Recently, an article was published in the Sydney Morning Herald discussing the lack of evidence to support the effectiveness of flossing. A number of patients have asked Jim and I what our views were so I thought this would be a good subject to address.
This sounds like a challenge to one of the most common pieces of advice that dentists give on preventing dental disease.
Flossing is difficult
Most people find flossing difficult and frustrating and that is because flossing is difficult and frustrating! However it is important to remember the reason why dentists advocate flossing. It is not because we enjoy making life difficult for our patients. The aim of flossing is to remove the plaque between teeth. Plaque contains bacteria which cause both inflammation of the gums and the fermentation of sugar into acids which cause cavities. If you were able to remove perfectly the plaque on your teeth every day then you would be able to prevent the vast majority of dental disease…and put us out of a job. How easy is that! In reality this is difficult thing to achieve and my job is fairly secure, at least in the forseable future.
I am not surprised that there is a lack of evidence to support the efficacy of flossing. The same can be said for many commonly held beliefs and medical practises. This does not mean that removing plaque is not a good idea. It’s just that most of us are not very good at it if we rely solely on floss. The relatively recent development of improved interdental brushes such as Picksters™ has made that goal of effective plaque removal much more easily achievable.
Regarding the claim the flossing can occasionally do harm by damaging dental work . I feel confident in telling my patients that if floss dislodges a filling that is a good thing beacause the filling was not sealing the tooth properly and was in urgent need of replacement. Discovering such problems promptly can prevent a lot of damage by recurrent decay.
As for the concern regarding “bad bacteria” invading the bloodstream that is a much more worrying issue. The risk posed by these bacteria is real and is indeed the reason that it is so important to control the build up of plaque on the teeth. Some of the bacteria associated with advanced periodontal disease are very “bad ” indeed. At the very least they result in chronic inflamation that has been implicated in a wide range of systemic diseases. At worst they could colonise the surfaces of heart valves or artificial joints and cause serious problems. The way to minimise this risk is to remove the bacteria by scaling the teeth [sometimes under antibiotic cover] and then to institute careful daily cleaning to prevent recurrence.
So is flossing a waste of time? Well yes and no! My advice is to remove the plaque between your teeth once every day, use interdental brushes wherever you can and use floss for the tight spaces.