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Federal health expert drop flossing from health guidelines

159 points by jld89 10y ago

adrianN 10y ago
I wonder why they don't fund proper studies. Maybe because the effect is too obvious to question? My oral hygienist can tell whether I floss regularly or not, so there must be an observable difference in plaque buildup. Subjectively my gums also feel better and bleed less when I floss regularly.
- flukus 10y ago
  I've never flossed, I don't have gaps in my teeth to get the floss in. My first trip to the dentist in 25 years was a few weeks ago and my teeth were perfect except for a wisdom tooth and the damage it caused. So i'm kind of skeptical of the effect. Edit - I always wonder what kind of toothbrush other people use. I've always used electric ones so I wonder if that helps.
  - tiddlydum 10y ago
    This is anecdotal, but when I don't floss my teeth hurt.
    - nommm-nommm 10y ago
      Probably poor technique. When the oral hygienist flosses my teeth it doesn't hurt at all but I can't replicate the pain free flossing at home.
  - pizza234 10y ago
    Anecdote is not evidence. A few people are certainly "gifted" teeth-wise (I know another case), but not going to the dentist for 25 years would be disastrous if applied on large scale.
    - flukus 10y ago
      >Anecdote is not evidence. Well that's the problem, we don't have better evidence.
      - totalcrepe 10y ago
        > Well that's the problem, we don't have better evidence. We actually have had it for quite a while. The CAMBRA MOOC is put together by a dentist/statistician and lays out a point system based on correlation between patient behaviors/health and carries. It has been iteratively corrected based on effective and ineffective results when modifying behavior according to the system. Notably in that system, floss is not given a point. Whatever effect it may have is either too weak or better described by other factors flossing correlates with. When points like that come up, the teacher stresses that the system is only measuring odds of near term carries, so flossing may be effective for something else with regards to oral health or preventing one of the negative factors.
        osteele 10y ago
        A claim is that flossing reduces gingivitis. The CAMBRA MOOC measures carries.
      - pizza234 10y ago
        The sentence above was about considering the extreme case irrelevant. Focusing on flossing itself, as person who started doing it regularly only as adult, I think that researching on how frequently one should floss (or not) is in a way like researching how frequently one should change underwear. It may make sense theoretically, but ultimately all it requires is just to pay attention. I never noticed the bleeding and/or irritation of the gums (which dentists always mention) until I started flossing regularly. Now I do feel a difference (as a matter of fact, I floss irregularly, depending on how the gums feel). Of course, I'm pretty sure I could survive without flossing at all. This is in line with what dentists generally suggest. Given that flossing can be ultimately considered as simply extra cleaning, and that the presence (or not) of the effects can be easily observed, a couple of weeks of flossing should be enough for anybody to make a solid judgment more than any theory.
  - cLeEOGPw 10y ago
    > I don't have gaps in my teeth to get the floss in. Same here. Never understood how people can physically floss. Maybe those with undeveloped teeth can do it, others, I don't see how it's even possible.
    - fredsted 10y ago
      I use one of these: http://imgur.com/8A3dopG http://imgur.com/8A3dopG For some teeth, I have to force it a little, my teeth are pretty close too. Its so worth it though: much better breath, clean feel, minimized risk of cavities.
      - flukus 10y ago
        I've tried them, but they refuse to go in too.
        TorKlingberg 10y ago
        I use these. I can bit down on it if I need extra force. http://www.apteekkituotteet.fi/WebRoot/Euran/Shops/Eura/506D/44FC/C30E/E6B0/D550/0A28/1050/7369/plackers_twin.jpg http://www.apteekkituotteet.fi/WebRoot/Euran/Shops/Eura/506D... Of course people's teeth are different. I know some prefer these, where you push it in from the side. http://www.tepe.com/uk/products/interdental-brushes/ http://www.tepe.com/uk/products/interdental-brushes/
        cLeEOGPw 10y ago
        Thing is, teeth are so close to each other that literally nothing can get between them, not even food. I have however few teeth that get food in between, but these are the ones that already went bad and were fixed, and have gaps as a result of that.
      - throwaway41597 10y ago
        I avoided purchasing one by forming a loop with the wire. I cut a 20cm (8in) piece, then I tie a triple knot (the simple over hand knot with both ends). The wire is very slippery so I move the first knot as close to the ends as possible, so as not to waste floss. Having a loop allows to have a firm hold on the floss and adjust tension. I use it with both hands though. And I waste very little floss because I can rotate the loop and use every inch of it.
  - deleted 10y ago
    [deleted]
  - imron 10y ago
    You might find that if you go to the dentist for teeth cleaning and they clear away all the plaque buildup that you'll be able to get the floss in between your teeth. Like you, I have good teeth (never had a filling) and on average have visited the dentist about once every 10 years. Like you I also used to never be able to get floss in between my teeth, but after a dental checkup some years back the dentist cleared all the plaque buildup and from then on getting the floss between my teeth was no problem, and I've been flossing regularly since. Once the plaque builds up and hardens, it's very difficult to break it up with just floss and you'll have difficulty getting floss in. For what it's worth, my teeth definitely feel cleaner after flossing, and if I miss a couple of days they start to feel dirty.
    - MarcusP 10y ago
      I had the issue that I couldn't floss due to lack of gaps too, I even have a wire behind my bottom teeth keeping them together after having braces when I was younger. This meant I had to visit the dentist if I wanted to clean between my teeth and even after that, normal floss just didn't fit. But now I have discovered floss tape; it's just what it sounds like, a thin strip of tape that you can slide between your teeth to floss. Now I can actually floss and it makes a big difference to how clean my teeth look and feel. I'm in the UK and the product I use is Oral-B Satin Tape - worth trying or finding an equivalent if you have teeth very close together.
      - imron 10y ago
        Snap! Oral-B Satin Tape for the win.
  - throwaway41597 10y ago
    If it works for you, then no need to change it. For me, it depends on which tooth I'm flossing. Some are easier than others. Some are so tight that floss won't come out, it feels like I'm pulling a tooth out. For this reason, I don't floss often and not every tooth. I use toothpicks though.
  - epalmer 10y ago
    My gaps are small. My dentist says my teeth are tight. I have found that using Glide is the best floss. Even with that I have at times cut right through the floss with a particular pair of teeth. You might want to try Glide. I floss daily and sometimes twice a day. I keep floss at my desk at work and some mouthwash to kill some of germs that get stirred up. It is easy to fit that in when thinking through a problem. I also take vitamin C twice a day. My dentists always comment on the good health of my gums and say "you take vitamin c don't you?" At 62 I want to maintain my gum and teeth health.
    - amalag 10y ago
      I have to use a plastic floss needle sometimes, you thread the needle with floss in order to get floss between teeth when there is some food stuck in there. Amazing that people are wondering what the "scientific" value in getting food particles out of your mouth.
  - huherto 10y ago
    I have tight straight teeth on one side and I wicked with little gaps on the other side. There is a big difference when I floss. On one side is usually clean, on the other is not. It requires a lot more maintenance.
  - specialist 10y ago
    Congratulations. You won the genetic lottery. I did well, for a while, too. Then I had a lot of chemo. First year post, I had 14 cavities requiring fillings. Now I have 3 crowns. Floss your teeth, preferably with a water pick. Older you will thank younger you.
- jbpetersen 10y ago
  Now I'm wondering whether brushing with added attention towards gums would provide an equivalent result.
  - cel1ne 10y ago
    From personal experience I can say: It helps, but it doesn't give you equivalent results.
- dualogy 10y ago
  > bleed less when I floss regularly Sheesh, shouldn't they ideally never-bleed? Just what is it you're ingesting (or not ingesting)?
- mrweasel 10y ago
  For years my oral hygienist kept telling me to a get an electric toothbrush. When I finally got one, I didn't tell her, but I never hear the "get an electric tooth brush" again. It was the same with flossing. When I started flossing I didn't say anything, and she hasn't commented that I need to floss since.
  - dazc 10y ago
    Also worth noting that if you floss properly (maybe also use interdental sticks) the descaling routine becomes a lot more comfortable. For this reason alone it's worth doing.
    - rangibaby 10y ago
      Flossing was a painful, bloody mess for me the first week or so I did it. Then it felt great, then I ran out of the floss sticks (like a disposable razor, but with floss instead of a blade) and haven't done it since. Such is life.
    - merpnderp 10y ago
      I found this to be the same with a water pick. At first my gums bled and hurt, but after a few weeks I could turn the power to max and it feels like an awesome massage on my gums. I used to get some food stuck between my teeth, but now almost never do which I presume is due to much healthier gums.
  - nextos 10y ago
    There's a ton of evidence in the literature supporting that gum disease and cavities are, obviously, a bacterial issue. Flossing is an obvious way to disrupt pathogenic bacterial colonies by abrasion. I think irrigation is much better, as it reaches deep pockets below gums. But it doesn't replace flossing entirely. Those two, coupled with regular brushing of teeth, gum and tongue, plus oral probiotics should keep issues at bay. In particular, my experience with probiotics is that tartar calculus fell apart within a few months. I have never had a cavity. Sadly most dentists don't place too much emphasis on these as it goes against their business model: drill, fill and bill.
- pw 10y ago
  I wondered that too. But I also worry whether the immediate-term indices of dental health that hygienists are taught to look for correspond to long-term dental health endpoints.
- INTPenis 10y ago
  The effect is very obvious. I'm not ashasmed to say that since the age of 18 - your last year of free dental care in Sweden - to the age of 31, I didn't go to the dentist at all. I brushed mostly regularly the second half of this period, I never flossed. I'm a computer geek, I can get caught up in code for days without brushing my teeth but try to do it regularly. The result was 13 years of plaque and two visits to a dentist to clean it all out. Dental plaque is a coating over your tooth and your gums will grow over this coating. So I think it's pretty obvious that dental plaque can cause cavities between your gums and your teeth, infections in your gums and all this will in turn lead to periodontitis. And also you have saliva glands at the bottom of your mouth that bring with them additional minerals and stuff that get stuck to your teeth, forming plaque. So the front bottom teeth are even more important to floss. Now I floss regularly and I'm proud to have actually made it one of my daily habits.
  - pc86 10y ago
    > I brushed mostly regularly the second half of this period I'm terrified to ask what you did the first half of that period.
    - geon 10y ago
      Brushed irregularly?
    - weavie 10y ago
      " I can get caught up in code for days "
      - pc86 10y ago
        "I have terrible personal hygiene and write it off as being 'quirky'"
- whack 10y ago
  Except that studies have now shown that the effect is not obvious at all. "Since doctors began saying that a string-based tooth scrapping was good for oral health, a handful of studies have been conducted. However, they all fall far short of what’s needed to make a convincing argument. A 2011 review of a dozen randomized controlled studies concluded that, “Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.” The US Agriculture and Health and Human Services departments quietly removed the flossing recommendation from the latest version of dietary guidelines. ---------- If anyone thinks that this is because the study's parameters are too narrow to show an effect, that is not the case. Other studies have successfully shown the benefits of flossing... if the dentist is the one performing it. But they haven't been able to show similar results when regular people do the flossing. "Maybe the evidence that flossing reduces tooth decay or gum disease does not hold up because we are all such poor flossers. Superflossers, like the zealous hygienist at your dentist’s office, aim to “hug the neck of the tooth” and get below the gum line, Dr. Hujoel said. But we common folk, staring woefully at our bathroom mirrors, tend to lightly give it the once-over. A review of six trials found that when professionals flossed the teeth of children on school days for almost two years, they saw a 40 percent reduction in the risk of cavities. So maybe perfect flossing is effective. But scientists would be hard put to find anyone to test that theory." ----------- Honestly, I'm not surprised at all. Years ago, my dentist strongly urged me to get my asymptomatic wisdom teeth removed. I then went home and did my own research on this subject. And what I found was the complete opposite of my dentist's recommendation. But a new study of more than 6,000 patients in Greece found that only 2.7 percent of the teeth had a cyst or tumor. An older study, often cited by critics of routine extraction, found that only 12 percent of 1,756 middle-aged people who had not had impacted wisdom teeth removed experienced a complication. Numerous comprehensive reviews of research, conducted by independent bodies not affiliated with oral surgeons, have concluded that there was no evidence to support routine prophylactic extraction of impacted but healthy wisdom teeth. Britain’s National Health Service stopped paying for the procedure if there was no good reason for it after an analysis by its Center for Reviews and Dissemination at the University of York concluded in 1998 that there was no solid scientific evidence to support it. Also that year, the Royal College of Physicians of Edinburgh said that for patients who do not have a condition related to third molars or whose teeth would probably grow in successfully, removal is “not advisable.” In 2005, a review by the respected Cochrane Collaboration said the number of extractions could be reduced by 60 percent if they were done only when patients were in pain or developed a condition related to wisdom teeth. The group also said there is “reliable evidence” that suggests that removing wisdom teeth does not prevent or reduce crowding of front teeth. In 2008, the American Public Health Association dismissed arguments typically made for removing wisdom teeth: that adjacent teeth might be damaged, or that the teeth may harbor bacteria that cause periodontal disease. The association approved a policy saying these concerns do not justify the risks of surgery, which include possible nerve damage, complications from anesthesia. loss of the sense of taste and, very rarely, death. “The few studies of long-term retention of impacted teeth have shown little risk of harm,” the association concluded. ------------- I've since brought this up with a few other friends who are dentists as well. They always start off by haranguing me for doing my own research, instead of following my dentist's recommendation. Then once I show them all the above evidence, which they have never seen before, they change their minds and accept that I'm probably right. With a track record like that, I wouldn't be surprised at all if flossing turns out to be yet another sacred cow that's virtually pointless in reality. I do have to say kudos to the dental field though. At least they are making efforts to validate their recommendations, using empirical studies. I wonder how many of the recommendations given by programmers/teachers/fitness-trainers etc are similarly flawed. http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0 http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavi... http://www.nytimes.com/2011/09/06/health/06consumer.html http://www.nytimes.com/2011/09/06/health/06consumer.html
- bbayles 10y ago
  I've tested a few times - if I floss the day before and day of I don't get the "floss more!" lecture.
  - JoshGlazebrook 10y ago
    It really depends. If the plaque is left too long it will harden and turn into tartar (calculus), which can't be easily removed with just floss.
leaveyou 10y ago
For me the water flossers (oral jet irrigators) are the best solution yet. I was never able to floss correctly with a wire, especially between the teeth in the back row but then my dentist told me about "the jet thing from amazon" and I wish I had it a lot earlier because it's so easy to use and quite efficient. (Just don't jet your gums with the highest power; it can hurt and make your gums bleed)
- mountaineer22 10y ago
  My wife recently purchased a battery-powered Waterpik and is obsessed with the thing (it works in the shower, too): http://amzn.to/2axkvkK http://amzn.to/2axkvkK She had been compulsively flossing, but this device has reduced that desire.
  - criddell 10y ago
    In the shower? Why didn't I think of that? I've used a Waterpik before and ended up throwing it away because I invariably made a big mess with it (especially my mirror).
- deanclatworthy 10y ago
  I looked into this. It just rinses the plaque in a lot of cases rather than scrapes it away.
  - leaveyou 10y ago
    I don't know what model you use but mine is quite powerful (it's not a "portable/battery" model and it has 10 steps of jet intensity) and obviously it's best used in combination with the brush. If this does not work, I don't know what else could work.
- maxxxxx 10y ago
  I have one of those and it made big difference with my gums. It washes away pieces of food that often don't get removed by brushing. My dentist noticed a difference after a year even though I didn't tell him that I use an irrigator.
fpoling 10y ago
From what I read and from personal experience it is a diet that has strongest effects on tooth health, not the the way to toothbrush or floss. For example, in Europe tooth health became much bigger problem after crusades when knights brought various dessert recipes from Lebanon and Syria.
- xlxlxlx 10y ago
  This would be my guess too. I've never had a cavity in my life, which I'm sure is partially genetic, but I don't floss and brush only once a day in the morning. I haven't been to a dentist in ~6 years. My diet is very clean though -- no soda, candy, or really anything else high in sugar other than fruit. I eat a lot of raw vegetables too, which I think clean my teeth as I chew.
  - mtberatwork 10y ago
    The few cavities that I have had were all extremely tiny and hardly visible to the eye. You won't really know on your own that you have a cavity until it's much more fully developed. At that point, getting it repaired is much more aggravating and a pain. I'd highly recommend getting to the dentist more than once every 6 years.
- gotofritz 10y ago
  It may well be, but since sugar is an integral part of modern diets that doesn't help us much.
  - Legogris 10y ago
    Once you get started, a diet free from refined sugar is not at all as difficult to maintain as you might think.
    - osteele 10y ago
      Don't you need to avoid unrefined sugar and starch too? Which is not impossibly difficult (lots of folks do keto), but is more difficult than just avoiding refined sugar.
return0 10y ago
Toothpicks work just as well for me.
- nailer 10y ago
  +1 but also a modern twist: intradental brushes. They're a piece of wire with a handle, coated with bits to pull plaque off teeth. You use them exactly like a toothpick but they have a nice big grip and you can get 90 degree versions with long handles for your back teeth. A pack will easily last a year. Cannot be bothered flossing (and I salivate a lot which makes it harder) but intradental brushes are now part of my daily routine.
  - 83457 10y ago
    How long does one last? Do you use one for a week, month or just whenever you change your toothbrush?
    - nailer 10y ago
      About a month. The main thing is the plastic bumps on the wire wear away after a while.
      - 83457 10y ago
        Oh nice. They are pretty cheap then. I don't floss as much as I should (or should I?) so might give these a try. Thanks
gotofritz 10y ago
I used to floss more or less regularly and had constant gum problems. I then switched to interdental brushes, same frequency of use, and my gum problems have since disappeared. So in my case _something_ was needed for the gum's health, but flossing itself proved to be useless.
- chebum 10y ago
  I use both depending on inter-teeth space. There are different techniques of flossing and different floss types. So, trying different may solve the problem with flossing itself. For those who cannot use interdental brushes. Some doctors suggest moving the floss up and down along the teeth. Others to put it inside teeth and the pull to the side. I found the second more convenient and less traumatic at the same time. But you need a wider floss to make it work. Try different. Me and my wife use different: one brand works better for her, but is too narrow for me. Experiment. I had chronic inflammation since school. Flossing completely solved the problem in a month or two.
exhilaration 10y ago
This is the AP article that's mentioned, it has lots more information: http://www.today.com/health/there-s-little-proof-flossing-protects-your-teeth-or-gums-t101389?cid=sm_fbn http://www.today.com/health/there-s-little-proof-flossing-pr...
dbg067 10y ago
I'm sure a lot of individual observations come down to genetics. In my own case, I challenged myself to go from flossing once a week to every day over the past six months. Just recently went to the dentist and my gum pocket depths all decreased (signaling healthier gums apparently). Diet remained exactly the same.
Booktrope 10y ago
Clickbait based on a 5-year old source which actually says, "Twelve trials were included in this review which reported data on two outcomes (dental plaque and gum disease). Trials were of poor quality and conclusions must be viewed as unreliable. The review showed that people who brush and floss regularly have less gum bleeding compared to toothbrushing alone. There was weak, very unreliable evidence of a possible small reduction in plaque. There was no information on other measurements such as tooth decay because the trials were not long enough and detecting early stage decay between teeth is difficult." So studies showed flossing helps prevent gum bleeding. This is not what the article reports. Are there studies of effectiveness of tooth brushing? Imagine the control group - people who don't brush their teeth at all!
- nailer 10y ago
  Brushing teeth isn't the only way of cleaning them. A lot of people use sticks or other means that are harder and more effective at cleaning teeth.
- jessriedel 10y ago
  The recommendation to floss was not justified by reduced gum bleeding, it was justifies by reduces tooth decay. Indees, its now been removes from official FDA recommendations. Likewise, flossing might very reliably make the backs of your teeth whiter, but this is a negligible benefit and is not curing a disease. The headline is a fair summary, even if it could have been more informative by not trying to be funny.
sedeki 10y ago
So this is not an argument against flossing it is just there are no studies for it, correct? (Haven't followed the thread)
- coldtea 10y ago
  Read the article. It mentions actual studies saying they haven't evidence it does much if anything.
- gulpahum 10y ago
  There are studies which show that flossing isn't effective. Here's an older article mentioning three studies: http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-say-you-need-to-floss-science-says-you-dont/#2b54386677d5 http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-... I read the conclusion so that flossing is useless, because it isn't done correctly or it is just a wrong way to clean teeth. I've had a similar personal experience. My dentist asked me to floss because my gums were bleeding. I flossed for few years, but it didn't cure my bleeding gums. Then my dentist suggested using interdental brushes. I did it for a while and it helped. My gums are no more bleeding. So, I say no to flossing, yes to cleaning teeth with better means.
dmalvarado 10y ago
Anyone ever smell the floss after each tooth? Yea, I'm gonna keep flossin.
koolba 10y ago
> Still, many dentists will continue to recommend flossing for removing debris between your chompers. "It's low risk, low cost," National Institutes of Health dentist Tim Iafolla told CNBC. "We know there's a possibility that it works, so we feel comfortable telling people to go ahead and do it." Instead of talking about flossing you could talk about keeping a pet rock in your pocket and it'd also be "low risk, low cost ... we know there's a possibility that it works".
snarfy 10y ago
For most of my life I brushed but never flossed. I had no cavities but I was at risk of losing my teeth due to plaque below the gum line. My teeth were loose and gums would bleed when I brushed. I've had all that fixed and now floss regularly. In retrospect flossing seems more important than brushing.
DHMO 10y ago
I'm going to keep flossing. Screw them.
niccaluim 10y ago
There are also no studies on whether parachutes prevent death when falling from the sky[1], but I'm sure as shit still wearing one when I jump out of a plane! [1] http://www.bmj.com/content/327/7429/1459.long http://www.bmj.com/content/327/7429/1459.long
- gjem97 10y ago
  If you had as many people jumping out of planes as those that have teeth, you assuredly would have studies about parachute design, packing methods, survivability in the face of failure. You absolutely would have research that shows that parachutes prevent death.
- ysavir 10y ago
  I don't floss, and I'm confident my day won't end with me hitting the ground at terminal velocity. I'll let you know if it turns out I'm wrong. Can we agree that the dangers of not flossing and the dangers of leaping from a plane without a parachute have little in common?
- kstrauser 10y ago
  There have been many controlled trials as to the efficacy of parachute braking, although I doubt many have been published outside the military.
- niccaluim 10y ago
  Everyone replying to this so far is fun at parties, I'm sure of it.
StavrosK 10y ago
Isn't it about time we got rid of the ridiculous "if we haven't researched it, we know nothing about it" fallacy? Research is strong evidence that points towards something. Lack of research doesn't mean complete lack of a-priori knowledge. If something is obviously good for you, then that's probably a good start for recommending it.
- gjem97 10y ago
  I think that's missing the point. And, as an aside, so are all the comments in this thread that are essentially "flossing works for me, so I'm going to keep doing it." The point of this article is not that people should stop flossing, or that it's bad for some reason. The point is that an entire industry of medical professionals were saying "floss because it reduces you risk of tooth decay and gum disease," when in fact there is little evidence that it does either. It is a huge detriment to the credibility of dentists in my opinion.
  - MicroBerto 10y ago
    Dentists and dental hygienists look into tens of thousands of mouths over the courses of their careers. It's not difficult for them to see that patients who floss have far healthier smiles, in general. That said, they should get more studies done. You could also be a bad flosser, so even the study could be flawed.
    - ptaipale 10y ago
      Again, there's the comparison of people who sell ice cream and see that when they sell more, there will be more drownings. Correlation does not imply causation. I think it is quite obvious that people who floss also brush their teeth more regularly, and that is enough to give them healthier smiles. (Regarding the benefits of flossing, I'm agnostic.)
      - MicroBerto 10y ago
        It's true that correlation does not imply causation, but you're still wrong from my experience with hygienists and dentists. They definitely and easily see a difference seen between those who floss and brush and those who just brush. Also, those who use Sonicare, especially when used properly around the gumlines, also tend to have healthier mouths than those who brush with an old brush. The one thing that can throw a wrench in this whole thing is smoking. Smokers' mouths are disgusting basically no matter what. Point being, I love research, but I trust those who put their hands in tens of thousands of mouths more than skeptics on ArsTechnica article comments.
ccannon 10y ago
One word: Waterpik. It's the only thing that has a major influence on my oral hygiene. Here's the one I use: http://amzn.to/2ahIghr http://amzn.to/2ahIghr
eksemplar 10y ago
I never learned flossing, and then in my early twenties I kind of ignored the dentist for around 7-8 years. I still brushed my teeth throughly two times a day, every day. Got me paradentosis and almost lost me my teeth. It's completely anecdotal, but I recomend flossing.
wilwade 10y ago
I think the issue here is not if it is actually helpful or not, but that it was claimed (and advertised) to be without the necessary research. The AP article explains that flossing had to be dropped from the federal guidelines as those are required to be backed by research. The groups that claim it is good for you all have a financial reason to claim it. Not alone wrong, but wrong in the absence of quality research backing the claims.
wvh 10y ago
My mother-in-law is a dentist. When she heard I always brush my teeth but rarely floss, she told me flossing is more important than brushing your teeth. For once I didn't get into the science of things, but still I accept that getting old bits of food and other junk away from between my teeth can only be a positive thing. It runs counter to my sceptic nature, I like to question everything, but I'm slowly starting to learn that sometimes you just have to take an expert's advice. I'm sure any half-way decent dentist can see pretty quickly how well you take care of your teeth, in the same way a seasoned programmer can often point out a beginner's bad code or a civil engineer warn about the wrong way to build a bridge or a house on a swamp.
- gjem97 10y ago
  Flossing can have benefits. That still doesn't mean that we should be ok with medical professionals making specific claims like, "flossing reduces the risk of tooth decay," that have no good science behind them.
  - HemanHeartYou 10y ago
    I get what you're saying, but using the flossing flavor of the month argument to prove that point is pretty weak.
- chengiz 10y ago
  When I feel food stuck in the teeth I'll floss. Rarely have I flossed out anything that I didnt feel - usually the tiny bits are taken out by a strong rinsing. I just dont see the point of taking more minutes out of my day for little reason. (I have never had issues with plaque so ymmv).
- skolos 10y ago
  My father in law is a dentist in Germany and he never recommended flossing. In fact flossing is not common in Germany and we don't hear that Germans have very bad teeth compared to Americans. So although dentists could notice if you have good dental hygiene I'm not sure they can spot easily if you floss or not. It might just mean that in US good dental hygiene means that you floss, but converse might not be true.
spdustin 10y ago
Flossing, meh. WaterPiks, meh. http://oralbreeze.com http://oralbreeze.com Hooks right up to your faucet or shower head, has multiple tips, and is effectively an endless and super-quiet WaterPik. I do own a WaterPik-like device, but I use saline water and a special adapter for sinus irrigation (making it a post-modern Neti Pot I guess). OralBreeze, brushing and sinus irrigation every day. Helps fight bad breath — post-nasal drip contributes a lot to bad breath, as does rotting food stuck between your teeth. For me, it's helped reduce the incidence sinus infections, too. Plus the more advanced "Neti" usage involves allowing the saline solution to flow out of your mouth, so if you're prone to tonsil stones, it can help reduce those.
codeulike 10y ago
Lots of USA specific views in here. How about: Most patients, even if they bother to get the minty-waxed out the box, are exceptionally heavy-handed and macerate their gums like they’ve been chewing on bare vacuum cleaner flex. Even in controlled studies, after instruction, the patients taking part couldn’t floss properly. I know of no dentist who flosses. Not one. UK dentist, writing in the Guardian https://www.theguardian.com/commentisfree/2016/aug/03/dentists-great-flossing-yarn https://www.theguardian.com/commentisfree/2016/aug/03/dentis...
- codeulike 10y ago
  This is an interesting thread to read and think about rationalisations, habits and culture. You have a good control group too: Floss usage is about 60%+ in the USA, and 20% or less in Europe.
Kinnard 10y ago
On a side note, most cavities/caries which get filled can be remineralized. That's particularly unfortunate because fillings need to be redone after two years on average, destroying even more of the natural tooth: http://www.wsj.com/articles/simple-dental-treatments-may-reverse-decay-1460407763 http://www.wsj.com/articles/simple-dental-treatments-may-rev...
- lkrubner 10y ago
  In 2011 I became aware of pain in my lower left chewing teeth. I had no health insurance, and no money to see a dentist. Over the course of two months, the pain got worse and worse. Finally, I decided I would rinse with Listerine, for long periods of time. I would take a swig of Listerine and hold it in my mouth for 30 minutes, spit it out and take another swig, and hold that in my mouth for another 30 minutes. I would do that all day, while I worked at my computer. My thought was that the bacteria could only do limited damage if my mouth was full of Listerine, so I kept Listerine in my mouth for several hours a day. Maybe I was right, or maybe the effect was psychosomatic, but after ten days of such treatment, the pain faded away.
  - Kinnard 10y ago
    That's scary . . . did you ever end up getting it checked out?
  - cableshaft 10y ago
    Either that or the nerve died, so you stopped feeling pain. I went through that with a tooth (was also unemployed at the time and couldn't afford proper dental treatment for it), and eventually it had to get removed because it decayed so much. It used to hurt a lot but eventually it stopped hurting entirely, even as it cracked and chipped away slowly.
aaron695 10y ago
This is the same bullshit around how fat and salt was really bad and no one could be bother changing that rule, because it might/is technically correct. Except everyone just ate sugar in mass quantities and we never moved forward (and probably moved backwards) We not only need to know if it works, we need studies to know how well so we can compare it to other methods people actually will implement.
- Someone1234 10y ago
  I agree that most animal fats are healthy (ex. saturates) but I believe excess salt is still considered unhealthy even by current studies? Or am I mistaken on that? No disagreement on sugar either, definitely unhealthy in excess (in particularly when artificially added disproportionately to the other nutrition within the food).
  - briHass 10y ago
    Generally, unless you have a specific medical condition that warrants restricting salt (kidney disease, high blood pressure), there's no need to worry about normal doses of salt in the diet. In fact, too little salt can actually be very harmful. This study [1] and the response from the CDC is very similar to the OP's article: despite research showing the recommendation is wrong, $BIG_AGENCY refuses to change its recommendation over fears of looking like boneheads. [1] http://www.webmd.com/food-recipes/news/20140402/cdc-salt-guidelines-too-low-for-good-health-study-suggests#1 http://www.webmd.com/food-recipes/news/20140402/cdc-salt-gui...
sambe 10y ago
I read this about 15 years ago in a book published a decade or two before that, IIRC. Unfortunately the book did not really make a case, just claimed there was no evidence. It was a book about evidence-based medicine before that was a popular term (unfortunately I've also lost the name the book). My dental hygienist recently told me that I have to shove bits of wood between all my teeth twice a day. I asked why I hadn't heard this before and for how long, and she said "for the rest of your life because it's good for you". Hmm.
venning 10y ago
> "It's low risk, low cost," National Institutes of Health dentist Tim Iafolla told CNBC. Isn't risk something that should be determined by study? I can think of a couple ways that flossing may actually damage a mouth.
vonmoltke 10y ago
A better discussion about the lack of evidence for flossing: https://www.sciencebasedmedicine.org/may-the-floss-be-with-you/ https://www.sciencebasedmedicine.org/may-the-floss-be-with-y... Basically, yes, flossing helps, but self-flossing really doesn't do anything more than just brushing daily. I'm a little disappointed at the number of comments here along the lines of, "Well, it's obvious! Why do we need to study it?" That's a very unscientific attitude.
- saurik 10y ago
  Or, people who were assigned a professional flosser every single school day were also more likely to brush their teeth better and were reminded constantly about their teeth and even possibly taught stuff about teeth and so maybe even ate less sugary things. I don't have access to the paper: did they at least have the professional flosser supervise the self-flossing to control for this? Otherwise this just seems like a much more likely reason for these results.
  - vonmoltke 10y ago
    The reference is a systematic review, not a single study; only one study in the review was run as you indicate. Beyond that, I am not sure what you are getting at. The point of the post I posted and the original article here is that self-flossing as an augmentation to brushing does effectively nothing. What you stated corroborates that. Am I missing something?
    - saurik 10y ago
      My point was that from the information in the article that isn't actually clear; it is like when people say that condoms are X% effective as a contraception technique, and so people assume that means that condoms have an X% failure rate, but what they really mean is that "couples who report using condoms as their primary means of contraception have an X% success rate at avoiding pregnancy". While it is interesting from a clinical perspective as to whether "sending a child home and telling them to floss by themselves" is a working strategy or not, it would be taking into account "children don't really floss" and doesn't tell us if an adult who actually knows they are flossing (such as an adult who actually knows they are using the condom every time) has a particular success rate.
Vexs 10y ago
Personal antecedent is that I never flossed for 18 years, and would always walk out of the dentist with a bleeding gum somewhere in my mouth, and my teeth would hurt drinking cold water, etc, but when I finally started flossing all those problems evaporated. Some mouths probably need it more than others, and it appears that mine is one of them. Is flossing the best option for inter-teeth cleaning? Maybe not. However, even after a good brush I can pull bits of food out by flossing, and I don't think anyone will disagree that it's a good thing to leave it in there.
- at-fates-hands 10y ago
  I can second that story. I spent years between dental visits when I was between my parents health insurance and getting a job that actually covered dental. By that time, it was almost too late. I had severe Periodontitis and was told that if I didn't do something within a few years, my teeth would start falling out. I had a root planing surgery and some other procedures done to save my teeth. My dentist said I was given another chance, but in order to save my teeth, it was paramount to floss every day. I started flossing and at first my gums bled like crazy, but over time, the bleeding lessened and after 6 months of flossing and several more visits to the dentist, my gums were almost fully recovered and my teeth were effectively saved. Since then I still floss daily and see my dentist every 6 months like clockwork. Since I started flossing my teeth, my teeth cleaning appointments are literally 30-40 minutes. I can get in and out and its completely painless. All of this I attribute to flossing daily.
- hashkb 10y ago
  You floss after brushing? I always thought the reverse was the best practice. Of course... there has been zero science, so maybe the best is brush -> floss -> brush -> Listerine -> floss.
  - Vexs 10y ago
    I don't really think there's a difference. My thoughts is that brushing pushes most of it off, but pushes some stuff into small holes and stuff, which is then removed by flossing.
  - 10y ago
6stringmerc 10y ago
This doesn't surprise me. If I had $10 for every experienced, certified specialist I saw until the age of 13 that said "The best thing for your condition is little-to-no activity, certainly not weight lifting!" I'd be able to pay for my legal steroid cycles for a good 10 years. The only thing that improved my quality of life was getting bigger, stronger, and tougher. That's why I don't look like one of their normal patients - because I refused to believe the counter-intuitive notion that weakness is a good thing biologically. FTR I don't disclose my condition but it's a physical one.
Mc_Big_G 10y ago
Lack of studies doesn't mean it's not true. Anecdotally, whenever I see a new dentist, the first thing they say (usually the assistant) is "I see you're a flosser!". Then they comment about how healthy are my gums. I'd guess every dental employee on the planet thinks flossing helps prevent gum disease at the very least.

159 points by jld89 10y ago

I wonder why they don't fund proper studies. Maybe because the effect is too obvious to question? My oral hygienist can tell whether I floss regularly or not, so there must be an observable difference in plaque buildup. Subjectively my gums also feel better and bleed less when I floss regularly.

flukus 10y ago
I've never flossed, I don't have gaps in my teeth to get the floss in. My first trip to the dentist in 25 years was a few weeks ago and my teeth were perfect except for a wisdom tooth and the damage it caused. So i'm kind of skeptical of the effect. Edit - I always wonder what kind of toothbrush other people use. I've always used electric ones so I wonder if that helps.
- tiddlydum 10y ago
  This is anecdotal, but when I don't floss my teeth hurt.
  - nommm-nommm 10y ago
    Probably poor technique. When the oral hygienist flosses my teeth it doesn't hurt at all but I can't replicate the pain free flossing at home.
- pizza234 10y ago
  Anecdote is not evidence. A few people are certainly "gifted" teeth-wise (I know another case), but not going to the dentist for 25 years would be disastrous if applied on large scale.
  - flukus 10y ago
    >Anecdote is not evidence. Well that's the problem, we don't have better evidence.
    - totalcrepe 10y ago
      > Well that's the problem, we don't have better evidence. We actually have had it for quite a while. The CAMBRA MOOC is put together by a dentist/statistician and lays out a point system based on correlation between patient behaviors/health and carries. It has been iteratively corrected based on effective and ineffective results when modifying behavior according to the system. Notably in that system, floss is not given a point. Whatever effect it may have is either too weak or better described by other factors flossing correlates with. When points like that come up, the teacher stresses that the system is only measuring odds of near term carries, so flossing may be effective for something else with regards to oral health or preventing one of the negative factors.
      - osteele 10y ago
        A claim is that flossing reduces gingivitis. The CAMBRA MOOC measures carries.
    - pizza234 10y ago
      The sentence above was about considering the extreme case irrelevant. Focusing on flossing itself, as person who started doing it regularly only as adult, I think that researching on how frequently one should floss (or not) is in a way like researching how frequently one should change underwear. It may make sense theoretically, but ultimately all it requires is just to pay attention. I never noticed the bleeding and/or irritation of the gums (which dentists always mention) until I started flossing regularly. Now I do feel a difference (as a matter of fact, I floss irregularly, depending on how the gums feel). Of course, I'm pretty sure I could survive without flossing at all. This is in line with what dentists generally suggest. Given that flossing can be ultimately considered as simply extra cleaning, and that the presence (or not) of the effects can be easily observed, a couple of weeks of flossing should be enough for anybody to make a solid judgment more than any theory.
- cLeEOGPw 10y ago
  > I don't have gaps in my teeth to get the floss in. Same here. Never understood how people can physically floss. Maybe those with undeveloped teeth can do it, others, I don't see how it's even possible.
  - fredsted 10y ago
    I use one of these: http://imgur.com/8A3dopG http://imgur.com/8A3dopG For some teeth, I have to force it a little, my teeth are pretty close too. Its so worth it though: much better breath, clean feel, minimized risk of cavities.
    - flukus 10y ago
      I've tried them, but they refuse to go in too.
      - TorKlingberg 10y ago
        I use these. I can bit down on it if I need extra force. http://www.apteekkituotteet.fi/WebRoot/Euran/Shops/Eura/506D/44FC/C30E/E6B0/D550/0A28/1050/7369/plackers_twin.jpg http://www.apteekkituotteet.fi/WebRoot/Euran/Shops/Eura/506D... Of course people's teeth are different. I know some prefer these, where you push it in from the side. http://www.tepe.com/uk/products/interdental-brushes/ http://www.tepe.com/uk/products/interdental-brushes/
        cLeEOGPw 10y ago
        Thing is, teeth are so close to each other that literally nothing can get between them, not even food. I have however few teeth that get food in between, but these are the ones that already went bad and were fixed, and have gaps as a result of that.
    - throwaway41597 10y ago
      I avoided purchasing one by forming a loop with the wire. I cut a 20cm (8in) piece, then I tie a triple knot (the simple over hand knot with both ends). The wire is very slippery so I move the first knot as close to the ends as possible, so as not to waste floss. Having a loop allows to have a firm hold on the floss and adjust tension. I use it with both hands though. And I waste very little floss because I can rotate the loop and use every inch of it.
- deleted 10y ago
  [deleted]
- imron 10y ago
  You might find that if you go to the dentist for teeth cleaning and they clear away all the plaque buildup that you'll be able to get the floss in between your teeth. Like you, I have good teeth (never had a filling) and on average have visited the dentist about once every 10 years. Like you I also used to never be able to get floss in between my teeth, but after a dental checkup some years back the dentist cleared all the plaque buildup and from then on getting the floss between my teeth was no problem, and I've been flossing regularly since. Once the plaque builds up and hardens, it's very difficult to break it up with just floss and you'll have difficulty getting floss in. For what it's worth, my teeth definitely feel cleaner after flossing, and if I miss a couple of days they start to feel dirty.
  - MarcusP 10y ago
    I had the issue that I couldn't floss due to lack of gaps too, I even have a wire behind my bottom teeth keeping them together after having braces when I was younger. This meant I had to visit the dentist if I wanted to clean between my teeth and even after that, normal floss just didn't fit. But now I have discovered floss tape; it's just what it sounds like, a thin strip of tape that you can slide between your teeth to floss. Now I can actually floss and it makes a big difference to how clean my teeth look and feel. I'm in the UK and the product I use is Oral-B Satin Tape - worth trying or finding an equivalent if you have teeth very close together.
    - imron 10y ago
      Snap! Oral-B Satin Tape for the win.
- throwaway41597 10y ago
  If it works for you, then no need to change it. For me, it depends on which tooth I'm flossing. Some are easier than others. Some are so tight that floss won't come out, it feels like I'm pulling a tooth out. For this reason, I don't floss often and not every tooth. I use toothpicks though.
- epalmer 10y ago
  My gaps are small. My dentist says my teeth are tight. I have found that using Glide is the best floss. Even with that I have at times cut right through the floss with a particular pair of teeth. You might want to try Glide. I floss daily and sometimes twice a day. I keep floss at my desk at work and some mouthwash to kill some of germs that get stirred up. It is easy to fit that in when thinking through a problem. I also take vitamin C twice a day. My dentists always comment on the good health of my gums and say "you take vitamin c don't you?" At 62 I want to maintain my gum and teeth health.
  - amalag 10y ago
    I have to use a plastic floss needle sometimes, you thread the needle with floss in order to get floss between teeth when there is some food stuck in there. Amazing that people are wondering what the "scientific" value in getting food particles out of your mouth.
- huherto 10y ago
  I have tight straight teeth on one side and I wicked with little gaps on the other side. There is a big difference when I floss. On one side is usually clean, on the other is not. It requires a lot more maintenance.
- specialist 10y ago
  Congratulations. You won the genetic lottery. I did well, for a while, too. Then I had a lot of chemo. First year post, I had 14 cavities requiring fillings. Now I have 3 crowns. Floss your teeth, preferably with a water pick. Older you will thank younger you.
jbpetersen 10y ago
Now I'm wondering whether brushing with added attention towards gums would provide an equivalent result.
- cel1ne 10y ago
  From personal experience I can say: It helps, but it doesn't give you equivalent results.
dualogy 10y ago
> bleed less when I floss regularly Sheesh, shouldn't they ideally never-bleed? Just what is it you're ingesting (or not ingesting)?
mrweasel 10y ago
For years my oral hygienist kept telling me to a get an electric toothbrush. When I finally got one, I didn't tell her, but I never hear the "get an electric tooth brush" again. It was the same with flossing. When I started flossing I didn't say anything, and she hasn't commented that I need to floss since.
- dazc 10y ago
  Also worth noting that if you floss properly (maybe also use interdental sticks) the descaling routine becomes a lot more comfortable. For this reason alone it's worth doing.
  - rangibaby 10y ago
    Flossing was a painful, bloody mess for me the first week or so I did it. Then it felt great, then I ran out of the floss sticks (like a disposable razor, but with floss instead of a blade) and haven't done it since. Such is life.
  - merpnderp 10y ago
    I found this to be the same with a water pick. At first my gums bled and hurt, but after a few weeks I could turn the power to max and it feels like an awesome massage on my gums. I used to get some food stuck between my teeth, but now almost never do which I presume is due to much healthier gums.
- nextos 10y ago
  There's a ton of evidence in the literature supporting that gum disease and cavities are, obviously, a bacterial issue. Flossing is an obvious way to disrupt pathogenic bacterial colonies by abrasion. I think irrigation is much better, as it reaches deep pockets below gums. But it doesn't replace flossing entirely. Those two, coupled with regular brushing of teeth, gum and tongue, plus oral probiotics should keep issues at bay. In particular, my experience with probiotics is that tartar calculus fell apart within a few months. I have never had a cavity. Sadly most dentists don't place too much emphasis on these as it goes against their business model: drill, fill and bill.
pw 10y ago
I wondered that too. But I also worry whether the immediate-term indices of dental health that hygienists are taught to look for correspond to long-term dental health endpoints.
INTPenis 10y ago
The effect is very obvious. I'm not ashasmed to say that since the age of 18 - your last year of free dental care in Sweden - to the age of 31, I didn't go to the dentist at all. I brushed mostly regularly the second half of this period, I never flossed. I'm a computer geek, I can get caught up in code for days without brushing my teeth but try to do it regularly. The result was 13 years of plaque and two visits to a dentist to clean it all out. Dental plaque is a coating over your tooth and your gums will grow over this coating. So I think it's pretty obvious that dental plaque can cause cavities between your gums and your teeth, infections in your gums and all this will in turn lead to periodontitis. And also you have saliva glands at the bottom of your mouth that bring with them additional minerals and stuff that get stuck to your teeth, forming plaque. So the front bottom teeth are even more important to floss. Now I floss regularly and I'm proud to have actually made it one of my daily habits.
- pc86 10y ago
  > I brushed mostly regularly the second half of this period I'm terrified to ask what you did the first half of that period.
  - geon 10y ago
    Brushed irregularly?
  - weavie 10y ago
    " I can get caught up in code for days "
    - pc86 10y ago
      "I have terrible personal hygiene and write it off as being 'quirky'"
whack 10y ago
Except that studies have now shown that the effect is not obvious at all. "Since doctors began saying that a string-based tooth scrapping was good for oral health, a handful of studies have been conducted. However, they all fall far short of what’s needed to make a convincing argument. A 2011 review of a dozen randomized controlled studies concluded that, “Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.” The US Agriculture and Health and Human Services departments quietly removed the flossing recommendation from the latest version of dietary guidelines. ---------- If anyone thinks that this is because the study's parameters are too narrow to show an effect, that is not the case. Other studies have successfully shown the benefits of flossing... if the dentist is the one performing it. But they haven't been able to show similar results when regular people do the flossing. "Maybe the evidence that flossing reduces tooth decay or gum disease does not hold up because we are all such poor flossers. Superflossers, like the zealous hygienist at your dentist’s office, aim to “hug the neck of the tooth” and get below the gum line, Dr. Hujoel said. But we common folk, staring woefully at our bathroom mirrors, tend to lightly give it the once-over. A review of six trials found that when professionals flossed the teeth of children on school days for almost two years, they saw a 40 percent reduction in the risk of cavities. So maybe perfect flossing is effective. But scientists would be hard put to find anyone to test that theory." ----------- Honestly, I'm not surprised at all. Years ago, my dentist strongly urged me to get my asymptomatic wisdom teeth removed. I then went home and did my own research on this subject. And what I found was the complete opposite of my dentist's recommendation. But a new study of more than 6,000 patients in Greece found that only 2.7 percent of the teeth had a cyst or tumor. An older study, often cited by critics of routine extraction, found that only 12 percent of 1,756 middle-aged people who had not had impacted wisdom teeth removed experienced a complication. Numerous comprehensive reviews of research, conducted by independent bodies not affiliated with oral surgeons, have concluded that there was no evidence to support routine prophylactic extraction of impacted but healthy wisdom teeth. Britain’s National Health Service stopped paying for the procedure if there was no good reason for it after an analysis by its Center for Reviews and Dissemination at the University of York concluded in 1998 that there was no solid scientific evidence to support it. Also that year, the Royal College of Physicians of Edinburgh said that for patients who do not have a condition related to third molars or whose teeth would probably grow in successfully, removal is “not advisable.” In 2005, a review by the respected Cochrane Collaboration said the number of extractions could be reduced by 60 percent if they were done only when patients were in pain or developed a condition related to wisdom teeth. The group also said there is “reliable evidence” that suggests that removing wisdom teeth does not prevent or reduce crowding of front teeth. In 2008, the American Public Health Association dismissed arguments typically made for removing wisdom teeth: that adjacent teeth might be damaged, or that the teeth may harbor bacteria that cause periodontal disease. The association approved a policy saying these concerns do not justify the risks of surgery, which include possible nerve damage, complications from anesthesia. loss of the sense of taste and, very rarely, death. “The few studies of long-term retention of impacted teeth have shown little risk of harm,” the association concluded. ------------- I've since brought this up with a few other friends who are dentists as well. They always start off by haranguing me for doing my own research, instead of following my dentist's recommendation. Then once I show them all the above evidence, which they have never seen before, they change their minds and accept that I'm probably right. With a track record like that, I wouldn't be surprised at all if flossing turns out to be yet another sacred cow that's virtually pointless in reality. I do have to say kudos to the dental field though. At least they are making efforts to validate their recommendations, using empirical studies. I wonder how many of the recommendations given by programmers/teachers/fitness-trainers etc are similarly flawed. http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0 http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavi... http://www.nytimes.com/2011/09/06/health/06consumer.html http://www.nytimes.com/2011/09/06/health/06consumer.html
bbayles 10y ago
I've tested a few times - if I floss the day before and day of I don't get the "floss more!" lecture.
- JoshGlazebrook 10y ago
  It really depends. If the plaque is left too long it will harden and turn into tartar (calculus), which can't be easily removed with just floss.

leaveyou 10y ago

For me the water flossers (oral jet irrigators) are the best solution yet. I was never able to floss correctly with a wire, especially between the teeth in the back row but then my dentist told me about "the jet thing from amazon" and I wish I had it a lot earlier because it's so easy to use and quite efficient. (Just don't jet your gums with the highest power; it can hurt and make your gums bleed)

mountaineer22 10y ago
My wife recently purchased a battery-powered Waterpik and is obsessed with the thing (it works in the shower, too): http://amzn.to/2axkvkK http://amzn.to/2axkvkK She had been compulsively flossing, but this device has reduced that desire.
- criddell 10y ago
  In the shower? Why didn't I think of that? I've used a Waterpik before and ended up throwing it away because I invariably made a big mess with it (especially my mirror).
deanclatworthy 10y ago
I looked into this. It just rinses the plaque in a lot of cases rather than scrapes it away.
- leaveyou 10y ago
  I don't know what model you use but mine is quite powerful (it's not a "portable/battery" model and it has 10 steps of jet intensity) and obviously it's best used in combination with the brush. If this does not work, I don't know what else could work.
maxxxxx 10y ago
I have one of those and it made big difference with my gums. It washes away pieces of food that often don't get removed by brushing. My dentist noticed a difference after a year even though I didn't tell him that I use an irrigator.

fpoling 10y ago

From what I read and from personal experience it is a diet that has strongest effects on tooth health, not the the way to toothbrush or floss. For example, in Europe tooth health became much bigger problem after crusades when knights brought various dessert recipes from Lebanon and Syria.

xlxlxlx 10y ago
This would be my guess too. I've never had a cavity in my life, which I'm sure is partially genetic, but I don't floss and brush only once a day in the morning. I haven't been to a dentist in ~6 years. My diet is very clean though -- no soda, candy, or really anything else high in sugar other than fruit. I eat a lot of raw vegetables too, which I think clean my teeth as I chew.
- mtberatwork 10y ago
  The few cavities that I have had were all extremely tiny and hardly visible to the eye. You won't really know on your own that you have a cavity until it's much more fully developed. At that point, getting it repaired is much more aggravating and a pain. I'd highly recommend getting to the dentist more than once every 6 years.
gotofritz 10y ago
It may well be, but since sugar is an integral part of modern diets that doesn't help us much.
- Legogris 10y ago
  Once you get started, a diet free from refined sugar is not at all as difficult to maintain as you might think.
  - osteele 10y ago
    Don't you need to avoid unrefined sugar and starch too? Which is not impossibly difficult (lots of folks do keto), but is more difficult than just avoiding refined sugar.

return0 10y ago

Toothpicks work just as well for me.

nailer 10y ago
+1 but also a modern twist: intradental brushes. They're a piece of wire with a handle, coated with bits to pull plaque off teeth. You use them exactly like a toothpick but they have a nice big grip and you can get 90 degree versions with long handles for your back teeth. A pack will easily last a year. Cannot be bothered flossing (and I salivate a lot which makes it harder) but intradental brushes are now part of my daily routine.
- 83457 10y ago
  How long does one last? Do you use one for a week, month or just whenever you change your toothbrush?
  - nailer 10y ago
    About a month. The main thing is the plastic bumps on the wire wear away after a while.
    - 83457 10y ago
      Oh nice. They are pretty cheap then. I don't floss as much as I should (or should I?) so might give these a try. Thanks

gotofritz 10y ago

I used to floss more or less regularly and had constant gum problems. I then switched to interdental brushes, same frequency of use, and my gum problems have since disappeared. So in my case _something_ was needed for the gum's health, but flossing itself proved to be useless.

chebum 10y ago
I use both depending on inter-teeth space. There are different techniques of flossing and different floss types. So, trying different may solve the problem with flossing itself. For those who cannot use interdental brushes. Some doctors suggest moving the floss up and down along the teeth. Others to put it inside teeth and the pull to the side. I found the second more convenient and less traumatic at the same time. But you need a wider floss to make it work. Try different. Me and my wife use different: one brand works better for her, but is too narrow for me. Experiment. I had chronic inflammation since school. Flossing completely solved the problem in a month or two.

exhilaration 10y ago

This is the AP article that's mentioned, it has lots more information: http://www.today.com/health/there-s-little-proof-flossing-protects-your-teeth-or-gums-t101389?cid=sm_fbn http://www.today.com/health/there-s-little-proof-flossing-pr...

dbg067 10y ago

I'm sure a lot of individual observations come down to genetics. In my own case, I challenged myself to go from flossing once a week to every day over the past six months. Just recently went to the dentist and my gum pocket depths all decreased (signaling healthier gums apparently). Diet remained exactly the same.

Booktrope 10y ago

Clickbait based on a 5-year old source which actually says, "Twelve trials were included in this review which reported data on two outcomes (dental plaque and gum disease). Trials were of poor quality and conclusions must be viewed as unreliable. The review showed that people who brush and floss regularly have less gum bleeding compared to toothbrushing alone. There was weak, very unreliable evidence of a possible small reduction in plaque. There was no information on other measurements such as tooth decay because the trials were not long enough and detecting early stage decay between teeth is difficult." So studies showed flossing helps prevent gum bleeding. This is not what the article reports. Are there studies of effectiveness of tooth brushing? Imagine the control group - people who don't brush their teeth at all!

nailer 10y ago
Brushing teeth isn't the only way of cleaning them. A lot of people use sticks or other means that are harder and more effective at cleaning teeth.
jessriedel 10y ago
The recommendation to floss was not justified by reduced gum bleeding, it was justifies by reduces tooth decay. Indees, its now been removes from official FDA recommendations. Likewise, flossing might very reliably make the backs of your teeth whiter, but this is a negligible benefit and is not curing a disease. The headline is a fair summary, even if it could have been more informative by not trying to be funny.

sedeki 10y ago

So this is not an argument against flossing it is just there are no studies for it, correct? (Haven't followed the thread)

coldtea 10y ago
Read the article. It mentions actual studies saying they haven't evidence it does much if anything.
gulpahum 10y ago
There are studies which show that flossing isn't effective. Here's an older article mentioning three studies: http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-say-you-need-to-floss-science-says-you-dont/#2b54386677d5 http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-... I read the conclusion so that flossing is useless, because it isn't done correctly or it is just a wrong way to clean teeth. I've had a similar personal experience. My dentist asked me to floss because my gums were bleeding. I flossed for few years, but it didn't cure my bleeding gums. Then my dentist suggested using interdental brushes. I did it for a while and it helped. My gums are no more bleeding. So, I say no to flossing, yes to cleaning teeth with better means.

dmalvarado 10y ago

Anyone ever smell the floss after each tooth? Yea, I'm gonna keep flossin.

koolba 10y ago

> Still, many dentists will continue to recommend flossing for removing debris between your chompers. "It's low risk, low cost," National Institutes of Health dentist Tim Iafolla told CNBC. "We know there's a possibility that it works, so we feel comfortable telling people to go ahead and do it." Instead of talking about flossing you could talk about keeping a pet rock in your pocket and it'd also be "low risk, low cost ... we know there's a possibility that it works".

snarfy 10y ago

For most of my life I brushed but never flossed. I had no cavities but I was at risk of losing my teeth due to plaque below the gum line. My teeth were loose and gums would bleed when I brushed. I've had all that fixed and now floss regularly. In retrospect flossing seems more important than brushing.

DHMO 10y ago

I'm going to keep flossing. Screw them.

niccaluim 10y ago

There are also no studies on whether parachutes prevent death when falling from the sky[1], but I'm sure as shit still wearing one when I jump out of a plane! [1] http://www.bmj.com/content/327/7429/1459.long http://www.bmj.com/content/327/7429/1459.long

gjem97 10y ago
If you had as many people jumping out of planes as those that have teeth, you assuredly would have studies about parachute design, packing methods, survivability in the face of failure. You absolutely would have research that shows that parachutes prevent death.
ysavir 10y ago
I don't floss, and I'm confident my day won't end with me hitting the ground at terminal velocity. I'll let you know if it turns out I'm wrong. Can we agree that the dangers of not flossing and the dangers of leaping from a plane without a parachute have little in common?
kstrauser 10y ago
There have been many controlled trials as to the efficacy of parachute braking, although I doubt many have been published outside the military.
niccaluim 10y ago
Everyone replying to this so far is fun at parties, I'm sure of it.

StavrosK 10y ago

Isn't it about time we got rid of the ridiculous "if we haven't researched it, we know nothing about it" fallacy? Research is strong evidence that points towards something. Lack of research doesn't mean complete lack of a-priori knowledge. If something is obviously good for you, then that's probably a good start for recommending it.

gjem97 10y ago
I think that's missing the point. And, as an aside, so are all the comments in this thread that are essentially "flossing works for me, so I'm going to keep doing it." The point of this article is not that people should stop flossing, or that it's bad for some reason. The point is that an entire industry of medical professionals were saying "floss because it reduces you risk of tooth decay and gum disease," when in fact there is little evidence that it does either. It is a huge detriment to the credibility of dentists in my opinion.
- MicroBerto 10y ago
  Dentists and dental hygienists look into tens of thousands of mouths over the courses of their careers. It's not difficult for them to see that patients who floss have far healthier smiles, in general. That said, they should get more studies done. You could also be a bad flosser, so even the study could be flawed.
  - ptaipale 10y ago
    Again, there's the comparison of people who sell ice cream and see that when they sell more, there will be more drownings. Correlation does not imply causation. I think it is quite obvious that people who floss also brush their teeth more regularly, and that is enough to give them healthier smiles. (Regarding the benefits of flossing, I'm agnostic.)
    - MicroBerto 10y ago
      It's true that correlation does not imply causation, but you're still wrong from my experience with hygienists and dentists. They definitely and easily see a difference seen between those who floss and brush and those who just brush. Also, those who use Sonicare, especially when used properly around the gumlines, also tend to have healthier mouths than those who brush with an old brush. The one thing that can throw a wrench in this whole thing is smoking. Smokers' mouths are disgusting basically no matter what. Point being, I love research, but I trust those who put their hands in tens of thousands of mouths more than skeptics on ArsTechnica article comments.

ccannon 10y ago

One word: Waterpik. It's the only thing that has a major influence on my oral hygiene. Here's the one I use: http://amzn.to/2ahIghr http://amzn.to/2ahIghr

eksemplar 10y ago

I never learned flossing, and then in my early twenties I kind of ignored the dentist for around 7-8 years. I still brushed my teeth throughly two times a day, every day. Got me paradentosis and almost lost me my teeth. It's completely anecdotal, but I recomend flossing.

wilwade 10y ago

I think the issue here is not if it is actually helpful or not, but that it was claimed (and advertised) to be without the necessary research. The AP article explains that flossing had to be dropped from the federal guidelines as those are required to be backed by research. The groups that claim it is good for you all have a financial reason to claim it. Not alone wrong, but wrong in the absence of quality research backing the claims.

wvh 10y ago

My mother-in-law is a dentist. When she heard I always brush my teeth but rarely floss, she told me flossing is more important than brushing your teeth. For once I didn't get into the science of things, but still I accept that getting old bits of food and other junk away from between my teeth can only be a positive thing. It runs counter to my sceptic nature, I like to question everything, but I'm slowly starting to learn that sometimes you just have to take an expert's advice. I'm sure any half-way decent dentist can see pretty quickly how well you take care of your teeth, in the same way a seasoned programmer can often point out a beginner's bad code or a civil engineer warn about the wrong way to build a bridge or a house on a swamp.

gjem97 10y ago
Flossing can have benefits. That still doesn't mean that we should be ok with medical professionals making specific claims like, "flossing reduces the risk of tooth decay," that have no good science behind them.
- HemanHeartYou 10y ago
  I get what you're saying, but using the flossing flavor of the month argument to prove that point is pretty weak.
chengiz 10y ago
When I feel food stuck in the teeth I'll floss. Rarely have I flossed out anything that I didnt feel - usually the tiny bits are taken out by a strong rinsing. I just dont see the point of taking more minutes out of my day for little reason. (I have never had issues with plaque so ymmv).
skolos 10y ago
My father in law is a dentist in Germany and he never recommended flossing. In fact flossing is not common in Germany and we don't hear that Germans have very bad teeth compared to Americans. So although dentists could notice if you have good dental hygiene I'm not sure they can spot easily if you floss or not. It might just mean that in US good dental hygiene means that you floss, but converse might not be true.

spdustin 10y ago

Flossing, meh. WaterPiks, meh. http://oralbreeze.com http://oralbreeze.com Hooks right up to your faucet or shower head, has multiple tips, and is effectively an endless and super-quiet WaterPik. I do own a WaterPik-like device, but I use saline water and a special adapter for sinus irrigation (making it a post-modern Neti Pot I guess). OralBreeze, brushing and sinus irrigation every day. Helps fight bad breath — post-nasal drip contributes a lot to bad breath, as does rotting food stuck between your teeth. For me, it's helped reduce the incidence sinus infections, too. Plus the more advanced "Neti" usage involves allowing the saline solution to flow out of your mouth, so if you're prone to tonsil stones, it can help reduce those.

codeulike 10y ago

Lots of USA specific views in here. How about: Most patients, even if they bother to get the minty-waxed out the box, are exceptionally heavy-handed and macerate their gums like they’ve been chewing on bare vacuum cleaner flex. Even in controlled studies, after instruction, the patients taking part couldn’t floss properly. I know of no dentist who flosses. Not one. UK dentist, writing in the Guardian https://www.theguardian.com/commentisfree/2016/aug/03/dentists-great-flossing-yarn https://www.theguardian.com/commentisfree/2016/aug/03/dentis...

codeulike 10y ago
This is an interesting thread to read and think about rationalisations, habits and culture. You have a good control group too: Floss usage is about 60%+ in the USA, and 20% or less in Europe.

Kinnard 10y ago

On a side note, most cavities/caries which get filled can be remineralized. That's particularly unfortunate because fillings need to be redone after two years on average, destroying even more of the natural tooth: http://www.wsj.com/articles/simple-dental-treatments-may-reverse-decay-1460407763 http://www.wsj.com/articles/simple-dental-treatments-may-rev...

lkrubner 10y ago
In 2011 I became aware of pain in my lower left chewing teeth. I had no health insurance, and no money to see a dentist. Over the course of two months, the pain got worse and worse. Finally, I decided I would rinse with Listerine, for long periods of time. I would take a swig of Listerine and hold it in my mouth for 30 minutes, spit it out and take another swig, and hold that in my mouth for another 30 minutes. I would do that all day, while I worked at my computer. My thought was that the bacteria could only do limited damage if my mouth was full of Listerine, so I kept Listerine in my mouth for several hours a day. Maybe I was right, or maybe the effect was psychosomatic, but after ten days of such treatment, the pain faded away.
- Kinnard 10y ago
  That's scary . . . did you ever end up getting it checked out?
- cableshaft 10y ago
  Either that or the nerve died, so you stopped feeling pain. I went through that with a tooth (was also unemployed at the time and couldn't afford proper dental treatment for it), and eventually it had to get removed because it decayed so much. It used to hurt a lot but eventually it stopped hurting entirely, even as it cracked and chipped away slowly.

aaron695 10y ago

This is the same bullshit around how fat and salt was really bad and no one could be bother changing that rule, because it might/is technically correct. Except everyone just ate sugar in mass quantities and we never moved forward (and probably moved backwards) We not only need to know if it works, we need studies to know how well so we can compare it to other methods people actually will implement.

Someone1234 10y ago
I agree that most animal fats are healthy (ex. saturates) but I believe excess salt is still considered unhealthy even by current studies? Or am I mistaken on that? No disagreement on sugar either, definitely unhealthy in excess (in particularly when artificially added disproportionately to the other nutrition within the food).
- briHass 10y ago
  Generally, unless you have a specific medical condition that warrants restricting salt (kidney disease, high blood pressure), there's no need to worry about normal doses of salt in the diet. In fact, too little salt can actually be very harmful. This study [1] and the response from the CDC is very similar to the OP's article: despite research showing the recommendation is wrong, $BIG_AGENCY refuses to change its recommendation over fears of looking like boneheads. [1] http://www.webmd.com/food-recipes/news/20140402/cdc-salt-guidelines-too-low-for-good-health-study-suggests#1 http://www.webmd.com/food-recipes/news/20140402/cdc-salt-gui...

sambe 10y ago

I read this about 15 years ago in a book published a decade or two before that, IIRC. Unfortunately the book did not really make a case, just claimed there was no evidence. It was a book about evidence-based medicine before that was a popular term (unfortunately I've also lost the name the book). My dental hygienist recently told me that I have to shove bits of wood between all my teeth twice a day. I asked why I hadn't heard this before and for how long, and she said "for the rest of your life because it's good for you". Hmm.

venning 10y ago

> "It's low risk, low cost," National Institutes of Health dentist Tim Iafolla told CNBC. Isn't risk something that should be determined by study? I can think of a couple ways that flossing may actually damage a mouth.

vonmoltke 10y ago

A better discussion about the lack of evidence for flossing: https://www.sciencebasedmedicine.org/may-the-floss-be-with-you/ https://www.sciencebasedmedicine.org/may-the-floss-be-with-y... Basically, yes, flossing helps, but self-flossing really doesn't do anything more than just brushing daily. I'm a little disappointed at the number of comments here along the lines of, "Well, it's obvious! Why do we need to study it?" That's a very unscientific attitude.

saurik 10y ago
Or, people who were assigned a professional flosser every single school day were also more likely to brush their teeth better and were reminded constantly about their teeth and even possibly taught stuff about teeth and so maybe even ate less sugary things. I don't have access to the paper: did they at least have the professional flosser supervise the self-flossing to control for this? Otherwise this just seems like a much more likely reason for these results.
- vonmoltke 10y ago
  The reference is a systematic review, not a single study; only one study in the review was run as you indicate. Beyond that, I am not sure what you are getting at. The point of the post I posted and the original article here is that self-flossing as an augmentation to brushing does effectively nothing. What you stated corroborates that. Am I missing something?
  - saurik 10y ago
    My point was that from the information in the article that isn't actually clear; it is like when people say that condoms are X% effective as a contraception technique, and so people assume that means that condoms have an X% failure rate, but what they really mean is that "couples who report using condoms as their primary means of contraception have an X% success rate at avoiding pregnancy". While it is interesting from a clinical perspective as to whether "sending a child home and telling them to floss by themselves" is a working strategy or not, it would be taking into account "children don't really floss" and doesn't tell us if an adult who actually knows they are flossing (such as an adult who actually knows they are using the condom every time) has a particular success rate.

Vexs 10y ago

Personal antecedent is that I never flossed for 18 years, and would always walk out of the dentist with a bleeding gum somewhere in my mouth, and my teeth would hurt drinking cold water, etc, but when I finally started flossing all those problems evaporated. Some mouths probably need it more than others, and it appears that mine is one of them. Is flossing the best option for inter-teeth cleaning? Maybe not. However, even after a good brush I can pull bits of food out by flossing, and I don't think anyone will disagree that it's a good thing to leave it in there.

at-fates-hands 10y ago
I can second that story. I spent years between dental visits when I was between my parents health insurance and getting a job that actually covered dental. By that time, it was almost too late. I had severe Periodontitis and was told that if I didn't do something within a few years, my teeth would start falling out. I had a root planing surgery and some other procedures done to save my teeth. My dentist said I was given another chance, but in order to save my teeth, it was paramount to floss every day. I started flossing and at first my gums bled like crazy, but over time, the bleeding lessened and after 6 months of flossing and several more visits to the dentist, my gums were almost fully recovered and my teeth were effectively saved. Since then I still floss daily and see my dentist every 6 months like clockwork. Since I started flossing my teeth, my teeth cleaning appointments are literally 30-40 minutes. I can get in and out and its completely painless. All of this I attribute to flossing daily.
hashkb 10y ago
You floss after brushing? I always thought the reverse was the best practice. Of course... there has been zero science, so maybe the best is brush -> floss -> brush -> Listerine -> floss.
- Vexs 10y ago
  I don't really think there's a difference. My thoughts is that brushing pushes most of it off, but pushes some stuff into small holes and stuff, which is then removed by flossing.
- 10y ago

6stringmerc 10y ago

This doesn't surprise me. If I had $10 for every experienced, certified specialist I saw until the age of 13 that said "The best thing for your condition is little-to-no activity, certainly not weight lifting!" I'd be able to pay for my legal steroid cycles for a good 10 years. The only thing that improved my quality of life was getting bigger, stronger, and tougher. That's why I don't look like one of their normal patients - because I refused to believe the counter-intuitive notion that weakness is a good thing biologically. FTR I don't disclose my condition but it's a physical one.

Mc_Big_G 10y ago

Lack of studies doesn't mean it's not true. Anecdotally, whenever I see a new dentist, the first thing they say (usually the assistant) is "I see you're a flosser!". Then they comment about how healthy are my gums. I'd guess every dental employee on the planet thinks flossing helps prevent gum disease at the very least.