The “News” Told Me I Don’t Need to Floss!
Last month a widely circulated news report stated that there might not be a need for anyone to use dental floss. It turns out that twelve randomized controlled trials published in the Cochran Database of Systematic Reviews in 2011 found “very unreliable evidence that flossing might reduce plaque”. According to the Associated Press, the Department of Health and Human Services had never actually looked into the practice of flossing and its effectiveness when issuing their health recommendations. Now their most recent report, which features guidelines issued jointly by the Department of Agriculture and the HHS, has left this recommendation off. I have had dozens of my patients ask me about this report, because information about it was published in the New York Times and featured on many network news programs.
As dental professionals, we know that removing plaque from between the teeth is essential to healthy teeth, gums, and bone. We know that inflammation resulting from a host response to bacteria growing in undisturbed plaque leads to gingivitis, bleeding gums, bad breath, tooth decay, and bone loss. We also know that the types of bacteria that love dental plaque also like to circulate in the bloodstream to other parts of the body, causing damage to tissues and organs far from the mouth.
For decades we have been telling our patients that effective plaque removal will help them to stay healthy. As a hygienist I have personally explained, demonstrated, and advocated for tooth brushing and flossing (or the use of any interdental plaque removing device) for over 20 years! While I understand that the trials conducted showed possible evidence discounting the use of floss, I think further study obviously needs to be done. Until that time, I intend to continue to recommend interdental plaque removal, with floss or other tools.
Here are the arguments that I have been presenting to my patients since this “news” came out:
• I tell them I can testify to the condition of my own patients. Consistent brushers and flossers are healthy. Inconsistent brushers and flossers have many dental problems. I explain that the idea of leaving bacteria and plaque in the mouth, undisturbed, makes no sense. The example I use is bathing. Most everyone would agree that frequent bathing contributes to overall health and well-being. A dirty body harbors germs that can work their way into our eyes, noses and mouths. In addition, a dirty body does not look nice or smell nice. In the modern world we value cleanliness of the body and frequent bathing. By the same token, a clean mouth harbors fewer detrimental germs, looks nice, and smells nice. It is common sense.
• Dental cavities are caused by bacteria in the crevasses of the teeth, along the gum line, or between the teeth. It is obvious that these areas are the least likely to be cleaned well by less than effective tooth brushing, and areas between the teeth cannot be reached at all unless accessed by floss or other interdental tools. Most patients have had experience with decay and can see that this is what has happened in their own mouths.
• The use of sealants is an attempt to keep bacteria from taking hold in the crevasses of the teeth. If it did not matter if these areas were clean or not, why bother with a sealant? We know that keeping the occlusal surfaces free from decay during the cavity prone years of childhood and adolescence can prevent people from developing cavities and needing fillings and crowns. Many patients have seen sealants work to reduce decay in their own mouths, or in the mouths of their children. Therefore, keeping bacteria out of areas around the teeth with brushing and flossing has an obvious benefit that patients understand.
• Bacteria around root surfaces is detrimental to dental health. Many people have seen individuals whose teeth appear “long”, or have such teeth themselves. It is easy to explain that “long looking teeth” are simply teeth that have lost bone and gum support, therefore root surfaces are visible. It is not a stretch for people to understand that root surfaces do not have enamel and are therefore more likely to decay. In addition, bacteria around root surfaces contributes to further bone loss. Cleaning thoroughly around these root surfaces lessens the chance for bacteria to take hold and begin the deterioration process.
• Gum tissue must be cleaned daily. I explain that the tooth root sits inside bone like a peg, which in turn is covered by a “cuff” of gum tissue, similar to a turtleneck sweater. This cuff has to be kept free of bacteria and plaque on a daily basis, in the same way that a person’s neck must be kept free of bacteria and “dirt”. I ask them to imagine trying to clean around a “tooth turtleneck” with a brush alone. It is easy to see that floss or an interdental device must also be used.
Our patients look to us for the proper information concerning their dental health. When a study is reported that goes against what we think we know right now, I tell my patients that as more studies are done more shall be revealed. In the meantime, we have to go by the best demonstrable evidence we have – that brushing, flossing, and/or the use of interdental cleaners can help keep a mouth healthy.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
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