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For most of us, the importance of brushing and flossing has been deeply ingrained from a young age. Many of us feel guilty as adults for failing to floss every single day.
Flossing is one of the most common and accepted health recommendations. It is right up there with the importance of eating vegetables and drinking water.
Yet, how many of us have actually researched flossing?
We’ve been told to do it from such a young age that we assume its beneficial. But it it really as important as we’ve been told?
The internet is abuzz with debate after the recent publication of an AP article called “Medical Benefits of Floss Unproven.”
Despite the sensationalist headlines, the study didn’t conclude that flossing is bad, just that there may not be any scientific reason to do it. Let’s look at the actual research and see what science really says about flossing.
The Logic of Flossing
At first glance, flossing seems to make perfect sense.
Food gets stuck between teeth. Floss removes this food. Thus, flossing is good.
Unfortunately, it isn’t quite so simple. There is also the issue of bacteria in the mouth, between the teeth and in the gums. This bacteria is what actually causes cavities and gum disease. This is well-documented:
Streptococcus mutans is the main cause of dental decay. Various lactobacilli are associated with progression of the lesion. (source)
Bacteria Lead to Cavities and Gum Disease
It is generally understood that cavities and gum disease occur in this way:
- Plaque forms in the mouth when we eat sugars and fermentable carbohydrates.
- The plaque creates acid which leads to mineral loss on the surface of the tooth.
- In a healthy mouth, the saliva will replenish the minerals on the teeth and teeth will remain strong. This is also why diet is important, as the body must have enough minerals to supply saliva.
- If a person consumes sugars and simple carbohydrates regularly, the minerals on the tooth can’t be replenished each time. The plaque builds up and creates acid that maintains a low pH (acidic) environment in the mouth.
- This creates an optimal environment for bacteria like S mutans and allows them to take hold, eventually leading to cavities and gum disease.
Does Flossing Help Reduce Bacteria in the Mouth?
This is the important question when it comes to flossing. If the acid>sugar>bacteria equation is the reason for cavities and gum disease, stopping these bacteria is very important to avoiding problems in the mouth.
But does flossing help?
According to dentist Dr. Reid Winick, flossing is not effective at removing this bacteria, and it may actually make things worse! He explains that these bacteria in the mouth affect the body in many ways:
If these pathogenic bacteria grows out of control and enter our blood stream, they can be transported through the body and cause inflammation. Chronic inflammation of any source leads to chronic disease. Failing to take care of your teeth may set you up for a range of serious medical issues such as heart disease, diabetes, preterm birth delivery, alzheimer’s and even inflammatory cancers like breast and pancreatic cancer.
But that flossing won’t fix the problem. In fact, he argues that the idea is laughable:
Don’t be fooled, flossing is not the answer! To me, it’s common sense. How can you kill an infection with a piece of string, especially if it can’t reach the bottom of the pocket where the infection lives?
The Stats About Flossing:
- Approximately 98.4% of adults report to their dentist that they floss regularly when asked.
- Approximately 60.5% of those people are lying.
- Also, 68% of statistics on the internet are made up, at least according to Abraham Lincoln.
All joking aside, when you actually start looking at the research, the “well-documented” benefits of flossing don’t stand up to scrutiny. This doesn’t necessarily mean that flossing is bad or not helpful, just that it deserves a closer look.
A Closer Look
The recent article that examines the evidence for flossing does so because the most recent American Dietary Guidelines make no mention of flossing. In the past, flossing has been part of their recommendations, but were noticeably missing in the most recent updates.
So what happened?
By law, these guidelines must be based on well-documented scientific evidence. About a year ago, the Associate Press requested documentation from the Department of Health and Human Services and the Department of Agriculture about the benefits of flossing.
Instead of responding, the recommendation to floss was simply removed from the guidelines this year.
In other words, the government’s Dietary Guidelines for Americans no longer recommends flossing.
Research about Flossing
The Associated Press examined the actual research about flossing. They looked at 25 studies that compared brushing alone or brushing+flossing and found that there was very little evidence for flossing with a large potential for bias.
The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year. Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy.”
In fact, in recent years, several reviews have looked at the available research about flossing and attempted to determine if there was a benefit or not:
Recent Studies & Reviews
- The first review looked primarily at children up to age 13. This review determined that children who had their teeth flossed by a trained dental hygienist at least five times a week noticed a 40% reduction in cavities and gum disease. Unfortunately, this reduction was not present in kids who flossed on their own. Since most of us don’t have trained dental professionals floss our teeth for us daily, the study concluded that the benefit of flossing was undocumented or limited at best.
- The second review out of Amsterdam looked at available studies and determined: “In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence.”
- The third and final review in recent years was the biggest to date: “Twelve studies, encompassing nearly 1,100 subjects were deemed suitable. Flossing was found to yield statistically significant reductions in levels of gingivitis and plaque buildup, however the reductions were minuscule, almost to the point of being unnoticeable. And in regard to reducing plaque, the authors deemed the evidence to be “weak” and “very unreliable.”
So, if flossing isn’t all that beneficial for reducing bacteria, cavities or gum disease, what can we do to avoid these problems?
Beyond Flossing: Other Ways to Reduce Bacteria
Thankfully, while flossing may not be as helpful as we once thought, there are other ways to keep the mouth healthy. Aside from brushing with a good natural toothpaste, you can try these alternatives:
This is one method I’ve been personally doing for years. I have seen a definite reduction in plaque and tooth/gum sensitivity since adopting this practice.
What is it?
The name is a bit misleading, but it is essentially the process of using oil as a mouthwash. This post explains how to do oil pulling, but it involves swishing an oil such as sesame or coconut oil in the mouth for up to 20 minutes (sometimes with added essential oils).
This is beneficial, because it reaches between teeth. The oil may help penetrate and break down the plaque. Additionally, oils like coconut oil can kill the S mutans bacteria that leads to tooth decay. This makes oil pulling a great addition to an oral health routine.
I’ve seen several articles since the AP article was published that were written by dentists suggesting mouthwash as an alternative. They point out that mouthwash (like oil in oil pulling) can reach between teeth and the edges of the gums. For this reason, mouthwash can reach bacteria that floss can’t and it is typically designed to kill bacteria in the mouth. (Here’s my own herbal mouthwash recipe if you’re interested in making it yourself.)
To be clear, most dentists still recommend flossing, but suggest adding mouthwash or another method to the mix as well.
Oral Irrigation is another method that can help address bacteria in the gums and between teeth. My own dentists recommended when I was younger and I used a Water Pik for years. Like mouthwash, the idea is that the water can reach between teeth and into gums to address bacteria in the mouth.
Bottom Line: Does Flossing Matter?
Flossing may not be as important as we once thought, but it is still beneficial for food stuck between teeth. In light of the recent research, we can probably stop feeling guilty if we don’t floss every single day. It may also be a great idea to add oil pulling or mouthwash to specifically address bacteria like S mutans in the mouth.
This article was medically reviewed by Dr. Steven Lin, who is a Board accredited dentist trained at the University of Sydney. With a background in biomedical science, he is a passionate whole-health advocate, focusing on the link between nutrition and dental health. As always, this is not personal medical advice and we recommend that you talk with your doctor or dentist.
Fess up… are you a daily flosser? What do you think of the recent news?