I wonder why they don't fund proper studies. Maybe because the effect is too obvious to question? My oral hygienist can tell whether I floss regularly or not, so there must be an observable difference in plaque buildup. Subjectively my gums also feel better and bleed less when I floss regularly.
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.
There's a ton of evidence in the literature supporting that gum disease and cavities are, obviously, a bacterial issue.
Flossing is an obvious way to disrupt pathogenic bacterial colonies by abrasion. I think irrigation is much better, as it reaches deep pockets below gums. But it doesn't replace flossing entirely.
Those two, coupled with regular brushing of teeth, gum and tongue, plus oral probiotics should keep issues at bay.
In particular, my experience with probiotics is that tartar calculus fell apart within a few months. I have never had a cavity.
Sadly most dentists don't place too much emphasis on these as it goes against their business model: drill, fill and bill.
Where is this research that flossing is "an obvious way to disrupt pathogenic bacterial colonies by abrasion".
Here's some research that claims flossing actually causes problems.
"Dental flossing can produce bacteraemia in periodontally healthy and periodontally diseased individuals at a rate comparable with that caused by some dental treatments for which antibiotic prophylaxis is given to prevent IE."
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-051X.2008....
But in general, interdental flossing is very good against contact cavities [1]. Perhaps deep flossing is leading to bacteraemia. I have always found hard and awkward to perform deep flossing, and that's why I use oral irrigators instead. However, maybe irrigation also leads to bacteraemia. I've seen some references supporting that too.
Blis M18 and K12 strains. There are many brands using these. I prefer pills straight from Blis or Life Extension.
If your mouth has an unhealthy microbiome, you might need to place a lot of emphasis on killing bad bacteria initially. For this purpose, salt water or mild antibiotics (chlorhexidine) for 2 weeks combined with double dose of probiotics should do the trick.
Obviously, sugars feed bad bacteria, which metabolize it into acids to erode your enamel. Avoid entirely.
I reckon milk kefir is pretty good, apparentiy it has a particularly broad and strong co-operative of micro-overlords, ahem, micro-organisms! Dental-protection? probably? No studies to back that, but in my opinion, it's one of the best cultures for your insides.
Also worth noting that if you floss properly (maybe also use interdental sticks) the descaling routine becomes a lot more comfortable. For this reason alone it's worth doing.
Flossing was a painful, bloody mess for me the first week or so I did it. Then it felt great, then I ran out of the floss sticks (like a disposable razor, but with floss instead of a blade) and haven't done it since. Such is life.
I found this to be the same with a water pick. At first my gums bled and hurt, but after a few weeks I could turn the power to max and it feels like an awesome massage on my gums. I used to get some food stuck between my teeth, but now almost never do which I presume is due to much healthier gums.
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.
You might find that if you go to the dentist for teeth cleaning and they clear away all the plaque buildup that you'll be able to get the floss in between your teeth.
Like you, I have good teeth (never had a filling) and on average have visited the dentist about once every 10 years.
Like you I also used to never be able to get floss in between my teeth, but after a dental checkup some years back the dentist cleared all the plaque buildup and from then on getting the floss between my teeth was no problem, and I've been flossing regularly since.
Once the plaque builds up and hardens, it's very difficult to break it up with just floss and you'll have difficulty getting floss in.
For what it's worth, my teeth definitely feel cleaner after flossing, and if I miss a couple of days they start to feel dirty.
I had the issue that I couldn't floss due to lack of gaps too, I even have a wire behind my bottom teeth keeping them together after having braces when I was younger. This meant I had to visit the dentist if I wanted to clean between my teeth and even after that, normal floss just didn't fit.
But now I have discovered floss tape; it's just what it sounds like, a thin strip of tape that you can slide between your teeth to floss. Now I can actually floss and it makes a big difference to how clean my teeth look and feel. I'm in the UK and the product I use is Oral-B Satin Tape - worth trying or finding an equivalent if you have teeth very close together.
My gaps are small. My dentist says my teeth are tight. I have found that using Glide is the best floss. Even with that I have at times cut right through the floss with a particular pair of teeth. You might want to try Glide.
I floss daily and sometimes twice a day. I keep floss at my desk at work and some mouthwash to kill some of germs that get stirred up. It is easy to fit that in when thinking through a problem.
I also take vitamin C twice a day. My dentists always comment on the good health of my gums and say "you take vitamin c don't you?" At 62 I want to maintain my gum and teeth health.
I have to use a plastic floss needle sometimes, you thread the needle with floss in order to get floss between teeth when there is some food stuck in there.
Amazing that people are wondering what the "scientific" value in getting food particles out of your mouth.
A few people are certainly "gifted" teeth-wise (I know another case), but not going to the dentist for 25 years would be disastrous if applied on large scale.
> Well that's the problem, we don't have better evidence.
We actually have had it for quite a while. The CAMBRA MOOC is put together by a dentist/statistician and lays out a point system based on correlation between patient behaviors/health and carries. It has been iteratively corrected based on effective and ineffective results when modifying behavior according to the system.
Notably in that system, floss is not given a point. Whatever effect it may have is either too weak or better described by other factors flossing correlates with.
When points like that come up, the teacher stresses that the system is only measuring odds of near term carries, so flossing may be effective for something else with regards to oral health or preventing one of the negative factors.
The sentence above was about considering the extreme case irrelevant.
Focusing on flossing itself, as person who started doing it regularly only as adult, I think that researching on how frequently one should floss (or not) is in a way like researching how frequently one should change underwear. It may make sense theoretically, but ultimately all it requires is just to pay attention.
I never noticed the bleeding and/or irritation of the gums (which dentists always mention) until I started flossing regularly.
Now I do feel a difference (as a matter of fact, I floss irregularly, depending on how the gums feel). Of course, I'm pretty sure I could survive without flossing at all.
This is in line with what dentists generally suggest. Given that flossing can be ultimately considered as simply extra cleaning, and that the presence (or not) of the effects can be easily observed, a couple of weeks of flossing should be enough for anybody to make a solid judgment more than any theory.
If it works for you, then no need to change it. For me, it depends on which tooth I'm flossing. Some are easier than others. Some are so tight that floss won't come out, it feels like I'm pulling a tooth out. For this reason, I don't floss often and not every tooth. I use toothpicks though.
I have tight straight teeth on one side and I wicked with little gaps on the other side. There is a big difference when I floss. On one side is usually clean, on the other is not. It requires a lot more maintenance.
For some teeth, I have to force it a little, my teeth are pretty close too. Its so worth it though: much better breath, clean feel, minimized risk of cavities.
I avoided purchasing one by forming a loop with the wire. I cut a 20cm (8in) piece, then I tie a triple knot (the simple over hand knot with both ends). The wire is very slippery so I move the first knot as close to the ends as possible, so as not to waste floss.
Having a loop allows to have a firm hold on the floss and adjust tension. I use it with both hands though. And I waste very little floss because I can rotate the loop and use every inch of it.
Thing is, teeth are so close to each other that literally nothing can get between them, not even food. I have however few teeth that get food in between, but these are the ones that already went bad and were fixed, and have gaps as a result of that.
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.
Honestly, I only need myself as evidence to the personal benefit; I have nothing to say about the generalizability of my results.
I've always had bad, painful dentist visits until my mid-20s. They were quite bloody. Since I started flossing, my dental visits are not painful, and my gums never bleed. When they do the gum measurements, I now get 2s and 3s instead of 4s and 5s.
The only change I made was flossing. I don't argue that it reduces plaque or has all of these life-changing benefits, but it stops my gums from bleeding and makes dentist trips a breeze. That's enough for me. Maybe others won't get the same benefit.
I've had a somewhat similar experience, but with a slight tweak. I now actually carry around a container of floss with me in my standard pocket loadout. But I don't floss everyday. I floss when I eat something that tends to get stuck in my teeth, beef jerkey being the worst offender, or when I notice I've got a bit of local inflammation in my gums, which has always turned out to be some piece of food stuck in there.
Given how bad inflammation has proved to be lately (be it because the inflammation itself is bad or because what is causing it is bad doesn't matter much to me if it's bad either way), it's at least plausible that flossing may have an effect on gum disease, but also plausible that it's an entirely situational thing. A habit may be better than never doing it, but you may just need to do it when the situation calls for it.
Ultimately I carry the floss around because regardless of whether it has long term benefits provable by science, it definitely can have short-term benefits of having less inflamed and at times slightly-painful gums because it's trying to use the immune system to remove a chunk of food better physically removed.
My teeth are tight and food tends to get stuck between them. If left attended the effect is festering, pain and infection. A quick floss, some mouthwash as a few days and the healing is complete. I will continue to floss. For me, the study size of one, flossing is a benefit. YMMV
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.
