“Do I really need to floss?”
Patients often ask this question. But those who go further and search the internet are likely to come across controversy over the benefits of flossing. Let me explain….
The confusion comes from the Dietary Guidelines for Americans, 2015-2020, released every five years by the US Department of Health and Humans Services and the US Department of Agriculture.
The 2010 edition contained this sentence:
“A combined approach of reducing the amount of time sugars and starches are in the mouth, drinking fluoridated water, and brushing and flossing teeth, is the most effective way to reduce dental caries.”
Later editions leave out this sentence. They don’t mention brushing and flossing teeth at all. In addition, a 2011 Cochrane review reported ‘limited evidence’ that flossing and brushing reduces gingivitis compared to brushing alone. It also reports ‘weak evidence’ of a reduction in plaque.
Because of this, publications like The New York Times (among others) suggested flossing isn’t necessary. Yet, dig deeper and you find the reason flossing is no longer recommended in the dietary guidelines is because it isn’t well studied.
The limited research there is into flossing uses outdated methods and small sample sizes. It’s no wonder the evidence is sparse. But more importantly, lack of evidence isn’t proof that something—in this case flossing—doesn’t work!
So, let’s not fall out with flossing just because it hasn’t been well studied.
Plaque is a sticky film containing different types of bacteria. It coats the teeth, making them feel ‘fuzzy’ when touched with the tongue. Dental plaque forms around the teeth and gum lines. And while regular tooth brushing can help, it doesn’t remove all plaque — particularly in hard-to-reach areas, such as in-between teeth.
However, it’s the bacteria in plaque that are the real culprits! Bacteria cause inflammation of the gums, known as gingivitis. Inflammation is the body’s response to the bacteria that have set up home around your teeth and gums.
In susceptible individuals, the inflammation can progress to periodontitis. This serious form of gum disease causes irreversible damage to the ligaments and bones that support your teeth.
The other problem with leaving plaque on teeth is that it hardens and becomes tartar (calculus). Not only is tartar much more difficult to remove than plaque, but it retains a lot more plaque, making it impossible to clean off at home. These issues can predispose individuals to decay, infection, gum disease and even tooth loss.
Now you know how plaque, tartar and gum disease relate. Study or no study, you can see how cleaning all sides of your teeth, including between your teeth where your toothbrush can't reach, is good for oral health.
Removing plaque reduces the chance of inflammation and lessens the risk of gum disease. Any method that effectively removes plaque will help to manage gum disease.
Ultimately, flossing is better than not flossing.
According to the Australian Dental Association, three quarters of Australian adults rarely or never clean between their teeth. This may be because they got caught up in the confusion over flossing, or they don’t know how. Here are the correct steps to take.
1. Take approximately 30-40cms of dental floss and wrap the ends around the middle finger of each hand. Hold the floss tight using your thumbs and index fingers.
2. Slide the dental floss between two teeth.
3. Gently slide the floss up and down, rubbing it along the sides of each tooth.
4. As the floss reaches the gumline, curve it slightly to form a C shape. This helps remove plaque trapped between the gum and tooth.
5. Move from tooth to tooth using a new section of floss each time.
Common mistakes people make when flossing include:
Want to floss your teeth correctly? These flossing Q&As will help you do just that.
It’s recommended you clean between your teeth by flossing or using interdental brushes at least once a day. This helps to remove and control plaque and prevent future issues. People with gum disease may need to clean between their teeth more often.
The latest research recommends flossing before brushing teeth. Floss first to loosen and break up plaque and food from in between your teeth. Next, brush teeth with toothpaste to remove the plaque and food particles from the mouth.
The study claims flossing first not only reduces total plaque but also leaves more fluoride between the teeth, which may help strengthen tooth enamel and protect against acids and plaque.
However, we believe that it doesn’t really matter. You can do it at any time that is convenient. Just do it.
The most important thing about flossing isn’t how long it takes but making sure you clean between every tooth. On average, flossing teeth should take 2-3 minutes. Given you should brush your teeth for at least 2 minutes, all you need is 5 minutes, twice a day to keep your mouth and teeth healthy.
While there may be limited evidence to support the benefits of flossing, there are no studies to show that flossing is bad for your teeth.
In our practice, we find almost 80% of damage from gum disease occurs in between the teeth, where a toothbrush can’t reach. This means if you’re susceptible to gum disease, it’s important to use a device that effectively cleans between the teeth—flossing is just one of them!
Flossing is really important to prevent the more advanced forms of gum disease (periodontitis). But for those who have larger spaces between the teeth or who already have experienced gum disease, interdental brushes are actually much more effective than flossing.
While the evidence for the benefit of flossing is weak, there is significant high-quality scientific data to support interdental brushing. We recommend the use of interdental brushes over flossing for everyone who can. And, particularly if you have periodontitis, our advice is to use a toothbrush plus interdental brushes (over the use of floss and a toothbrush).
You can find out more about interdental brushing here.
If you still have questions about flossing or gum disease, talk to your dentist or periodontist. They can help you find the most effective method of cleaning between your teeth and maintaining your oral health.
Learn about gum disease and how to prevent it. Or, if you have been diagnosed with gum disease, find out how to manage it.
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