Sorry Haters, You Do Have to Floss


The American Dental Association says you don't need a study to prove the benefits of flossing. Klaus Vedfelt/Getty Images
The American Dental Association says you don't need a study to prove the benefits of flossing. Klaus Vedfelt/Getty Images

The collective jaws of the public recently dropped when an Associated Press (AP) report came out claiming the "medical benefits of flossing unproven."

This year, without fanfare, the U.S. government removed flossing from its Dietary Guidelines for Americans, issued every five years. The feds acknowledged in a letter to the AP that it had never researched the effectiveness of flossing, as required for the guidelines. Further, the AP looked at 25 research studies that compared the use of the toothbrush alone to floss-and-toothbrush combo use. "The findings? The evidence for flossing is 'weak, very unreliable,' of 'very low' quality, and carries 'a moderate to large potential for bias,'" wrote reporter Jeff Donn.

So what's the deal, assorted dental associations? Why do you keep recommending this practice? Are you trying to pull the floss over our eyes, or what? Before you scream "right-wing conspiracy," take a moment to ponder some good old-fashioned common sense. From the dentists.

"It was so obvious centuries ago that flossing is necessary to help clean the teeth that it didn't take research to prove it," explains Ronald Goldstein, D.D.S., cosmetic dentistry pioneer and author of "Change Your Smile." "They're saying there are not sufficient long-term results with the flossing, there's no evidence to support it, but logic takes over sometimes from lack of evidential research."

"I was surprised over all the fuss over this [AP report]," says Matthew Messina, D.D.S., consumer adviser to the American Dental Association (ADA). "The dietary guidelines removing flossing actually kind of make sense. Floss is not a food or drug. I don't need federal guidelines to include flossing."

But the American Dental Association (ADA) has not changed its position on flossing every day. "From the dental association perspective we've been advocating for flossing since 1908, long before it was cool to be advocating prevention," says Messina. "So, the landmark study on dental flossing has never been done because everybody has been convinced that it's one of the pillars [of good dental hygiene]." (The others, he says, are brushing, healthy diet and regular trips to the dentist).

Both Drs. Goldstein and Messina agree that flossing hits those sweet spots that even the best tooth-brushers fail to access. "I would like to know how without flossing they're going to remove pieces of food from between the teeth," Goldstein says. "What's interesting is if the person just uses the toothbrush and then uses floss they'll see what they didn't remove with the toothbrush. It's virtually impossible to remove all of the areas of food breakdown, especially in tight contacts."

This is a big deal because food left to simmer and stew in between the teeth will eventually turn acidic and attack the sides of the teeth. "That's the more frequent place we see decay," he says. Failure to floss can result in numerous nasty scenarios, including bad breath, gingivitis (inflammation of the gums), plaque, tartar, cavities and even eventual bone breakdown.

An uptick in good hygiene practices is credited with better lifelong dental health. "Two decades ago most people passed away earlier with dentures or missing teeth, and now most, if not all, will have natural teeth at the end of the finish line," Messina says.

So are dental professionals concerned about how this report will impact their clients? "I can't conceive of any patient who's been flossing all of a sudden stopping because of this report," Goldstein says. Indeed, the Department of Health and Human Services continues to recommend flossing.

"I don't think anybody is ready to throw out 60 years of success on one report that certainly didn't say there was anything dangerous about flossing," Messina says, adding, "If all of this attention about flossing gets people to think about it and talk to their own dentist about it, then maybe some good can come out of this."