References

Berchier CE, Slot DE, Haps S, Van der Weijden GA The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg. 2008; 6:265-279
Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ Dental flossing and interproximal caries: a systematic review. J Dent Res. 2006; 85:298-305
Kressin NR, Boehmer U, Nunn ME, Spiro A Increased preventive practices lead to greater tooth retention. J Dent Res. 2003; 82:223-227
Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, Glenny AM Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;
Marinho VC, Higgins JP, Sheiham A, Logan S Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003a; 1
Lang NP, Cumming BR, Loe H Toothbrushing frequency as it relates to plaque development and gingival health. J Periodont. 1973; 44:396-405

Flossing, remoaning and remania – dentistry in denial

From Volume 43, Issue 8, October 2016 | Page 793

Authors

Crawford Bain

BDS, DDS, MSc, MBA

Glasgow Dental School

Articles by Crawford Bain

Article

It is uncomfortable to be asked to face up to a reality which does not agree with our long established beliefs. In the past the powers that be just ‘knew’ that the sun went round the earth (which was, of course flat). Heretics were denounced, dismissed and even martyred for challenging dogma with evidence. But that couldn't happen today; could it?

Just as we are daily being told by the wise and totally informed 48% that the ignorant, misled 52% of the UK population should all be allowed to take a re-sit in plebiscites; so the internet is replete with those who ‘know’ that the recent AP report highlighting the ineffectiveness of flossing is obviously wrong; it's just the useless patients who can't master it! The lay press has merely noticed that ‘Dental Heretics’ have dared to question the benefits of flossing; how can they say such a thing?

The problem is we have known about flossing for almost a decade. Berchier et al,1 after reviewing more than 1350 papers, found that these overall ‘…did not show a benefit for floss on plaque and clinical parameters of gingivitis’ and concluded that ‘….. a routine instruction to use floss is not supported by scientific evidence’. In relation to caries reduction, Hujoel et al,2 in another systematic review (in the dental journal with one of the highest impact factors), found no reduction in interproximal caries when comparing patients who flossed and those who did not. There was, however, a significant reduction in high risk children when they received daily professional flossing. Reassuring, if only by bringing closer together dental professionals married to each other! If it doesn't prevent gingivitis or caries what is it for?

Fortunately, brushing works and some power brushes are more effective than manual brushes.3,4 Fluoride toothpaste reduces caries.5 Let's tell patients the scientific facts and give up our long held and much cherished dogmas. Brush your teeth thoroughly at least once a day6 and make sure that your kids' teeth are also thoroughly brushed and are exposed to fluoride toothpaste twice a day.5

Cognitive Dissonance makes it tempting to make up all kinds of reassurance to patients to keep flossing, however, let's not go into denial and continue to mislead our patients. Over 80% do not floss regularly and it is hard to accept that these ‘the great unflossed’ were right and we, ‘the highly educated intelligencia’ may actually have been wrong. They will welcome the news with open arms and free of cyanotic fingertips.

Flossing doesn't work – get over it! And we are also leaving the EU – if you are also within the 48% highly educated intelligencia who just know the ignorant, misled 52% were wrong; get over that too!