Is the Associated Press right? Response to the AP regarding the benefits of flossing

August 3, 2016

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The Associated Press (AP) came out with a report earlier this week stating there are no proven benefits to flossing. Working in dentistry, we know how important cleaning in interproximally is, not only for oral health but for overall health.

The AP stated the evidence for the benefits of flossing is weak, very unreliable, of very low quality and has a potential for bias. The AP also stated all the studies were over too short of a time and have not enough participants. It is concerning that national news stories like this come out with blanket statements not giving context to these studies, let alone citing the research they are referring to. The AP also stated that the departments of Health and Human Services and Agriculture said that the effectiveness of floss had never been researched.

Let’s first clear up one thing regarding there being no studies that show the benefits of flossing. This is patently false. Just one example is a 2006 study titled “Dental Flossing and Interproximal Caries: a System Review.” Here Hujoel, Cunha-Cruz, et. al. performed a comprehensive study on children aged four to 13 with 808 participants. This study was done over the course of a year and a half with six total trials. The trials were broken into three categories with a control group attached to each one to get to the total of six. The trials were: 1) professionally flossed five days a week, 2) professionally flossed one every three months, and 3) self-reported flossing at home.

The results of this study were clear. Those who were flossed professionally five days a week had a 40 percent decreased risk of caries. Being flossed professionally every three months and flossing at home showed no decrease in risk of caries. This is where things may be confusing for people reading the results. If people who flossed at home showed no decrease in the risk of caries, then flossing obviously doesn’t work, right? Not quite.

The key here is being flossed professionally. In other words, those children in the study were being flossed correctly by a dental professional. Just because somebody flosses at home (with or without braces) doesn’t mean they are doing it correctly. In fact, this study shows that when patients don’t know the proper techniques of flossing, they don’t get the benefits of it. It’s as simple as that. When somebody is flossed with the proper techniques, or “professionally” as this study calls it, the decreased risk of caries is clear. This is where the context of the studies mentioned by the AP is so important, yet negligently left out.

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Beyond misrepresenting that there are no studies showing the benefit of flossing, the AP report made no mention about other ways to clean interdentally and that it should still be done. Brushing only reaches about 65 percent of a tooth’s surface. While many people think flossing constitutes using string floss, there are other options available such as interproximal brushes and waterflossers. Using string floss isn’t always the best option for every patient. Failing to mention these other options, while stating flossing doesn’t make a difference, gives the impression to the general public that they shouldn’t be cleaning below the gumline.

The AP needs to look into research, and microbiology 101, about biofilm and the build-up of virulent bacteria that causes inflammation, bleeding, tissue destruction, and the possibility of that leading to losing teeth. Not to mention the research supporting the link between oral bacteria and health problems such as heart disease, stroke, cancers, diabetes, low birth weight and pre-term babies. Simply put, virulent oral bacteria needs to be kept in check by disruption. This disruption can be with string floss, interproximal brushes, waterflossers, and other floss aids. Healthy mouths and healthy bodies depend on it.

The Associated Press report also attempted to add some juiciness to the story by implying the American Dental Association is somehow in cahoots with floss manufacturers like Proctor & Gamble and Johnson & Johnson to recommend flossing just to boost sales. While it might be easy to start conspiracy theories around flossing, it doesn’t change the fact that properly flossing and cleaning interdentally is effective at removing bacteria. It is insinuations like these that build mistrust in society of their dental professionals.

Let’s be real here about the government giving recommendations to floss. Does it really take a governmental recommendation to do something?! For example, does the departments of Health and Human Services and Agriculture give recommendations on using toilet paper? Further, are there studies backing up the efficacy of using said toilet paper? If the toilet paper was used incorrectly in the research they decided to cite, I bet they would say it’s ineffective too. Any human can tell you toilet paper is effective, it’s common sense.

You can find research backing up just about any claim when your research is biased to begin with. Yes, I’m saying the AP’s research was biased. I will also say again that it’s negligent to report such bias to the greater public. Shame on the AP.

Now, as dental professionals, we have our work cut out for us, as if it wasn’t difficult enough already to educate and promote compliance with our patients. Patients will ask about what they saw or read on the news. Be prepared to explain the mouth/body link, the role of bacteria/biofilm which can lead to disease, and with options to disrupt and remove this bacteria. No blanket statements here; it’s up to dental professionals to find the best interproximal cleaner for each individual patient and to educate on the proper use.