Flossing: The Ancient Ruse?

For ages, flossing has always been preached as the savior of tooth decay.  Growing up with a dental hygienist mother, I endured the embarrassment of being sent to school with a toothbrush and floss in my lunch bag.  My teachers were instructed to make sure I brushed and flossed after lunch and before I went out for recess.  As utterly and completely embarrassing as this was as an adolescent, I have never had a cavity and I am very proud of that.

There was a study conducted that garnered much press this last year about the benefits of flossing (or the lack thereof, according to this study).  In August 2016, the NY Times published an article on the topic stating:

“..the American Academy of Periodontology acknowledged 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.”

The revelation has caused a stir among guilt-ridden citizens who strive to floss daily but fall short of that lofty goal. Among experts, however, it has been something of an open secret that flossing has not been shown to prevent cavities or severe periodontal disease.

A review of 12 randomized controlled trials published in The Cochrane Database of Systematic Reviews in 2011 found only “very unreliable” evidence that flossing might reduce plaque after one and three months. Researchers could not find any studies on the effectiveness of flossing combined with brushing for cavity prevention.

“It is very surprising that you have two habits, flossing and tooth brushing without fluoride, which are widely believed to prevent cavities and tooth loss, and yet we don’t have the randomized clinical trials to show they are effective,” said Dr. Philippe Hujoel, a professor of oral health sciences at the University of Washington in Seattle.

The American Dental Association’s website says flossing “is an essential part of taking care of your teeth and gums.” Last year, Dr. Edmond R. Hewlett, a spokesman for the group and a professor of restorative dentistry at the University of California, Los Angeles, said, “We’re confident that disturbing the bacteria in plaque with brushing and flossing is, indeed, beneficial.”

Actually, that is only half proved: Brushing with fluoride does prevent dental decay. That flossing has the same benefit is a hunch that has never been proved.

If it is any consolation, there is some mediocre evidence that flossing does reduce bloody gums and inflammation known as gingivitis. That Cochrane review found that regular brushers and flossers had less gum bleeding than people who only brushed, although the authors cautioned that the quality of the evidence was “very low.”

Early gingivitis is a long way from severe periodontal disease. Still, some dentists argue that despite a lack of rigorous study, flossing matters if it can reverse initial gum problems.

“Gum inflammation progresses to periodontitis, which is bone loss, so the logic is if we can reduce gingivitis, we’ll reduce the progression to bone loss,” said Dr. Sebastian G. Ciancio, the chairman of the department of periodontology at the University at Buffalo.

Severe periodontal disease may take five to 20 years to develop.

“It’s a very insidious, slow, bone-melting disease,” said Dr. Wayne Aldredge, the president of the American Academy of Periodontology, who practices in Holmdel, N.J.

Even without rigorous evidence that flossing prevents late-stage periodontal disease, Dr. Aldredge urges his patients to floss. Those who quit are “rolling the dice,” he said.

“You don’t know if you’ll develop periodontal disease, and you can find out too late,” he said.

Maybe the evidence that flossing reduces tooth decay or gum disease does not hold up because we are all such poor flossers. Superflossers, like the zealous hygienist at your dentist’s office, aim to “hug the neck of the tooth” and get below the gum line, Dr. Hujoel said.”


What’s my take and what’s the bottom line? 

Brush your teeth twice a day with fluoride and floss once a day.

Will flossing ever cause harm? 

No.  And if there is any chance that it is beneficial, then I say go for it.  There is no replacement for your teeth and if you can do anything extra to save them, why wouldn’t you?  There are also other adjuncts such as gum stimulators, floss picks, water picks, proxy brushes or go-betweens, superfloss, and the list goes on.  Oral hygiene should be tailored to each person’s specific needs.  This is always open for discussion and should be reviewed with each hygiene visit as needed.

Countless times with my elementary school talks, I have asked the question, “Can a toothbrush get in between your teeth?”  No.  Only floss can get in between your teeth!  I wasn’t fibbing then and I will continue to tell this to help prevent caries and form good oral health care habits.  Until there is more research completed with a larger patient population and results collected over a longer time span, I do not think the risk is worth any gain.

Want to talk more?

Give our office a call at 949-396-3803 and we would be happy to ponder the flossing question to your heart’s delight.

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