It’s not surprising to hear that you have to take a news story with a grain of salt these days. Journalists only have a job if they’re able to get people to hear their stories. New York Times’ Catherine Saint Louis recently wrote a piece about flossing recently that I’m sure everyone has heard about. This article is far from the first of its kind and certainly not the last. But each day since the story has been published on August 2, I’ve had patients come in and make sure I’d heard about the “news” on how necessary flossing is. Whether the patient is joking or not, it’s discouraging to hear that the public is being told that part of their basic dental hygiene is not important (the title of the article is “Feeling Guilty About Flossing? Maybe There’s No Need” for crying out loud).
As dental professionals, we need to be able to recognize what our patients are reading and have an honest response to it. In short, Louis writes that “brushing with fluoride does prevent dental decay. That flossing has the same benefit is a hunch that has never been proved” in response to UCLA’s Dr. Hewlett explaining the benefits brushing and flossing by disturbing the bacteria that build up in our mouths over time.
For dentists, hygienists, and students, quitting flossing because there aren’t overwhelming amounts of clinical control trials may seem like a shortsighted idea. But that is where we must think from our training to connect with stories like this one. Not many patients research biofilms, periodontology, and cariology on their own or with credible sources. That’s what we’re trained to do. Explaining to patients how bacteria acidify oral microenvironments that lead to demineralization can help explain that without accessing the interproximal spaces, there is a very real opportunity for bacteria and caries to take hold. Biofilms left undisturbed are able to increase gum inflammation as well as allow bacteria to continue producing an acidic environment that will weaken tooth mineralization.
Is flossing guaranteed to solve all of life’s problems? No. Does it decrease the risk of dental concerns? Even Louis admits a study by Dr. Phillipe Hujoel at the University of Washington showing a 40% decrease in dental caries over 2 years when school children had their teeth flossed daily. Periodontal benefits can be seen every time we do a prophy or SRP.
The importance of this conversation with our patients is to say that there is no single expectation for all patients. Some people can never floss and never have any problems, but other patients get interproximal caries on every posterior tooth or have major subgingival calculus deposits that lead to mobility and bone loss. Though our intent should never be to scare patients into better habits, it is our job to make sure that misleading information is explained from both sides of the coin while recognizing the basis of such stories.
The American Academy of Periodontology has recognized that there are not many extensive long term studies specifically on how flossing is related to caries and periodontitis. However, an August 2 press release from the AAP explains that the long-term progression of periodontal disease and the number of factors that influence the speed of its onset require studies to be much more in-depth with data collection and be followed over a longer period of time. Because no research has yet presented to suggest that these factors do not influence the progression of periodontal disease, AAP recommends flossing daily until other information can prove otherwise.
In AAP’s August 9th follow up press release, AAP president Dr. Aldredge explains their position on daily flossing:
”Gum disease is typically caused when prolonged exposure to bacteria in dental plaque causes an inflammatory reaction. Flossing is an effective and useful way to remove the plaque, especially in between the teeth or under the gum line- places where a toothbrush cannot reach;.”
We need to be thankful that our patients are willing to read about oral health as it presents in the news, but we also need to be aware of what they’re reading so that we can be prepared to have a conversation about it. Articles like this may go against our common sense, but it is logic that is explained in textbooks and lectures that our patients may not have access to. Having a great periodontist on your dental team is important, but let’s do our best to make sure the New York Times isn’t responsible for their next wave of referrals.
Catherine Saint Louis. “Feeling Guilty About Not Flossing? Maybe There’s No Need”. New York Times. August 2, 2016. http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0
“AAP recommends flossing”. American Academy of Periodontology. August 2, 2016. https://www.perio.org/consumer/AAP-recommends-flossing
“Gum disease experts: floss or risk losing your teeth”. American Academy of Periodontology. August 6, 2016. https://www.perio.org/consumer/AAP-recommends-flossing-as-essential