Yes, Flossing is Still a Really Good Idea

The media is quite a powerful force.  Many news outlets have recently covered a story stating that the medical benefits of flossing are unproven.  Here you will find a real dentist's thoughts and opinions, written from a clinician's perspective.  I do not conduct clinical research, although I do treat patients daily, and from that view I have the ability to observe real-world trends that make a positive or negative impact on an individuals health.  Simply put, patients that floss regularly absolutely have less gum inflammation, less plaque/tartar accumulation and less cavities or major dental issues than patients that do not.  So lets break down what is going on here:

Every five years the U.S. Department of Health and Human Services releases a publication outlining their recommended dietary guidelines for Americans.  In their latest addition, flossing has been removed as a recommended practice.  The Associated Press then reported on this missing guideline last Tuesday.  The government has since responded stating the reason for the removal of the recommended practice is that there has never been a "high quality" extended (longer than about two weeks) research study published that demonstrates flossing is both effective in plaque removal and definitively prevents periodontal (gum) disease.  Regarding this fact about research, the government is correct, long term well designed studies on the benefits of flossing are lacking.  I wonder if there are any long term well designed studies on the effectiveness of face washing or bathing, but it sure feels good doesn't it?  Additionally, one of the AP reviews stated "The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal" - I interpret this statement as "floss may not be doing enough, but plaque definitely exists" This is great, because I can tell you that the sticky stuff does exist.  So I think this is a good place to explain what plaque/tartar is and why it is a good idea to remove that stuff daily and keep on flossing.  

Plaque is simply a film on your teeth that bacteria produce by thriving off of the carbohydrates in the foods that you eat.  The by-product of the bacteria consuming the carbohydrates in your diet is acid.  That acid buildup damages your enamel and causes tooth decay.  (please also note that acidic foods and beverages can also directly damage teeth and initiate cavities without help from bacteria)

At this point good daily brushing and flossing habits can remove most of this plaque.  Although, if you neglect your routine (or neglect your regular dental visits to allow the dentist to remove that plaque you have missed) it will allow time for the bacteria bio-film to mature, and your saliva (which contains minerals such as calcium) will harden that plaque into tartar (dentists call this calculus).  This stuff is tough and definitely requires the use of special dental instruments to remove.

Now all of this junk sitting on your teeth is recognized as a foreign invader by your body's immune system, and your body will respond by trying to fight its presence with inflammation.  Your gums will swell and bleed easily and if not caught early and removed regularly, that constant inflammation will cause bone loss around your teeth, gum disease and eventually tooth loss.  

In the big picture this disease process is complex - bacteria type, family history of gum disease, diet, and and oral hygiene all play roles in determining how severe gum problems can get, floss is not the end-all.  But, as far as I'm concerned, manually cleaning out those spaces in-between with a length of string daily just puts another tool in your belt to keep plaque/tartar levels down and help prevent bigger problems.  So America, keep on flossing, and ask your dentist how to do it properly and maybe someday we can call it effective...


Anthony J. Papinsick, DMD

Kansas Dental Center

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