A String around Your Finger: Do We Really Need to Floss?
Dental plaque containing pathogenic microflora, is a necessary component in the initiation of both dental caries and periodontal disease, the two most prevalent oral diseases. As an integral part of the prevention and treatment of caries and periodontal diseases, patients become co-practitioners with their oral health providers and their sustained daily maintenance of oral hygiene becomes critical to the success of professional oral health interventions. However, patient levels of home care vary considerably and are often suboptimal. Despite recommendations from the American Dental Association (ADA) that individuals brush for two minutes twice daily.12 the average individual performs 45-70 seconds of toothbrushing daily.10 Similarly, patient compliance with regular and sustained daily use of dental floss for interdental cleaning has been estimated to be as low as 2%.13 In a survey from the American Academy of Periodontology (AAP), more than 35% of respondents stated they would rather perform an unpleasant task, like filing their tax return or cleaning their toilet, than floss.14
Given the lack of public enthusiasm for oral hygiene measures and, in particular, for flossing,14 there was a large amount of public interest in August 2016 when the U.S. government released a statement that discussed the rationale for the omission of references to oral hygiene from the 2015-2020 Dietary Guidelines for Americans.15 Included in this omission were recommendations for 1) consumption of fluoridated water, 2) reduction of sugary food and beverage consumption, and 3) tooth brushing and flossing as effective methods to reduce the risk of dental caries. In response to a government Freedom of Information Act request, it was reported by the Associated Press that the flossing recommendation was excluded due to a lack of definitive scientific evidence stating flossing prevents dental caries.16 This was based upon a 2011 meta-analysis that concluded current scientific evidence exists to support interdental cleaning for the prevention and treatment of gingivitis, but more studies may be needed to demonstrate definitive benefit for the prevention of dental caries and periodontitis.1
Given the current oral hygiene practices and public interest in the omission of oral health references from the 2015-2020 Dietary Guidelines for Americans for the first time since 1979,15 it is critical for dental healthcare providers to be able to review the current scientific evidence and recent recommendations from government and non-profit groups to make recommendations for their patients, to allow for optimal implementation and compliance for oral self-care in their patients.