Today in all the newspapers there are articles (from america) that state that flossing is unnecessary:




Here is my view on this:

  1. It is hard to conduct a good clinical trial to show the significance that flossing has. ie You need a control group who are instructed to brush their teeth in the proper way (modified bass technique in case you feel geeky and want to look it up), and then the trial group who brush AND floss. I am not surprised that there is no ‘significant difference’ in the results. ie both outcomes will show very good results. So do we conclude, therefore, that flossing is not worth it just because of this?
  2. What I would like to see is a psychology experiment, where people are chosen at random from the general population and they look at plaque scores of those who floss versus those who don’t. I would expect the ‘flossers’ to have better results. Not necessarily because they floss, but because they are generally more interested in oral hygiene. This is because oral hygiene is not a technical thing (we can all brush our teeth if we bother!! -), but it’s dictated by the person’s attitude. Let’s face it, if we all did what the hygienist actually asked us to do then our mouths would be a far better place.
  3. Flossing mainly cleans the part that is the contact point. This is where ‘interproximal caries’ starts (look that up, I find it hard to put in basic terms – it’s the decay we look for when we take x-rays and can sometimes be missed). So therefore I advocate it. For the front six teeth it is especially important. Round the back then the ’embrasure’ is more triangular and so I recommend brushes (e.g tepe brushes).
  4. There are different types of floss and many of my patients have implant restorations, or advanced crown, veneer and bridge work and frankly flossing is essential in these cases. No mention of this in all the articles!!
  5. So should we still floss – YES. !! Is there a ‘significant difference’ (in clinical trials) – NO.
  6. Finally – Do not take everything that you read in newspapers as ‘good evidence’. In fact it is one of the lowest form of evidence. Fortunately you see a dentist who is a bit geeky (me) and I have been trained on how to interpret medical literature. For real ‘evidence’ I recommend the cochrane library, where evidence and clinical techniques are scrutinised based on studies with strict inclusion criteria, and formulated from cohorts of studies.