Federal health expert drop flossing from health guidelines (opens in new tab)

For years my oral hygienist kept telling me to a get an electric toothbrush. When I finally got one, I didn't tell her, but I never hear the "get an electric tooth brush" again.

It was the same with flossing. When I started flossing I didn't say anything, and she hasn't commented that I need to floss since.

I've never flossed, I don't have gaps in my teeth to get the floss in. My first trip to the dentist in 25 years was a few weeks ago and my teeth were perfect except for a wisdom tooth and the damage it caused.

So i'm kind of skeptical of the effect.

Edit - I always wonder what kind of toothbrush other people use. I've always used electric ones so I wonder if that helps.

The effect is very obvious. I'm not ashasmed to say that since the age of 18 - your last year of free dental care in Sweden - to the age of 31, I didn't go to the dentist at all.

I brushed mostly regularly the second half of this period, I never flossed. I'm a computer geek, I can get caught up in code for days without brushing my teeth but try to do it regularly.

The result was 13 years of plaque and two visits to a dentist to clean it all out.

Dental plaque is a coating over your tooth and your gums will grow over this coating. So I think it's pretty obvious that dental plaque can cause cavities between your gums and your teeth, infections in your gums and all this will in turn lead to periodontitis.

And also you have saliva glands at the bottom of your mouth that bring with them additional minerals and stuff that get stuck to your teeth, forming plaque. So the front bottom teeth are even more important to floss.

Now I floss regularly and I'm proud to have actually made it one of my daily habits.

Except that studies have now shown that the effect is not obvious at all.

"Since doctors began saying that a string-based tooth scrapping was good for oral health, a handful of studies have been conducted. However, they all fall far short of what’s needed to make a convincing argument. A 2011 review of a dozen randomized controlled studies concluded that, “Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.”

The US Agriculture and Health and Human Services departments quietly removed the flossing recommendation from the latest version of dietary guidelines.

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If anyone thinks that this is because the study's parameters are too narrow to show an effect, that is not the case. Other studies have successfully shown the benefits of flossing... if the dentist is the one performing it. But they haven't been able to show similar results when regular people do the flossing.

"Maybe the evidence that flossing reduces tooth decay or gum disease does not hold up because we are all such poor flossers. Superflossers, like the zealous hygienist at your dentist’s office, aim to “hug the neck of the tooth” and get below the gum line, Dr. Hujoel said.

But we common folk, staring woefully at our bathroom mirrors, tend to lightly give it the once-over.

A review of six trials found that when professionals flossed the teeth of children on school days for almost two years, they saw a 40 percent reduction in the risk of cavities.

So maybe perfect flossing is effective. But scientists would be hard put to find anyone to test that theory."

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Honestly, I'm not surprised at all. Years ago, my dentist strongly urged me to get my asymptomatic wisdom teeth removed. I then went home and did my own research on this subject. And what I found was the complete opposite of my dentist's recommendation.

But a new study of more than 6,000 patients in Greece found that only 2.7 percent of the teeth had a cyst or tumor. An older study, often cited by critics of routine extraction, found that only 12 percent of 1,756 middle-aged people who had not had impacted wisdom teeth removed experienced a complication.

Numerous comprehensive reviews of research, conducted by independent bodies not affiliated with oral surgeons, have concluded that there was no evidence to support routine prophylactic extraction of impacted but healthy wisdom teeth.

Britain’s National Health Service stopped paying for the procedure if there was no good reason for it after an analysis by its Center for Reviews and Dissemination at the University of York concluded in 1998 that there was no solid scientific evidence to support it. Also that year, the Royal College of Physicians of Edinburgh said that for patients who do not have a condition related to third molars or whose teeth would probably grow in successfully, removal is “not advisable.”

In 2005, a review by the respected Cochrane Collaboration said the number of extractions could be reduced by 60 percent if they were done only when patients were in pain or developed a condition related to wisdom teeth. The group also said there is “reliable evidence” that suggests that removing wisdom teeth does not prevent or reduce crowding of front teeth.

In 2008, the American Public Health Association dismissed arguments typically made for removing wisdom teeth: that adjacent teeth might be damaged, or that the teeth may harbor bacteria that cause periodontal disease. The association approved a policy saying these concerns do not justify the risks of surgery, which include possible nerve damage, complications from anesthesia. loss of the sense of taste and, very rarely, death.

“The few studies of long-term retention of impacted teeth have shown little risk of harm,” the association concluded.

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I've since brought this up with a few other friends who are dentists as well. They always start off by haranguing me for doing my own research, instead of following my dentist's recommendation. Then once I show them all the above evidence, which they have never seen before, they change their minds and accept that I'm probably right.

With a track record like that, I wouldn't be surprised at all if flossing turns out to be yet another sacred cow that's virtually pointless in reality.

I do have to say kudos to the dental field though. At least they are making efforts to validate their recommendations, using empirical studies. I wonder how many of the recommendations given by programmers/teachers/fitness-trainers etc are similarly flawed.

http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavi...

http://www.nytimes.com/2011/09/06/health/06consumer.html

I've tested a few times - if I floss the day before and day of I don't get the "floss more!" lecture.

I wondered that too. But I also worry whether the immediate-term indices of dental health that hygienists are taught to look for correspond to long-term dental health endpoints.

Now I'm wondering whether brushing with added attention towards gums would provide an equivalent result.

> bleed less when I floss regularly

Sheesh, shouldn't they ideally never-bleed? Just what is it you're ingesting (or not ingesting)?

Your argument is a slippery slope for the acceptance of every kind of pseudoscience.

How do we know something is 'obviously' good for you without research? NOTHING Is so cut and dry that you can make that statement. For example: organic food. Obviously, must be amazing for you. Got two great buzzwords in it: organic and food. Therefore, amazing for you. Does the research bear this out?

Similarly, homeopathy, reiki, psychic surgery, acupuncture.

Vaccines: foreign substance entering our body. Therefore, terrible for you. Stands to reason right?

How could you make such a sweeping statement claiming the higher ground that we must exist in such an enlightened age that we don't have to continually fight the battle for evidence based activities in all activities?

I think that's missing the point. And, as an aside, so are all the comments in this thread that are essentially "flossing works for me, so I'm going to keep doing it." The point of this article is not that people should stop flossing, or that it's bad for some reason. The point is that an entire industry of medical professionals were saying "floss because it reduces you risk of tooth decay and gum disease," when in fact there is little evidence that it does either. It is a huge detriment to the credibility of dentists in my opinion.

Except even when we have researched something, it turns out we were wrong half of the time. We've only had a couple centuries since the Age of Enlightenment - we know practically nothing for sure (ie: well enough to take for granted). Unfortunately human nature seems to be vastly overconfident, so that's not a popular opinion.

Yeah but my gut tells me you're wrong.

I had the opposite reaction: how on earth has no one looked into this!?

But if you dig into it, it's horrifying how little "evidence" goes into treating a lot of common medical conditions. For another trivial example, the stuff in Sudafed PE (phenylephrine) http://www.sciencedirect.com/science/article/pii/S1081120610... is much worse than the psuedophedrine it replaced.

I wish the NIH (and other funding agencies) would consider running big, confirmatory trials on a lot of "obvious" things that affect people every day, the money clearly isn't there and it's politically difficult to get it there: There are a fair number of ignorant Congressman in the US who love to rant about 'wastes' of government money on studies like these.

Remember "chocolate is good for you"? Turns out that: "While research shows that cocoa can have a beneficial effect with regards to maintaining healthy vascular tone and insulin sensitivity, the reverse is true for sugar. Eating sweetened chocolate is still not good for you." [1]

Yet plenty of people seem to have fallen over each other to share that article (and this article). It seems anything that says you can have your cake and eat it too will have plenty of social media shares. In this case, it looks like flossing may be lightly studied, but is still good for us. Perhaps we can change that famous old adage to, "if it sounds too good to be true, it's probably clickbait".

Here's another piece of research on flossing, "In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss." [2]

That's on a study of 319 people, flossing regularity is based on surveys and dental health based on examinations.

[1] https://www.bulletproofexec.com/is-chocolate-good-for-you-he... [2] http://onlinelibrary.wiley.com/doi/10.1111/j.1752-7325.1995....

Or, people who were assigned a professional flosser every single school day were also more likely to brush their teeth better and were reminded constantly about their teeth and even possibly taught stuff about teeth and so maybe even ate less sugary things. I don't have access to the paper: did they at least have the professional flosser supervise the self-flossing to control for this? Otherwise this just seems like a much more likely reason for these results.

I can second that story.

I spent years between dental visits when I was between my parents health insurance and getting a job that actually covered dental. By that time, it was almost too late.

I had severe Periodontitis and was told that if I didn't do something within a few years, my teeth would start falling out. I had a root planing surgery and some other procedures done to save my teeth. My dentist said I was given another chance, but in order to save my teeth, it was paramount to floss every day.

I started flossing and at first my gums bled like crazy, but over time, the bleeding lessened and after 6 months of flossing and several more visits to the dentist, my gums were almost fully recovered and my teeth were effectively saved.

Since then I still floss daily and see my dentist every 6 months like clockwork. Since I started flossing my teeth, my teeth cleaning appointments are literally 30-40 minutes. I can get in and out and its completely painless.

All of this I attribute to flossing daily.

You floss after brushing? I always thought the reverse was the best practice. Of course... there has been zero science, so maybe the best is brush -> floss -> brush -> Listerine -> floss.

Same here. Going from no-floss to 1x WaterPik and 1x floss daily has radically lowered scraping, bleeding, pain, etc. during my regular checkups.

From my own experience, I would have to agree. I've never had braces so the gaps between my teeth vary between wide enough to fit the tip of my tongue to so tight that floss has a hard time getting in. Brushing can't handle those very tight spaces.

My wife recently purchased a battery-powered Waterpik and is obsessed with the thing (it works in the shower, too):

http://amzn.to/2axkvkK

She had been compulsively flossing, but this device has reduced that desire.

I have one of those and it made big difference with my gums. It washes away pieces of food that often don't get removed by brushing. My dentist noticed a difference after a year even though I didn't tell him that I use an irrigator.

I looked into this. It just rinses the plaque in a lot of cases rather than scrapes it away.

My father in law is a dentist in Germany and he never recommended flossing. In fact flossing is not common in Germany and we don't hear that Germans have very bad teeth compared to Americans.

So although dentists could notice if you have good dental hygiene I'm not sure they can spot easily if you floss or not. It might just mean that in US good dental hygiene means that you floss, but converse might not be true.

Flossing can have benefits. That still doesn't mean that we should be ok with medical professionals making specific claims like, "flossing reduces the risk of tooth decay," that have no good science behind them.

When I feel food stuck in the teeth I'll floss. Rarely have I flossed out anything that I didnt feel - usually the tiny bits are taken out by a strong rinsing. I just dont see the point of taking more minutes out of my day for little reason. (I have never had issues with plaque so ymmv).

This would be my guess too. I've never had a cavity in my life, which I'm sure is partially genetic, but I don't floss and brush only once a day in the morning. I haven't been to a dentist in ~6 years. My diet is very clean though -- no soda, candy, or really anything else high in sugar other than fruit. I eat a lot of raw vegetables too, which I think clean my teeth as I chew.

It may well be, but since sugar is an integral part of modern diets that doesn't help us much.

If you had as many people jumping out of planes as those that have teeth, you assuredly would have studies about parachute design, packing methods, survivability in the face of failure. You absolutely would have research that shows that parachutes prevent death.

I don't floss, and I'm confident my day won't end with me hitting the ground at terminal velocity. I'll let you know if it turns out I'm wrong.

Can we agree that the dangers of not flossing and the dangers of leaping from a plane without a parachute have little in common?

There have been many controlled trials as to the efficacy of parachute braking, although I doubt many have been published outside the military.

Everyone replying to this so far is fun at parties, I'm sure of it.

In 2011 I became aware of pain in my lower left chewing teeth. I had no health insurance, and no money to see a dentist. Over the course of two months, the pain got worse and worse. Finally, I decided I would rinse with Listerine, for long periods of time. I would take a swig of Listerine and hold it in my mouth for 30 minutes, spit it out and take another swig, and hold that in my mouth for another 30 minutes. I would do that all day, while I worked at my computer. My thought was that the bacteria could only do limited damage if my mouth was full of Listerine, so I kept Listerine in my mouth for several hours a day. Maybe I was right, or maybe the effect was psychosomatic, but after ten days of such treatment, the pain faded away.

I agree that most animal fats are healthy (ex. saturates) but I believe excess salt is still considered unhealthy even by current studies? Or am I mistaken on that?

No disagreement on sugar either, definitely unhealthy in excess (in particularly when artificially added disproportionately to the other nutrition within the food).

The recommendation to floss was not justified by reduced gum bleeding, it was justifies by reduces tooth decay. Indees, its now been removes from official FDA recommendations. Likewise, flossing might very reliably make the backs of your teeth whiter, but this is a negligible benefit and is not curing a disease. The headline is a fair summary, even if it could have been more informative by not trying to be funny.

Brushing teeth isn't the only way of cleaning them. A lot of people use sticks or other means that are harder and more effective at cleaning teeth.

There are studies which show that flossing isn't effective. Here's an older article mentioning three studies:

http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-...

I read the conclusion so that flossing is useless, because it isn't done correctly or it is just a wrong way to clean teeth.

I've had a similar personal experience. My dentist asked me to floss because my gums were bleeding. I flossed for few years, but it didn't cure my bleeding gums. Then my dentist suggested using interdental brushes. I did it for a while and it helped. My gums are no more bleeding.

So, I say no to flossing, yes to cleaning teeth with better means.

Read the article. It mentions actual studies saying they haven't evidence it does much if anything.

+1 but also a modern twist: intradental brushes. They're a piece of wire with a handle, coated with bits to pull plaque off teeth.

You use them exactly like a toothpick but they have a nice big grip and you can get 90 degree versions with long handles for your back teeth.

A pack will easily last a year.

Cannot be bothered flossing (and I salivate a lot which makes it harder) but intradental brushes are now part of my daily routine.

This is an interesting thread to read and think about rationalisations, habits and culture. You have a good control group too: Floss usage is about 60%+ in the USA, and 20% or less in Europe.

I use both depending on inter-teeth space. There are different techniques of flossing and different floss types. So, trying different may solve the problem with flossing itself. For those who cannot use interdental brushes. Some doctors suggest moving the floss up and down along the teeth. Others to put it inside teeth and the pull to the side. I found the second more convenient and less traumatic at the same time. But you need a wider floss to make it work. Try different. Me and my wife use different: one brand works better for her, but is too narrow for me. Experiment. I had chronic inflammation since school. Flossing completely solved the problem in a month or two.