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To Floss, Or Not To Floss?

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The Associated Press recently came out with a story that had nearly everyone on the planet flashing their pearly whites in a big collective grin: Flossing is a waste of time.

According to the report, which ran on Aug. 2, there is a striking lack of scientific evidence to show that daily flossing actually prevents gum disease and tooth decay. (Whether as a result or by coincidence, flossing got dropped from federal dietary guidelines when the AP began pressing the feds for evidence last year.)

As floss-slackers rejoiced, the flossing faithful felt they had been duped—even abandoned. How could every dentist they’d known since they’d grown teeth have been so wrong?

But please, let’s all cool off and turn down the heat on the great flossing flap of 2016. As with many questions related to health and medicine, experts do not always agree. But while it may be surprising to learn that there’s scant evidence supporting such a universal health dogma, there may be a lot less here than meets the eye-grabbing headlines.

Let’s brush up on the basics.

Flossing reduces plaque, the sticky film that collects at the gum line as a result of eating—or just being alive. This plaque harbors lots of bacteria. In fact, the American Dental Association estimates that more than 500 species of bacteria thrive in this plaque. Some are good; some not so good.

An overgrowth of these bacteria can contribute to the development of gingivitis. If left untreated, gingivitis can progress to periodontitis: gum disease with associated bone loss. Without flossing and regular dental cleaning, gingivitis can lead to tooth loss as well as chronic systemic illnesses such as low-birth-weight babies, diabetes and heart disease.

“The mouth is often the forgotten part of systemic health, and it’s really the gateway to the body,” says Susan Pugliese, D.D.S., program director for the General Practice Dental Residency Training Program at Christiana Care Health System.

In today’s world, we look to the evidence to determine if what we believe is true. But there’s a saying in the science world that “absence of proof isn’t proof of absence.” In other words, unproven is simply unproven, not disproven. And there’s plenty of anecdotal evidence that supports the belief that flossing helps to maintain good oral and systemic health.

Take the case of tooth decay. Most decay occurs when plaque builds up between neighboring teeth. If the plaque is not removed, the bacteria break down the tooth surface to cause a cavity.

Flossing does just what a toothbrush does but it reaches the surfaces the toothbrush bristles can’t. The toothbrush cleans the cheek-side and tooth-side of each tooth and the floss gets the interdental area.

Bruce Matthews, D.D.S., of Matthews Dental Associates in North Wilmington compares the process to that of proper hand washing. “If you put your fingers together and washed your hands, you would miss the bacteria in between your fingers,” he says. “That’s why you interlace your fingers and move back and forth to get the soap into those crevices.”

Not even a Waterpik can disrupt plaque as effectively as flossing, he says.

Still not convinced? Matthews recommends examining a piece of floss after using it to see how much plaque it actually removes.

The bottom line: Keep flossing! Floss deeply, curving it into a C-shape around the tooth and hugging it as you move up and down as far as you can.

Flossing remains a low-cost, low-risk method that has some (potentially) sound health benefits. It may very well be a good idea waiting to be studied, says Pugliese.

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