Flossing no longer recommended

Where the Statement “Flossing no longer recommended” Originated

The U.S. Departments of Agriculture and Health and Human Services determine the Dietary Guidelines based on analysis of scientific literature. In 2016, they concluded there was insufficient high-quality evidence to support flossing benefits and removed it from their recommendations.

However, this does not mean flossing provides no oral health benefits or should be avoided. The Guidelines also noted the importance of removing plaque. And research continues demonstrating flossing’s unique interdental cleaning effects when combined with brushing.

Lack of Rigorous Supporting Evidence

There are good reasons flossing itself has limited vigorous scientific study dedicated to it:

• Dentistry relies heavily on accepted best practices rather than strong clinical trials for many procedures.
• Rigorously studying isolated flossing is extremely challenging due to ethics and control – you cannot instruct people to avoid all oral hygiene long-term.
• Commercial interests have not driven large-scale flossing studies, though objective data does exist.
• The effect size between brushing alone and adding flossing is smaller and difficult to accurately assess.
• Self-reported flossing compliance is questionable making conclusions problematic.

So a lack of robust studies on flossing does not equate to lack of effectiveness or safety. And data clearly shows brushing alone is not enough.

Ongoing Support for Flossing Benefits

Despite limited vigorous clinical trials, extensive evidence indicates flossing benefits oral health:

• The ADA, AAPD, and other major dental organizations continue firmly recommending daily flossing given its unique interdental cleaning abilities.
• Systematic reviews continue showing flossing combined with brushing provides a significant reduction in gingivitis, plaque, and gingival bleeding compared to brushing alone.
• Flossing is proven to remove up to 80% of plaque buildup from between teeth that brushing misses.
• Periodontal health improves most when flossing is added to a brushing regimen.
• Proper flossing technique prevents tissue damage, enamel wear, and other alleged risks.

Professional dental consensus remains that flossing protects oral health when practiced properly. Patients should continue following individualized recommendations from their dentist.

Flossing Effectiveness:

It’s a well-established fact that any type of dental floss, when used in conjunction with a manual toothbrush, is more effective at removing plaque and debris from between teeth than brushing alone. This combination helps reach areas that a toothbrush alone cannot access, reducing the risk of cavities, gum disease, and bad breath.

Dental Floss Evolution:

Dental floss has indeed evolved significantly over the years. Today, there are various types of dental floss available, including:

a. Traditional String Floss: 

It consists of a thin string, typically made of nylon, polyethylene, or similar materials. To use it effectively, one must manually slide the floss up and down the sides of each tooth, carefully navigating the spaces between. 

This method requires wrapping a length of floss around the fingers and demands some dexterity to achieve the proper technique. Traditional string floss is available in both waxed and unwaxed varieties, catering to individual preferences for ease of use.

b. Floss Picks:

Floss picks offer a convenient alternative to traditional string floss. These tools come pre-strung with floss and feature a plastic pick with a handle. Instead of using one’s fingers to manipulate the floss, users can hold the handle for a more comfortable grip. 

Floss picks are particularly useful for navigating tight spaces between teeth and can be an excellent option for individuals with dexterity issues. They are available in disposable forms and also in models with replaceable floss heads, offering both convenience and eco-friendliness.

c. Water Flossers:

Water flossers introduce a modern twist to interdental cleaning. These devices use water pulsations at adjustable pressure levels to effectively clean between teeth. Users guide a specialized tip along the gumline and between each tooth, allowing the water pressure to flush out bacteria and debris from the gaps. 

Water flossers serve as a valuable alternative for those who may struggle with traditional string floss due to dexterity or comfort issues. However, they require a power source and routine maintenance to ensure optimal performance, making them a high-tech but efficient addition to oral hygiene routines.

These innovations aim to provide individuals with options that best suit their needs and preferences for interdental cleaning between teeth. Discuss best options with your dentist.

Comprehensive Oral Care:

While dental floss is highly effective, it should be viewed as one component of a comprehensive oral care routine. Brushing, flossing, and regular dental check-ups work synergistically to maintain optimal oral health. Flossing plays a unique role in ensuring the cleanliness of interdental spaces, which is critical for preventing gum disease and cavities.

Your Dentist Should Determine Recommendations

The 2016 Guidelines do not mean healthy patients should universally cease flossing. But expectations should be personalized based on each patient’s unique oral health status and needs. Considerations might include gum disease risk factors, dexterity, level of interdental crowding, use of interdental brushes, and more. Discuss your habits with your dentist and listen to their tailored flossing recommendations.

Bottom Line

Flossing is still considered an important supplement to daily tooth brushing for optimal oral hygiene by reputable dental organizations. Make decisions based on what your dentist recommends for your specific needs, not sweeping headlines. Avoid absolutes.

While rigorous, direct clinical trials may be lacking, extensive evidence and professional consensus supports flossing’s unique ability to clean between teeth when done properly. Continue taking advantage of this benefit as part of your individualized prevention strategy.