Keep Flossing: It Isn't If You Should Floss, It's How You Floss

Recently, the Associated Press reported that due to lack of research, flossing isn't necessary and therefore had been removed from federal government dietary guidelines as of last year. However, a lack of research does not equate to the effectiveness of flossing.  Flossing is difficult to study per federal regulations as they require evidence be obtained via strict clinical trials. Such trials have quite rigorous requirements, and they quickly become very costly. They must have a control group, and they must also be single- or double-blind, over a substantial period of time. Furthermore, in the case of flossing, there are also ethical implications the investigator would have in telling subjects not to floss for a period of time despite having buildup between teeth. So there is health risk or cost these subjects could suffer from not taking care of their teeth and gums.  Little wonder then that they weren't able to find a substantial body of flossing research that met these guidelines. The question, then, shouldn't be whether  or not to floss, but instead should be how to floss effectively. Asking the question “is flossing effective” is just like asking if brushing your teeth is effective – are you doing it correctly and with an effective toothbrush? Brushing versus flossing – Brushing only covers about 65% of teeth surface area. In order to disrupt plaque and debris buildup from in between teeth, an interdental tool, such as floss, must be used to clean the remaining 35% of teeth surface area. The effects of not removing all such debris can be quite harmful to teeth and gums down the road. Poor gum health also can lead to a myriad of other systemic diseases in the body. Effective studies still exist – While the AP and FDA may not feel there is a large enough body of evidence, there are in fact many other studies that show just how effective flossing is. In a recent study published in the Journal of Periodontology (aka the official publication of the American Academy of Periodontology), it was demonstrated that including flossing as a part of daily oral care can help reduce the amount of gum disease-causing bacteria in the mouth. Participants were 51 sets of twins between the ages of 12 and 21. The study randomly assigned one twin to just toothbrushing and the other to both toothbrushing and flossing. At the end of the two-week trial, those twins that were flossing had a significant reduction in bacteria known to cause periodontal disease. The study said that "putative periodontal pathogens and cariogenic bacteria were overabundant in the group that did not floss compared to the group that performed flossing."  Bacteria included P. gingivalis and Streptococcus mutans, commonly known as 'strep'. With the comparison of twins, outside factors were minimized as much as possible. Choosing the right floss – The degree to which this harmful bacteria can be removed also depends on the type of floss used. Floss quality can have a significant impact on the effectiveness of flossing as a whole. In a study comparing Smart Floss to other leading flosses, it was found that Smart Floss® was up to 55% more effective than other flosses in the trial. Patients using Smart Floss® experienced up to 70% reduction in plaque removal. This is because floss that is not too thin or too slippery, such as Smart Floss®, is able to disturb and remove more plaque for the user. The study showed that in general, cleaning was proportional to surface area of the floss. Because Smart Floss® expands and covers more surface area when in use, it is thus most beneficial for removing harmful buildup and improving gum health overall. You can read more about this study and its summary of findings on the blog here.