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The Effectiveness of Flossing

I’ve had some patients recently ask me about an article they read in the news regarding the effectiveness, or lack thereof, of flossing on oral health. The article, reported by the Associated Press, claimed that the evidence for flossing was weak and unreliable.

These types of reports tend to present faulty or incomplete information. The main reason that no direct evidence exists for the benefit of flossing, is that a study of this sort would take many years to accomplish, as tooth decay and gum disease tends to occur over long periods of time. Everyone reacts differently to the presence of bacteria in their mouth, and whereas some are more susceptible to tooth decay, others are more prone to gum disease.

The basic facts are that tooth decay and gum disease are caused by bacteria on your teeth. These bacteria reside in the plaque that is on your teeth. This is the soft, often yellowy surface covering on the teeth. This plaque is easily removed by mechanical means (brushing and flossing) and takes 24 hours to reform after it has been removed. If not removed, this plaque will, in time, become mineralized and hardened and becomes what is known as tartar or calculus. At this stage it can only be removed by a dentist or dental hygienist. If left on the teeth, the bacteria will use sugars in our diet as their own food, and produce acid as a byproduct. It’s this acid that will cause the gums to become irritated and bleed, bone loss to occur, and cause the minerals in the teeth to dissolve away, leaving a cavity. The degree to which this occurs, and the speed in which it occurs, will vary from person to person.

Thus the best way to prevent tooth decay and gum disease is to effectively remove the plaque that is present on your teeth. The best way is to use a toothbrush (manual or electric). This will remove 70-80% of the plaque on your teeth if you are diligent and are able to access hard to reach places such as in the back of the mouth. However some tooth surfaces cannot be accessed with a toothbrush, mostly in the contact area between the teeth. This is where flossing would be effective. It is an inexpensive and safe method for cleaning those areas that a toothbrush cannot reach. For some patients other devices such as a proxibrush may also be effective, but this is something that would be assessed on an individual basis. Using an antibacterial mouth wash such as Listerine can also help, but it is not a substitute for mechanical removal of the plaque, and in fact, most mouth washes that are available over the counter are nothing more than breath fresheners and are not antibacterial.

I have seen many cases where cavities are occurring in between the teeth, especially in young children and teens. For the majority of cases these cavities could have been prevented with proper brushing AND flossing. This also applies to the progression of gum disease. The plaque needs to be removed effectively and thoroughly to minimize the disease process. Remember that cavities and gum disease are usually painless until it reaches an advanced stage, to which addressing the issue can become difficult and costly.

In conclusion, I would like to present to you the Canadian Dental Association’s Statement on Flossing which was published in the fall of 2016:

The Canadian Dental Association supports flossing as one step of maintaining healthy teeth and gums. Flossing is an effective preventative measure to remove plaque, the main cause of gum disease. The weakness of the evidence supporting the value of floss in the prevention of gum disease is a reflection of the difficulty of conducting the necessary studies, not of the value of flossing for the maintenance of good oral health. Brushing, flossing, eating a healthy diet, and seeing your dentist regularly are all steps in preserving a healthy mouth.

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