To Floss or Not to Floss?

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Ann Clark, RDH
To Floss or Not to Floss?
Since the Feds removed flossing from their dietary guidelines I still get a lot of patients asking if they really need to floss.  The answer is simple:  only the floss the teeth you wish to keep.  How did something so basic and assuredly easy to understand become the subject of debate?  Does anyone really believe that after years of hearing your hygienists request you to floss that we had it wrong?  No.  It is one of the most universal recommendations in all of public health.
So, how has this happened?  Why would the Federal Government remove a guideline so firmly endorsed by the American Dental Association?  The Associated Press reported that the Federal Government removed the recommendation to floss from its dietary guidelines which was first recommended by them in 1979.  Long story short: when asked, they reported that the research supporting its effectiveness didn’t meet their standards.  Any recommendations recommended in its guidelines must, by law, be based on scientific evidence.  They focused on 25 studies over the past decade.  They found the evidence to be “weak/very unreliable”.  The studies sadly used outdated methods or tested too few subjects.  Some lasted only two weeks, too short for a cavity or dental disease to manifest.  One, actually tested people after a single use of floss.  The research focused on warnings signs like bleeding and inflammation, not dealing with gum disease or cavities. Unfortunately there just hasn’t been any great research done on flossing and it’s effects.  There is not only a lack of research done in this area but also it’s actually a difficult subject to produce clear research on for a number of reasons.  So, weak scientific evidence and brief duration of studies has gotten us into this mess.  When the Associated Press failed to get the research to back their recommendations and kept pursuing it…the Feds gave in and removed it from their latest guideline postings.  It’s respectful that they require evidence-based research, and until someone does the work, it just is what it is.
As a dental hygienist of long-standing who sees the difference of a flossed mouth and  a non-flossed mouth on a regular basis, I highly recommend flossing.  Regular flossers can attest to changes in their oral health for the better.  24 hours a day we build a fuzzy film of plaque bacteria in the mouth.   Above the gumline we can clear them with a toothbrush on 3 of the 5 sides of your tooth.  These bacteria also grow below the gumline where the toothbrush can not reach.  Then, let’s say you have deeper pocket depths, places for bacteria to hide?  And what about the 2 sides of the tooth where teeth touch?  How will you get those cleaned?  What small, flexible aide would make sense to use under the tissues to remove that thicker, smelly film?  Unremoved plaque is known to cause redness and inflammation.  Unremoved debris after a period of time lets those conditions fester away eventually eating its way to the bone and subsequently:  causing boneloss…the root of periodontal disease.
The American Dental Association still recommends that you floss.  Regular flossers can attest to changes in their gum health and tooth health.  There are just common sense benefits to flossing.
Questions that I have heard:
     -Can I just use my water pick? ( Or water flosser?) This is another great aide but does not replace floss.  Plain and simple the bacteria on your tooth above the gumline are mechanically disrupted by the motion of the toothbrush.  You need the same between the teeth and below the gumline.  Floss is small enough to go under the gum and extend down the side of the tooth, bend into a “C” shape, stay tight against the tooth structure and physically disrupt the plaque in it’s formation.   Also the very small spot where the 2 sides of your tooth touch together is usually the exact spot where cavities form.  The only way to clean it?? Yes! With floss.   Always floss in conjunction with this great aide.
     -Do I still have to floss?  Lack of strong evidence does not equal lack of effectiveness.
The dept. of Health and Human Services reaffirms the importance of floss in an August 4th statement to the ADA.  “Flossing is an important oral hygiene procedure.  Tooth decay and gum disease can develop when plaque is allowed to build-up on the tooth and along the gumline.  Professional cleaning, tooth brushing and cleaning between the teeth (with aides) have been shown to disrupt and remove plaque.”
Sources:
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