I will admit it, I pretty much never floss. The days before my checkups at the dentist I will frantically floss in hopes that they won’t realize my lack of flossing and scold me. But despite my bad flossing habits, I’ve never had a cavity, so I started wondering if flossing actually makes that much of a difference.
The most recent addition of the dietary guidelines as stated by the Departments of Agriculture and Health and Human Services did not include flossing, which had previously been included, as a necessary action for your health. This is believed to have been left out because we don’t have enough scientific evidence to actually prove the health benefits of flossing, even though it’s a widely held belief that flossing is necessary to maintaining good gum and teeth health. But The American Dental Association still states on their website that flossing is necessary to maintain clean dental hygiene. This definitely made me, and many others, skeptical as to whether flossing actually matters, so I delved into some studies.
This study looked at the effects of professional flossing on children aged 4 to 13 years old. Six trials of 808 subjects were conducted, and the researchers stated that there was potentially bias involved, which is good to know and very important to keep in mind, although the bias and why there may have been some was not explained. The study concluded that professional flossing reduces the risk of cavities, and the addition of fluoride is particularly helpful. This study, although it is somewhat large, was stated as possibly biased and also bases its evidence on professional flossing. Most children and adults do not have a professional regularly flossing their teeth, so it would be a much more applicable study if the children had flossed themselves.
So I continued to search for studies that looked at self-flossing effects, and found two meta-analyses. This meta-analysis, conducted by The Cochrane Library, studied the results of twelve randomized control trials that examined the effects of just brushing your teeth versus brushing your teeth and flossing on adults’ dental hygiene (i.e. plaque and gingivitis). 1,083 participants made up the twelve total studies—582 in the flossing and toothbrushing group and 501 in just the toothbrushing group. Flossing plus brushing your teeth was shown to be associated with a decrease in gingivitis, but there was no statistically significant evidence that the addition of flossing reduced plaque. However, out of the twelve studies, the researchers thought that five of the studies could very likely be biased, leaving just seven that were believed to be well-conducted and therefore without bias. The studies also were relatively short term, so long-term problems related to not flossing like tooth decay was not able to be measured. But this meta-analysis also concluded that flossing is not scientifically supported, leaving me still wondering whether the benefits of flossing are real and as strong as dentists make us believe them to be.
Another experiment looked at various teeth cleaning techniques and their effect on plaque. After randomly assigning 156 healthy people to four groups: toothbrushing and rinsing with chlorhexidine and fluoride, toothbrushing and rinsing with cetylpyridiniumchloride and fluoride, toothbrushing and flossing, and just toothbrushing, the researchers found after 8 weeks that mouthwash was better than flossing or just brushing your teeth for decreasing plaque. The scientists concluded that mouthwash may actually be better for reducing plaque than flossing. So maybe using mouthwash is really the solution, and for lazy me that seems like a much better solution to flossing. But once again, this study was relatively small and short-term, so I wouldn’t make any rash decisions based off of the results.
The American Dental Association, in addressing the recent published reports of the lack of effectiveness of flossing, stated that just because there isn’t strong evidence doesn’t mean that flossing is actually ineffective. They want the public to know that dentists know best because they know each patient individually. They also state that just because flossing was dropped from the 2015 US Dietary Guidelines doesn’t mean that people should stop flossing, it just means that the committee decided to focus on food consumption’s effects on tooth decay, especially sugary foods. They still recommend brushing twice a day, flossing once a day, and going to regular dental checkups. The ADA also contended that self-reported flossing is not reliable data, as people do not always tell the truth about their flossing habits. I can definitely agree with this, as I used to lie to my dentist all the time about how frequently I flossed so they wouldn’t yell at me.
So based on these studies, I can’t say that flossing is effective or ineffective. The results that conclude that flossing does not lead to a decrease in plaque and gingivitis may be true, but they also may be biased because of the way data was collected, because many people do not floss correctly, or because of various other factors. I would advise myself and everyone else to just floss, because it only takes a little bit of time and it definitely doesn’t have a negative impact. And swishing around some mouthwash is definitely a good option too. It’s better to look after our teeth now than to find twenty years down the line that our teeth are going to fall out (extreme, I know, but wow what a nightmare!).