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There has been some recent controversy about the need for flossing as a regular part of the oral hygiene. Is it something that works as advertised or are dentists having second thoughts? Is there enough evidence about its role in preventing gum disease?

Dentists have recommended flossing for decades and one would almost be forgiven for thinking that its benefits to oral health are set in stone. Unfortunately, that’s not true.

There have been some high profile publications that have carried headlines about how flossing and its benefits are still disputed according to scientific research. The truth is that flossing has been shown to be very effective in preventing gum disease but not as effective in the prevention of cavities.

Flossing and Gum disease

It has been conclusively proven that gum disease is caused by the accumulation of plaque on the surface of the teeth [1]. Plaque left undisturbed on the surface of the teeth changes in character from being harmless to being populated with a number of disease-causing bacteria [2]. The likelihood of plaque being left undisturbed is also the most on the sides of teeth, the area which is cleaned effectively by flossing [3].

Simply put, flossing removes plaque from an area which the brush cannot reach and that is directly beneficial to gum disease prevention [4]. Bleeding gums treatment is most effective if regular flossing is carried out after a professional scaling has been performed.

Where is the controversy then?

Flossing is done most often with waxed thread that is easy to pass between the contact points of the teeth. Some studies have shown that this wax can actually increase the amount of plaque being accumulated on the teeth [5].  

The other problem with flossing is that the process of flossing requires a certain amount of dexterity that not everyone has. People, as they get older, are unable to floss because they are physically unable to move the floss in between their teeth as they are required to [6].

Flossing has also been associated with the development of injuries to the gums as the floss is passed through the contact points with force. This is again down the issue of the method of flossing rather than any problem with flossing itself [7].

The last bit of controversy associated with flossing is that it can lead to the development of spaces in between the teeth and thus actually increase the chances of food lodgment between the teeth. There is no evidence to suggest that healthy teeth are damaged by floss. Most likely, it is the underlying gum disease which can cause the appearance of spaces between the teeth.

Flossing, as it pertains to gum disease, has been shown to unequivocally beneficial to the teeth and the prevention of periodontitis [8].

Flossing and tooth decay

There are a number of conditions that must be fulfilled in order for decay to take place. One of those is the accumulation of plaque and the growth of micro-organisms that produce acids that destroy the surface of the teeth.

There are numerous studies which have tried to examine the link between flossing and the development of decay. The data is mixed. There are some studies which show a reduction in the incidence of decay while others do not [9].

Tooth decay can occur on any surface of the teeth, not just the in-between areas where flossing is done. Genetics, pH of the saliva, and brushing habits also dictate to a large degree whether decay occurs in the mouth or not.

Flossing may not have been found to be helpful in all studies, but it was definitely not found to be harmful either. It continues to be seen as a useful aid in maintaining good oral hygiene.

Can a mouthwash be used as a substitute to flossing?

An antibacterial mouthwash is often advised to people suffering from gum disease or from widespread tooth decay. Its use should be seen as an adjunct to brushing but not as a replacement for flossing [10]. There is no doubt that the mouthwash is able to go into the nooks and crevices in the mouth but it is only going to be effective on clean surfaces.

The physical action of either a brush or floss to remove the plaque from the surface of the tooth is important.  

In certain cases where the gaps between the teeth are very large, the use of an inter-dental brush may actually be more beneficial than floss. The inter-dental brush and an antibacterial mouthwash should be enough to keep the in-between parts of the teeth clean even without the use of floss.

Conclusion

Flossing is something that is done quite rarely in a lot of developing countries. Its use is quite prevalent in developed nations but nowhere near as much as it should be. Learning how to floss at a young age is important because the habit can be difficult to inculcate at a later age. The benefits of flossing are many and in the case of gum disease, unquestioned.

The few extra minutes spent flossing may result in increasing the lifespan of the teeth by several years. A worthwhile payoff for sure!  

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