cost to patients.  Considering all this along with issues specific to the individual will allow the dentist to tailor an appropriate message for their patient.”

Why Do the Experts Love Flossing?

There are many benefits to flossing, per the experts. Among them are:

  1. The removal of harmful bacteria on surfaces of the teeth that a toothbrush cannot reach: You floss the sides of your teeth, where a toothbrush can’t go but the harmful bacteria can. These harmful bacteria, called biofilm or plaque, can cause decay on these surfaces.
  2. The prevention of inflammation in gum tissue: When you floss below the gum line, you remove any plaque that has made its way down into the spaces between the tooth and the gum. When you don’t, that bacteria flourishes down in the dark, moist environment, causing inflammation in the surrounding tissue. Dentists can see a difference in patients’ mouths who do floss and those who don’t.
  3. Reversing the effects gum disease has already made to tissues: Flossing can help gums heal even after inflammation starts. However, periodontal therapy will be needed in addition to more attention to flossing at home to eradicate the disease completely.

Despite these benefits, many people don’t floss the way they should. Moreover, many people don’t own up to it in the dentist chair. A study in 2015 revealed that 27% of adults in the U.S. lie to their dental professionals about how much they floss.

So why not floss? Many people think of flossing as a painful, unpleasant experience for them. In fact, 36% of the respondents in the study said they would rather do another unpleasant task, like cleaning the toilet, than floss their teeth.

However, experts agree that flossing should not be painful. Anyone who is experiencing pain after the first few times flossing is likely being too aggressive with the floss on their gum tissue. Dentists and hygienists are proponents of taking a different approach, advising patients to hug the tooth with the floss rather than sawing between the teeth.

For now, when it comes to the debate on flossing, the dental community agrees that there is no debate at all. Whether hard evidence exists to support it or not, the experts are in unanimous agreement that there is no downside to flossing, but plenty of downside to not flossing. You may have heard your dentist say it before: You don’t have to floss all of your teeth, just the ones you want to keep.

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