Yes, Keep Flossing

Earlier in the month this New York Times article was published and caused quite a bit of controversy in both the dental community and with the general public. While it is not conclusive in its findings, the overarching claim is that flossing may not be as beneficial as once thought. As dental professionals, we take very seriously the responsibility we have ensuring our patients receive the best possible education and care regarding the health of their smiles; for this reason, we feel compelled to say a few words as to why we disagree with the suggestion flossing may be overrated, and why that’s a harmful position to propagate.

We would first like to point attention to the fact that the article uses a lot of language such as the following:

  • “…flossing may be
  • “…most of the current evidence fell short…”
  • “That flossing has the same benefit is a hunch that has never been proved.”
  • “…there is some mediocre evidence that flossing does reduce bloody gums and inflammation known as gingivitis.”

To summarize the point we are trying to make: there is a stark difference between something ‘not having been proved’ and something being ‘disproved’. Additionally, there is no evidence remotely close to suggesting the latter; in fact whether the evidence is “mediocre” or not, the only evidence the article does mention is in favor of flossing! Dr. James G. Wilson, past president of the Florida Association of Periodontitis, responded to the claims most poignantly:

“When the US government removed flossing from its 2015-2020 Dietary Guidelines, it did so because the strength of the studies regarding the effectiveness of flossing were admittedly weak. They were generally short-term with a small number of study participants due to the cost of running high quality scientific studies. It makes sense that companies that sell dental floss and Universities are not going to pay hundreds of thousands, if not millions, of dollars for large scale studies lasting many years to prove what most dentists and patients took as truth. Because long term studies are so expensive, dentists have, for years, extrapolated from shorter term ones that the buildup of plaque and increased level of inflammation that occurs when patients do not floss can, in a susceptible individual, lead to an increased amount of cavities and gum disease. These extrapolations are reinforced by what we see in our patients daily.”

We reinforce his statements (which we encourage you to read in full here), and we again cite the line “…there is some mediocre evidence that flossing does reduce bloody gums and inflammation known as gingivitis.” Gingivitis is the first stage in periodontal disease – the very condition flossing aims to combat. To reduce gingivitis is to reduce your chances of progressing into advanced gum disease, a condition more than half of Americans already suffer from (CDC). We do not agree with the article’s brash call to action, or more accurately, call to inaction, and we fear how this may increase the number of people inflicted with preventable damage to their smile.

It is unfortunate the scale of damage this article has the potential to incite; too many readers will take this “lack of evidence” as being evidence to the contrary, and feel it gives them permission to neglect a very essential part of their oral health care. Dr. Wilson expressed this concern as well, suggesting “Unfortunately, many who read this article will use it as an excuse to justify not cleaning between their teeth. The long-term result for many, but certainly not all, will be an increased level of dental diseases, potential pain, and increased costs” (Wilson). Neither Dr. Wilson nor our practice can better educate the entire readership of the NYT article, but can only encourage our patients to remain as committed to flossing and overall oral care as they always have been.

We hope this blog keeps our patients educated and on the path to a lifelong happy and healthy smile – a path that certainly includes consistent flossing.

South Florida Center for Periodontics & Implant Dentistry

3020 North Military Trail, Suite 200
Boca Raton, FL 33431

CDC: "Periodontal Disease." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 10 Mar. 2015. Web.

Wilson, James G. "Dr. Wilson Response." Facebook. N.p., 4 Aug. 2016. Web.

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