To Floss or Not to Floss – That is the Question
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Every dental website I’ve seen on the Internet praises the virtues of flossing and the necessity of doing it daily.
To be up front with you from the beginning, that is also my opinion, but as often as is the case, there are two sides to this story.
So, with the best interest of providing you with the full story, here is some information you probably have not seen before.
I was first alerted to this body of contrary opinion by an article in the Harvard Health Blog The author, Robert H. Shmerling, MD, points out that the evidence supporting flossing turns out to be surprisingly thin according to the health experts who developed the Dietary Guidelines for Americans, 2015-2020..
The 2010 edition of the guidelines included this sentence:
“A combined approach of reducing the amount of time sugars and starches are in the mouth, drinking fluoridated water, and brushing and flossing teeth, is the most effective way to reduce dental caries.”
But, the latest edition leaves that sentence out.
I’m sure you are shocked to hear that, unless you are one of the 14% of people who say they would rather clean the toilet than floss every day.
So what caused the eminent authors of the guidelines to take such a radical step?
Well, it seems they could not find convincing evidence to support flossing.
According to reviews of the evidence published in 2011 and 2015, there is minimal, short-term, and generally unreliable evidence that flossing might reduce gum inflammation, and no convincing evidence that it promotes plaque removal or prevents tooth decay or dental caries (cavities).
(These guidelines are issued every five years by the U.S. Department of Health and Humans Services and the U.S. Department of Agriculture “…to reflect the current body of scientific evidence on nutrition, food, and health.” )
So, is the lack of evidence for flossing good enough to stop you flossing?
Shmerling notes several eye-grabbing headlines regarding this development, including:
- “Feeling Guilty About Not Flossing? Maybe There’s No Need” (New York Times)
- “Guilty No More: Flossing Doesn’t Work” (Mother Jones)
- “A big problem with flossing” (CBS News)
No, don’t stop flossing, stop to look at the evidence. . There’s a saying in the science world that “absence of proof is not proof of absence.” To put it another way, just because the evidence isn’t there, doesn’t mean the concept is wrong. Unproven is unproven, not disproven!
Could it be that these headlines are just sensationalising a legitimate doubt that has no more evidence to support it than the opposite point of view?
The experts who removed the flossing recommendations from the dietary guidelines did not find flossing was useless. They only found that flossing had never been well-studied and that the evidence to date was inconclusive.
If a person has gum disease, flossing might be important for their oral health. Flossing is low-cost, low-risk, has potential and biologically plausible health benefits he says. Shmerling concludes that it may be premature to conclude it is useless. In fact, it may very well be a good idea just waiting to be well-studied.
So, back to our question; to floss, or not floss?
As you will see in our article on Flossing and Brushing there are good reasons to floss and that is supported by almost every dentist around the world. Maybe it’s just time that the relevant research institutes conduct some in depth research into the health impact of flossing.
With a well-funded, well-designed study, it may be easy to prove that flossing is good for your oral health, and I would not be surprised if it turned out to be good for you in other ways, since gum disease has been linked to an increased risk of cardiovascular disease, diabetes, and stroke.
I’m not going to wait for the research; I’m going to keep flossing. I hope you do too.