The silly season is in the month of August when the news feeds dry up and the media are reduced to publishing ridiculous stories. Bang on cue, in early August, Associated Press, a US news agency, reported that flossing is not supported by evidence. Check out the story for yourself here.
This was picked up by the mainstream media in the UK and by August 3rd it was everywhere. I must say I was disappointed at the way this story was handled. An American reporter had decided to investigate why flossing is recommended and discovered there is no scientific evidence to support this. The reporting style suggested that this was equivalent to a major scientific breakthrough.
But the truth of the matter is that there is no scientific evidence for flossing because it would be extremely hard to gather. I certainly wouldn’t want to be part of a study where people were being told not to clean their teeth in order to gather evidence and prove a point.
Treating patients as individuals
Meanwhile, there IS evidence to support the use of interdental brushes. I always recommend interdental brushes, especially for patients with spaces between their teeth. But for those with negligible space between their teeth or narrow mouths, flossing is effective at cleaning between the teeth. For these patients, floss is the only way to get into the narrow spaces. Just because there is no evidence to support flossing should not mean you don’t floss!
In early August, dental patients around the country were calling in to check with their dentist or hygienist whether they should carry on flossing. My answer to my patients was yes. Older patients or those with narrow mouths find interdental brushes difficult. Anecdotally, I KNOW floss works! Achieving dental health is about eliminating risk factors. And the main risk factor is plaque bacteria so we need to get into all the little nooks and crannies and disturb the bacteria. Floss, superfloss, tufted floss, flossette, interdental brush, airflosser, waterpik- all can be effective and should be used regularly.
My recommendations
Teeth have five surfaces and brushing alone is not enough as it only cleans three surfaces. I recommend floss/flosspick/flossette to people with healthy interdental papillale (the triangle-shaped bit of gum between teeth), brushes (eg. tepe, interprox) for larger embrasure spaces.
But this news story has been taken very seriously and we are told that Public Health England (PHE) is to review the guidance on flossing.
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I leave the last word of this blog to Wayne Aldredge, a prominent American dentist who said that while the evidence for flossing is weak, it’s still relevant. ” It’s like building a house and not painting two sides of it” he said. Ultimately, those two sides are going to rot away quicker.†Or as I say to my patients, only clean between the teeth you want to keep!
