
Federal health expert drop flossing from health guidelines - jld89
http://arstechnica.com/science/2016/08/dentists-forgot-to-study-flossing-for-a-century-recommended-it-anyway/
======
vonmoltke
A better discussion about the lack of evidence for flossing:
[https://www.sciencebasedmedicine.org/may-the-floss-be-
with-y...](https://www.sciencebasedmedicine.org/may-the-floss-be-with-you/)

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
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
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
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.

------
adrianN
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
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.

~~~
cLeEOGPw
> 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
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
I've tried them, but they refuse to go in too.

~~~
TorKlingberg
I use these. I can bit down on it if I need extra force.
[http://www.apteekkituotteet.fi/WebRoot/Euran/Shops/Eura/506D...](http://www.apteekkituotteet.fi/WebRoot/Euran/Shops/Eura/506D/44FC/C30E/E6B0/D550/0A28/1050/7369/plackers_twin.jpg)

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
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.

------
Vexs
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.

~~~
hashkb
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.

~~~
fpgaminer
I am not a dentist, but based on my understanding (derived from reading
commentaries by dentists) the "best" would be floss -> brush. Never mouth wash
(except when recommended by your dentist for specific conditions).

That's derived from the idea that brushing is not about cleaning the teeth.
It's about disrupting bio-films and depositing fluoride on the teeth. That's
the reason why dentists recommend not rinsing your mouth after brushing. If
brushing were about cleaning then clearly you would want to rinse to remove
everything from your mouth. But since brushing is more about applying fluoride
to your teeth, it makes more sense not to rinse as that would remove all the
fluoride that you just worked to apply. (The recommendation is to brush, then
take a teaspoon or two of water into your mouth to form a toothpaste slurry,
swish around, then spit.)

I thus argue that flossing should come before brushing because flossing would
remove the food from between your teeth, allowing fluoride to penetrate those
areas.

And with regards to Listerine/mouth wash, the alcohol based stuff causes mouth
cancer and hasn't shown any benefit to the reduction of cavities (I don't
recall its effectiveness with respect to bad breath or gum disease). There is
fluoride based mouthwash, which dentists do recommend to certain patients, but
for most people there's no point since they're getting all the fluoride they
need from the toothpaste. And of course there are mouth washes medicated for
specific conditions, which again will be recommended by your dentist when
needed.

~~~
Mathnerd314
My understanding is that, although possible, if the cancer risk does exist,
it's very small; here's an article placing it at 3-4 cases per 1,000,000:
[http://aaem.pl/fulltxt.php?ICID=1011054](http://aaem.pl/fulltxt.php?ICID=1011054)
(They cite a 2012 meta-analysis which showed no statistically significant
effect of mouthwash) Here's a recent large-sample statistical study:
[https://healthcare.utah.edu/huntsmancancerinstitute/research...](https://healthcare.utah.edu/huntsmancancerinstitute/research/labs/population-
sciences/hashibe/images/Boffetta2015_Inhance_mouthwash.pdf) They find an 1.15
odds ratio of cancer for mouthwash users, but in the non-smoking non-alcohol-
drinking cohort this effect goes the opposite direction (OR 0.83); statistics
is hard and there isn't high-quality data to give a real conclusion. But since
the overall incidence of oral cancer is roughly 1 in 10000
([http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/Oral...](http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/OralCancer/OralCancerIncidence.htm))
I wouldn't be too worried; all these show is that the effect is tiny. (Of
course, if you only remember the big headline from ten years ago with a tiny
sample size...)

There's a clear line of research showing benefits in mouthwash:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948552/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948552/)
It's true that the fluoride in mouthwash does little, and there are some
stupid mouthwashes that don't have any real ingredients, but essential oil
mouthwashes (like Listerine) and several others (as mentioned in the review)
have been shown to have significant gum benefits.

There's also some interesting research with tetrapotassium pyrophosphate and
tartar buildup: [http://periogen.com/periogen-
studies.html](http://periogen.com/periogen-studies.html) Although I expect
these studies are manufacturer-funded and thus overstate the effect, it seems
pretty hard to deny that it helps.

Note: I'm not a dentist either, but I read this book my dentist recommended:
[https://amzn.com/B009LPLMRU](https://amzn.com/B009LPLMRU). It's well-
referenced for everything except water fluoridation and her conflict of
interest (xylitol products).

~~~
Mathnerd314
Here is the author saying flossing is useless, a few years ago:
[http://www.medicaldaily.com/dental-floss-useless-dentist-
say...](http://www.medicaldaily.com/dental-floss-useless-dentist-says-243635)

------
wilwade
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.

------
StavrosK
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
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
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
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
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.

~~~
fnordfnordfnord
They look in your mouth and make assumptions that fit their preconceived
notions. ie: "These teeth are in good shape, this person must've followed my
advice on brushing and flossing!"

------
leaveyou
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
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
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).

------
codeulike
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/dentis...](https://www.theguardian.com/commentisfree/2016/aug/03/dentists-
great-flossing-yarn)

~~~
codeulike
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.

------
wvh
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.

~~~
skolos
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.

~~~
daveguy
> 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.

It's all the sauerkraut. It acts as a natural floss.

~~~
Kinnard
I can't tell if you're being serious or not.

------
fpoling
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.

~~~
gotofritz
It may well be, but since sugar is an integral part of modern diets that
doesn't help us much.

~~~
Legogris
Once you get started, a diet free from refined sugar is not at all as
difficult to maintain as you might think.

~~~
osteele
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.

------
niccaluim
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
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.

------
aaron695
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
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
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-
gui...](http://www.webmd.com/food-recipes/news/20140402/cdc-salt-guidelines-
too-low-for-good-health-study-suggests#1)

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

------
Booktrope
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!

~~~
jessriedel
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.

------
gotofritz
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
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.

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

~~~
gulpahum
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-...](http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-
say-you-need-to-floss-science-says-you-dont/#2b54386677d5)

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.

------
snarfy
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.

------
spdustin
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.

------
sambe
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.

------
koolba
> 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".

------
Kinnard
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-
rev...](http://www.wsj.com/articles/simple-dental-treatments-may-reverse-
decay-1460407763)

~~~
lkrubner
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.

~~~
cableshaft
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.

------
Mc_Big_G
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.

------
dbg067
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.

------
eksemplar
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.

------
venning
> _" 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.

------
ccannon
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)

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

------
6stringmerc
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.

------
return0
Toothpicks work just as well for me.

~~~
nailer
+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
How long does one last? Do you use one for a week, month or just whenever you
change your toothbrush?

~~~
nailer
About a month. The main thing is the plastic bumps on the wire wear away after
a while.

~~~
83457
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

------
DHMO
I'm going to keep flossing. Screw them.

