Weighing the Studies: Is Flossing Still Important?

We all know that when you go in for a dental exam and cleaning, the hygienist will invariably encourage you to floss more. This federal government has also made this recommendation since 1979. However, this summer, CBS shared a surprising story about how this recommendation has been revoked! You can see for yourself at CBS News:

A Big Problem with Flossing

When the federal government issued its latest dietary guidelines this year, the flossing recommendation had been removed, without notice. In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required.

 

The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is "weak, very unreliable," of "very low" quality, and carries "a moderate to large potential for bias." Read the full story . . .

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This is rather shocking that there seems to be so much evidence against a habit that has been ingrained in so many Americans' daily lives. But despite a plethora of research, many dentists are still adamant in their recommendations. After all, CBS even had a dentist--Dr. Steven Glassman--on the show, and he said that after about two and a half decades of practicing, he could tell that patients who didn't floss would usually have more inflammation.

And according to an article at Live Science, Dr. Tim Iafolla--a health analyst and dentist--says that he can immediately tell when an individual has or hasn't flossed. While studies are conducted with the premise that there's controls and variables, one has to wonder if these tests and mock scenarios really outweigh a professional's years of experience.

In fact, Dr. Iafolla was featured again this month in a blog run by the National Institute of Health. Despite some studies refuting the benefits, that's not the whole story:

Don’t Toss the Floss! The Benefits of Daily Cleaning Between Teeth

If dentists—and maybe even your personal experience—suggest that regular flossing keeps your mouth healthy, then why the news reports? It’s because long-term, large-scale, carefully controlled studies of flossing have been somewhat limited.

 

Researchers have found modest benefits from flossing in small clinical studies. For instance, an analysis of 12 well-controlled studies found that flossing plus toothbrushing reduced mild gum disease, or gingivitis, significantly better than toothbrushing alone. These same studies reported that flossing plus brushing might reduce plaque after 1 or 3 months better than just brushing.

 

Another research challenge is that large, real-world studies of flossing must rely on people accurately reporting their dental cleaning habits. And people tend to report what they think is the “right” answer when it comes to their health behaviors—whether flossing, exercising, smoking, or eating. That’s why well-controlled studies (where researchers closely monitor flossing or perform the flossing) tend to show that flossing is effective. But real-world studies result in weaker evidence.

 

“The fact that there hasn’t been a huge population-based study of flossing doesn’t mean that flossing’s not effective,” Iafolla says. “It simply suggests that large studies are difficult and expensive to conduct when you’re monitoring health behaviors of any kind.” While the scientific evidence for flossing benefits may be somewhat lacking, there’s little evidence for any harm or side effects from flossing, and it’s low cost. So why not consider making it part of your daily routine? Read full blog post here . . .

So the fact there's these different studies head-butting one another makes it difficult for patients to really figure out if it's a necessary practice. However, as the previous article mentioned, it's an affordable and harmless practice, so better be safe than sorry! If dentists are seeing more patients with inflammation in difficult-to-reach spots, then flossing probably has its place.

And despite the research, the issue may eventually just boil down to a motivation factor. Let's be honest: a lot of people would rather just brush instead of floss, and now these studies give them credence to do so. However, rdhmag.com has an interesting article about how to spur motivation with different flossing products. For instance, interdental brushes were found to be easier to use and many test subjects enjoyed using them more than regular floss. Water flossers are also a great alternative to those who have sensitive gums.

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