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Innovative News and Views

Understanding the Recent Flossing Controversy

by Donna Grzegorek

Recently, I visited Washington DC to attend a four day dental symposium.  This well-respected meeting attracts the most forward thinking dental professionals in the country.  With particular emphasis on dental hygiene, the curriculum is second to none.  This year, I participated in a rather intense conversation about recent literature that seems to dismiss the importance of dental flossing.  For some, this discussion was a dream come true.  For others, including myself, this discussion was a nightmare.

How could this be true?  After all, flossing is one of the most universal recommendations in all of public health.  “Floss daily to prevent gum disease and cavities.”  I was taught the merits of dental flossing in hygiene school 36 years ago and have stood firmly on my soapbox as a clinical dental hygienist with regard to the efficacy of dental floss.


With a strong desire not to succumb to the prevailing literature, I began my personal mission to research this concept a bit further.  Encapsulating, I can unequivocally state—all people must clean between their teeth!


So here is the skinny… 

1) Approximately 87% of the population does not floss regularly.

2) Of the 13% who do floss regularly, only 5 % floss correctly.

There it is... the reason why the studies and systematic review by the prestigious Cochrane Group found weak evidence supporting the effectiveness of dental flossing for the reduction of plaque and/or dental caries (cavities).   Very few people are compliant and only a very small percentage of the compliant patients floss effectively.

This makes more sense to me.  As a dental professional I know the merits of flossing.  I see it every day in the clinic.  But if I am honest with myself, I would admit I don’t see it often enough.  This is where science and practicality meet.  It’s not that flossing doesn’t work; it’s that it has to be done meticulously and consistently to gain the benefit.  Unfortunately most people lack the dexterity to floss well enough to achieve optimal oral health.  This does not mean that patients don’t need to clean between their teeth.  I know that it is essential.  Brushing alone is not enough.  As uncomfortable as reports like this make me feel, they also shake me up and force me to find more effective ways to help my patients clean between their teeth.


One of my favorite products to give patients is the Sunstar GUM Soft Picks:



Another option is a Waterpik Cordless Water Flosser:



So at the end of the day, I can sleep at night knowing that the foundation of my dental hygiene education, namely dental flossing, is still a viable option.  But as paradigms must occur, I also recognize I must be open to change and willing to make practical recommendations for my patients that will make cleaning between their teeth easier and more effective.

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