Does Flossing Really Reduce Gum Disease and Cavities?

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Wellness Mama » Blog » Health » Does Flossing Really Reduce Gum Disease and Cavities?

For most of us, our parents ingrained the importance of brushing our teeth and flossing from a young age. Many of us feel guilty as adults for failing to do both every single day.

Flossing is one of the most common and accepted general health recommendations. It’s right up there with the importance of eating vegetables, drinking water, and getting regular exercise.

Yet, how many of us have actually researched the benefits of daily flossing?

Adults told us to do it from such a young age that we assume it’s beneficial to do it daily. But is it important?

I was a daily flosser for years upon the recommendation of my dentist, but since converting to more natural oral health options, I’ve wondered how important it is.

Flossing for Health Is Under Investigation

The internet is still abuzz with debate on the importance of this recommended daily practice after the 2016 publication of an AP News article called “Medical Benefits of Floss Unproven.”

Did you miss that one? Are you surprised?

After all, TV and the internet are still full of ads and articles promoting flossing for good oral health. You’ll still likely get a free sample of it the next time you go to a dentist.

Dental recommendations haven’t changed since this article came out.

Despite the sensationalist headline, that article didn’t conclude that flossing is necessarily bad, just that there may not be any scientifically-proven reason to do it.

Let’s look at the logic of this practice and then the actual research to see what science says about it.

The Logic of Flossing

At first glance, it seems to make perfect sense. Food gets stuck between teeth. Floss removes this food. Thus, this is a good daily habit.

While that may technically be true, taking care of your oral health isn’t quite so simple. After all, there’s also the issue of bacteria in the mouth, between the teeth, and in the gums.

Now, not all bacteria are bad. Some of it is actually protective—just like in your gut. But certain bacteria (referred to as pathogenic bacteria) contribute to cavities and gum disease. It is well documented that Streptococcus mutans is the main cause of dental decay. Various lactobacilli are associated with the progression of the lesion.

In other words, the Streptococcus mutans species of bacteria is associated with dental decay. Certain lactobacilli species contribute to making the cavity worse. Bad breath can be an indicator that your oral bacteria are out of balance.

Bacteria Lead to Cavities and Gum Disease

Dentists explain 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 essential, 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 It Help Reduce Bacteria in the Mouth?

This is an 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 for avoiding problems in the mouth.

But does it actually help?

According to dentist Reid Winick, DDS, it isn’t effective at removing this bacteria, and doing it daily may actually make things worse! He explains that it doesn’t affect these pathogenic bacteria in the mouth and that when they multiply, they can affect the body in many ways:

“If these pathogenic bacteria grow out of control and enter our bloodstream, 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 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:

  • 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 start looking at the research, the “well-documented” benefits don’t stand up to scrutiny. This doesn’t necessarily mean that it’s 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 two most recent versions of Dietary Guidelines for Americans (2015-2020 and 2020-2025) make no mention of it. In the past, flossing has been part of their recommendations but was noticeably missing in the most recent updates.

So what happened?

The law requires experts to base these guidelines on well-documented scientific evidence. A few years ago, the Associated 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 experts simply removed the recommendation from the guidelines for 2015-2020 and left it out again in the most recent one put out in 2020.

In other words, the government’s official health and nutrition publication, Dietary Guidelines for Americans, no longer recommends flossing.

The Research

The Associated Press examined the actual research. They looked at 25 studies that compared brushing alone or brushing and flossing and found that there was very little evidence for doing both—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.”

So, it doesn’t even necessarily remove plaque.

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 did it on their own. Since most of us don’t have trained dental professionals to floss our teeth for us daily, the study concluded that its benefits were 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, what can we do to avoid these problems if flossing isn’t all that beneficial for reducing bacteria, cavities, or gum disease?

Other Ways to Reduce Bacteria

Thankfully, while flossing may not be as helpful as we once thought, it’s still useful in food removal. If you’re environmentally conscious, opt for the original natural silk version rather than the modern nylon version.

Beyond brushing and flossing, there are other ways to keep the mouth healthy. Aside from brushing with a good natural toothpaste and flossing with silk, you can try these alternatives:

Oil Pulling

This is one method I’ve been personally doing for years. Since adopting this practice, I have seen a definite reduction in plaque and tooth/gum sensitivity.

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 lead to tooth decay. This makes oil pulling a great addition to your oral care routine.

Mouthwash

I’ve seen several dentists write articles suggesting mouthwash as an alternative since the AP article. 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. Companies design it to kill bacteria in the mouth. (Here’s my own herbal mouthwash recipe if you’re interested in making it yourself to maintain some of your mouth’s biome.)

To be clear, most dentists still recommend flossing but suggest adding mouthwash or another method, like interdental cleaners, to the mix as well.

Oral Irrigation

Oral Irrigation is another method that can help address bacteria in the gums and between teeth. My own dentists recommended it 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?

While it may not be quite as important as we once thought, it’s 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. Still, it’s a good idea to avoid food particle buildup leading to the growth of pathogenic (“bad”) bacteria and infections.

In that case, it’s good to be aware of proper techniques. If you’re not quite sure how to do it, here’s what the American Dental Association (ADA) recommends (it requires just a bit of dexterity):

  1. Break off about 18 inches of floss. Take it and wind it around one of your middle fingers. Do the same on your other hand.
  2. Hold the floss up tightly between your thumbs and index fingers.
  3. Gently glide the string between your teeth, but don’t snap it into your gums.
  4. When you get to the gum line, curve it into a C shape against one tooth. Slide it gently into the space between the gum and the tooth.
  5. Hold the floss tightly against the tooth and rub against the side of the tooth, moving it away from the gum. Use up and down motions. Repeat with the rest of your teeth, making sure to slide against all tooth surfaces.

It may also be a great idea to add oil pulling or mouthwash to address specifically pathogenic bacteria like S. mutans in the mouth.

How to Get The Right Type of Floss

The type you use matters. You don’t want to be putting petrochemicals and other toxins like Teflon, common in larger, well-known brands, into your delicate gum tissue. Remember, what goes on your skin and the inside of your mouth gets into your bloodstream.

For that reason, you’re not going to want to pick up regular floss from your local grocery store or drugstore. It’s important to know the ingredients that make up your dental products. After all, you’re putting them in your mouth!

If you’d like to add a completely natural, biodegradable dental floss to your daily oral hygiene routine, we’ve got you covered. Wellnesse now carries a silk floss that’s coated with natural candelilla wax (derived from a plant) and flavored with real antibacterial peppermint oil.

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.

Share with us! Are you a daily flosser? What do you think of this new information on dental health? 

Sources
  1. AP National Investigative Team. (2016). Medical Benefits of Floss Unproven. AP News.
  2. Loesche WJ. (1996). Microbiology of Dental Decay and Periodontal Disease. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston;  Chapter 99.
  3. Winick, R. (2013, June 23). Dentist’s Advice: Stop Flossing & Do This Instead! MindBodyGreen.
  4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2015-2020. 8th Edition. December 2015.
  5. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.
  6. Longbottom, C. (2006). Professional flossing is effective in reducing interproximal caries risk in children who have low fluoride exposures. Evidence-Based Dentistry, 7, 68.
  7. Berchier, C. E., Slot, D. E., Haps, S., & Van der Weijden, G. A. (2008). The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. International journal of dental hygiene, 6(4), 265–279.
  8. Matthews, D. (2012). Weak, unreliable evidence suggests flossing plus toothbrushing may be associated with a small reduction in plaque. Evidence-Based Dentistry, 13, 5–6.
  9. American Dental Association. (n.d.). How to Floss Your Teeth: 5 Steps to a Flawless Floss. Mouth Healthy™.

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Katie Wells Avatar

About Katie Wells

Katie Wells, CTNC, MCHC, Founder of Wellness Mama and Co-founder of Wellnesse, has a background in research, journalism, and nutrition. As a mom of six, she turned to research and took health into her own hands to find answers to her health problems. WellnessMama.com is the culmination of her thousands of hours of research and all posts are medically reviewed and verified by the Wellness Mama research team. Katie is also the author of the bestselling books The Wellness Mama Cookbook and The Wellness Mama 5-Step Lifestyle Detox.

Comments

72 responses to “Does Flossing Really Reduce Gum Disease and Cavities?”

  1. juli Avatar

    Without trying to argue or trying to prove a point, I will say that after 40 years of cleaning teeth, working in private dental office, clinics, free medical/dental clinics, and dental mission trips out of the country and with in, that I’ve seen what brushing and flossing, or the lack there in can lead to. I’m not talking about what I’ve read, or been told, but what I’ve seen. And while I agree with the dangers of fluoride, I would have to tell you that I have seen that flossing DOES make a difference in a positive way. No, young children are not going to be able to floss as well as a “trained professional”, but if the child starts practicing at a young age he or she will be able to floss every bit as well as their hygienist by the time they are in high school or college and will have developed a great, healthy habit.

  2. Han-Lin Avatar

    I’m quite convinced that it’s gum disease that causes health problems too. The looked at the history of gum disease, losing teeth, etc, and adjusted for other risk factors.

    It’s possible that I didn’t reach far enough because of sensitive teeth as their roots were exposed. I’ve been using all the methods to minimize missed spots. I felt that a low setting doesn’t reach deep enough.

  3. Jolaine Avatar

    I’m also a dental hygienist and you better believe flossing makes a huge difference in oral health. Interdental aids such as proxy brush, sulca brush and especially a water pick are all great tools as well and can be very beneficial in reducing the toxic bacteria that leads to gingivitis, and then more severe-periodontitis.
    There are very well know health risks associated with periodontal disease- heart disease, stroke, diabetes, low birth weight and pre term babies, Alzheimer’s disease just to name a few. There is a strong correlation between periodontal diseas and all these illnesses.
    Overall, the goal is to reduce inflammation in the body, even more than being cavity-free, is the goal in my opinion. Inflammation is the killer. If you have inflammation and toxic bacteria in your mouth, it’s more than likely in your body causing you health problems. You could never even know that you have periodontal disease if you aren’t seeing a dental hygienist.
    I see it ever single day. I can tell in one second if you are using an interdental aid if some sort for plaque removal. The tissue will be healthy and not inflamed.
    Oil pulling has good results for sure, but floss or even better, a Waterpik will be a better choice or use both together.

  4. Han-Lin Avatar

    I think whether flossing is enough also depends on whether we have gum disease and whether we’re prone to gum inflammation. If you have 1 or 2mm pockets, brushing and flossing should be enough for prevention. If your pockets are at least 4mm deep, floss can’t clean them. I have gum recession, furcation involvement, and had pockets measured 6mm deep. I need to use interdental brushes and the Water Pik to have healthy gums and to maintain lower pocket depths. With gum recession, there’s more surface to clean, concavities, and the roots are more vulnerable because there’s no enamel. I first noted gum bleeding in my early 20s. Prevention is important even when we’re young. Healthy gums is important for our overall health too. The reviews for the Water Pik are encouraging.

  5. Gloria Knight Avatar
    Gloria Knight

    Flossing is really great, but we should also note that it should not be too harsh. That might damage your teeth. But if we are thinking about stopping this activity, then we should ensure that we should clean our teeth twice daily with a good toothpaste.

  6. Nitsrek Avatar

    The use of natural herbal remedies which use essential oils in treating periodontal disease is popular in alternative medicine circles and works very well. Natural Herbal Gum Disease Remedy from Kerstin’s Nature Products for People and Pets is a powerful combination of sweet almond oil and some of the finest essential plant oils, designed specifically to maximize tooth and gum health. It can be applied directly or diluted with some olive oil to the gums or toothache or you can add a drop or two of the remedy on your toothbrush on top of the toothpaste before brushing. This will help inflamed and irritated gums and prevent gum disease. You also can put one or two drops to a cotton ball and dab your gums.

  7. Lorinda Avatar

    I have to say I just don’t agree with the information here generallyrics in this article. While oil pulling is excellent, and water pike is a great way to clean between teeth as well, especially if you have larger spaces to deal with, I have found significant benefit to flossing. While I don’t floss with every single brushing, I floss servants days a week.
    I make my own toothpaste, with essential oils, cocnut oil, kaolin, and some minerals,and I also use charcoal a couple times weekly. I read an article similar to this one and decided to stop flossing, but do everything else we do. I am on a no sugar and very low carb diet too, so I thought it would be good to try this out.
    I have not had a new cavity in over twenty years, but after two months of no flossing, I have a cavity between my two front teeth! I’m so upset about this!!
    To me personally, this is a no flossing fail!!

    Also, I have excess bleeding from my gums from time to time and always have. Typically when pregnant and was usually one of my earliest “tells” that I was expecting again. I found increasing my vit c intake stopped it.

  8. Tina Avatar

    The problem with the studies conducfed regarding flossing is that they were never done long term. Most of them didn’t last more than 6 months to a year. Gum disease takes years to progress.

  9. April Avatar

    I always bled and struggled with flossing until one glorious dentist visit when the hygienist changed my flossing world.

    First, she was AMAZED with my teeth (something that never happens) and asked about my diet and oral regime. I gladly boasted about my change in eating the last year, but admitted to flossing maybe twice a month. She said my teeth were the best she’d seen in quite a while and couldn’t believe I hadn’t been to a dentist in over two years.

    And that’s when she dropped the flossing bomb! She asked if I could show her how I floss, and it turns out I’ve been attacking my mouth and damaging it more than anything, stripping my gums. She taught me that flossing is not about stabbing between teeth with string to get out the gunk; rather it’s very, very gently sliding the floss down one side of the tooth, deep into the gum bed under the tooth, and back up the other tooth as gently as possible, like a massage. It’s all about bacteria disruption.

    She said it’s time for a good floss when your gums have that deep itch, and the reason to do it every day is to confuse bacteria. She said with a diet like mine (and most of the folks on this blog), one wouldn’t need to brush/floss nearly as often! 🙂

    She also asked that I brush much more gently, and to focus not on brushing my teeth, but to very gently brush my gums (!!!). She said brushing does very little for teeth, but does much for gums. She said everything is about healthy gums, which make sparkling teeth.

    PS: Myrrh is excellent for gum repair, so I swish with that as my homemade mouth-rinse to repair and grow healthier gums. 🙂

  10. Kim Werr Avatar
    Kim Werr

    I have been flossing for years each and every day. I did not grow up flossing regularly. Since flossing regularly I have not had to endure a “deep” clean where the technician has to go up under the gum near the roots which is painful. My cleanings are much faster and there is no blood. Think I will stick with flossing. Pulling is interesting and I may add that as well. Interesting reading.

  11. Krista Avatar

    This is a very interesting article with some good points, but there is much more to oral hygiene than just talking about “floss removing bacteria.” Flossing and brushing help each other out to prevent a variety of mouth problems.

    My mom and sister are both dental hygienists. My mom has been practicing for over 20 years and my sister recently graduated and is now joining the dental hygiene field. Both always say that flossing is just as important as brushing.

    Until recently I was (ironically) very bad at brushing and flossing. At my recent cleaning visit I learned:

    When you don’t get those extra ting pieces of food and bacteria out, they turn into plaque. Over time that plaque turns into tartar which builds up and gets into the gums. That is when more issues happen like inflammation and perhaps gum disease!!

    Now, I brush every night before bed. I floss maybe every other day. So fresh and so clean clean…No cavities and gum disease, the way to be!! 😀

    Still interested in the topic? Check out this article:
    https://www.nidcr.nih.gov/health-info/gum-disease/more-info

  12. Sam Avatar

    To the dental hygienists, who can’t let go of years of indoctrination, to make a balanced decision do a minimum of 3 months comparison of Flossers vs Non-flossing Oil Pullers (who do it properly for at least 20 minutes). Then we will see which one is superior. It will also show the added benefits of oil pulling, which has been shown to remove so much bad bacteria, etc. that it is important NOT to swallow the oil at the end of the pulling session as it is considered toxic! Ridding one’s system of these toxins has an overall positive impact on one health.

  13. Sarah Klaudt Avatar
    Sarah Klaudt

    Bottom line? Food between teeth = nasty breath. I’ll keep my floss, thank you very much.

    1. Sandy Avatar

      I agree! Flossing prevents an awful smell from between my teeth. However, I do use coconut oil and baking soda in place of traditional fluoride toothpaste.

  14. Toria Avatar

    In a few years, after lots of ignorant and trusting ppl have stopped flossing and consequently paid the price with their health, these same “experts” will come back and say, “Oops, we got that one wrong (too).” (and just a coincidence that all this ill health made us lotsa money) LOL … History repeating itself. Dang, I’m amazed that wellnessmama wasn’t impressed by the fact that improvement was seen in those who had the flossing done by a professional. Hence, it’s not about flossing but not doing it properly. I would add to that on the type of floss. Toss the skinny stuff and use “dental tape” (wider), and even better, coated with tea tree oil. And of course, do oil pulling and toss mainstream pastes (etc).

  15. Brad Avatar

    I floss every day. I actually have missed a day or two in the past couple years and the days I miss I wake up smelling my breath. My dentist suggested me to also lost behind the last teeth which I have not been doing. He must have noticed me flossing everyday and getting rid of plaque build-up. I will definitely keep on flossing everyday. I also will follow the example of Bass technique toothbrushing, an article that was posted on this website. After two weeks from the day I started the Bass technique I’ve noticed a difference of the freshness in my mouth. Thank you for posting wonderful articles.

  16. Stan Avatar

    I do floss everyday without fail, and I’ll never give it up. But it never has been enough…I use a pick every couple of weeks. I use Periopaste, which I like very much, and I’m going to try the oil. My gums never bleed and pockets = 1 and 2s 9and I’m almost 70). it’s a matter of enzymes, which are a problem for me that I’ve known about for 45 years.

  17. Audry Avatar

    I like eating foods that naturally reminerilze my teeth to keep them strong and healthy. Then, once a week, when I do all of my “beauty maintence” (tweeze eyebrows, manicure fingernail, etc) I give my teeth a really good cleaning, floss and waterpick, followed by brushing with baking soda. That’s what works for me?

  18. Stefanie Avatar
    Stefanie

    I think flossing should be done. It seems, most are overlooking the part of the study that says ” if the flossing is done by a trained person, it is 40% better” So if it is done “right” it works to improve the mouth-health. That tells me the aim should be to teach people the proper way of flossing !

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