Flossing isn’t usually seen as an enjoyable activity. Fifty-five percent of Americans, in fact, would rather wash dishes, sit in traffic, wait in a checkout line, or even clean the toilet than floss, according to a 2015 survey from the American Academy of Periodontology.
If you’re in that camp, you may have rejoiced recently when headlines proclaimed that the medical benefits of flossing were unproved. But does that mean you can simply toss the floss? Here’s what you need to know about flossing and your dental health.
Dental Floss: Where’s the Evidence?
The fuss about floss arose shortly after Jeff Donn, a writer for The Associated Press, noticed that the latest version of the Dietary Guidelines for Americans, issued at the end of 2015, included no recommendation for flossing although earlier versions did.
Donn looked at the medical literature on flossing and found little solid evidence that using dental floss reduces the amount of plaque, the sticky, bacteria-laden biofilm that forms on teeth. And there’s also scant proof that the practice prevents advanced gum disease, or periodontitis.
For example, a 2015 analysis of four large reviews on the prevention of periodontitis, conducted by an international team of experts and published in the Journal of Clinical Periodontology, concluded that “the majority of available studies fail to demonstrate that flossing is generally effective in plaque removal and in reducing gingival inflammation.” A 2011 review of 12 studies by the independent Cochrane Collaboration found some signs that flossing might ease the gum inflammation of gingivitis but only “weak, very unreliable evidence” that doing it along with teeth brushing reduced plaque.
But the evidence for flossing’s benefits is inconsistent in part because studies haven’t followed people long enough to detect potential improvements, says Jay W. Friedman, D.D.S., M.P.H., an expert on dental public health and quality standards and an adviser to Consumer Reports.
The mixed findings may also be related to how well or poorly people use dental floss. In a 2010 review of six studies, researchers at the University of Washington School of Dentistry found that when youngsters 4 to 13 had their teeth professionally flossed five days per week for 1.7 years, they saw a 40 percent drop in their cavity risk. But adolescents who flossed on their own saw no such benefit.
And some of us may overstate how often we floss. That 2015 AAP survey found that one in four Americans who claim to floss regularly were fibbing.
To Floss or Not to Floss?
The American Dental Association still endorses “cleaning between teeth once a day with an interdental cleaner,” contending that the practice can reduce plaque. The Department of Health and Human Services concurs, noting that leaving flossing out of the most recent dietary guidelines didn’t signal that the practice was unimportant. Be aware too, that the Dietary Guidelines Advisory Committee made a deliberate decision to focus on food and nutrient intake in its 2015 report, and that’s why the flossing recommendation was dropped.
Friedman, an expert in evidence-based dentistry, says that whether you floss or use another method, it’s worthwhile to clean between your teeth every day. Getting food particles out from between your teeth before they can break down—feeding bacteria and increasing the likelihood of bad breath—is one reason, he notes. That’s especially important as you get older, because gum tissue between the teeth shrinks with age, leaving wider gaps where bits of your breakfast toast can get stuck.
He says that flossing can help dislodge small pieces of food, along with rinsing vigorously with water after eating. Flossing with a water-jet device may be especially helpful. “Water flossing has been shown to be more effective in removing plaque,” Friedman says, “and is recommended by periodontists, in particular, for patients with periodontal disease and also for cleansing around dental implants to prevent or minimize peri-implantitis, the inflammation of the gums around an implant.”
Interdental brushes, usually found in drugstores near the dental floss, may be another good option. The 2015 analysis found that they did a better job than dental floss at removing plaque, but they might be hard to use without irritating your gums. The researchers concluded that flossing is a good idea if you can’t fit the tiny brushes between your teeth easily.
But no matter how you clean between your teeth, it should still be just one part of an overall dental-health plan aimed at preventing gum problems as well as cavities. “The most effective means of reducing tooth decay is public-water fluoridation, brushing with a fluoridetoothpaste, a low-sugar diet, eliminating soda pop, and not smoking,” Friedman notes. And if you floss, do it right. Instead of sawing away at those tender gums, follow these steps.