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Why You Should Never Skip Flossing Your Teeth (raymondduke.com)
37 points by raymondduke on Jan 22, 2013 | hide | past | favorite | 61 comments

FTA: Just recently I decided that I would give myself another dental check up. I seemed to have forgotten my horse racing lesson because I was expecting to have perfect teeth, again. I didn’t. I was given a bill that would be the equivalent of buying a decent used car. Ugh. Could I have prevented this? Yes, I could have. If only I had been flossing my teeth two times a day, I would have had less problems.

My personal anecdote: last time when I went to the dentist, for the first time in ~10 years, because a tiny bit of a tooth broke off while trying to strip a piece of wire with my mouth (yes I know that's bad), I expected my teeth to be in horrible shape. Dentist fixed my tooth and did a full check-up including X-rays, and as it turns out, my teeth where in near-perfect condition, no cavities or other bad spots, just some dental plaque that needed to be removed. I haven't flossed a single time in my 30+ years long life.

Moral of the story: flossing probably has nothing to do with dental health, as long as you brush your teeth and don't eat a lot of sugar.

Flossing has everything to do with dental health. It's just that dental health has everything to do with cavities when you're young, and everything to do with gum health and gingivitis when you're older.

There are many factors that affect tooth decay and plaque buildup including the microbial content of your mouth, your diet, and the amount of saliva produced.

But one thing that is clear is that oral health is very important. I've noticed that when I brush around midday, I'm in a much better mood. But don't take my word for it -- numerous studies have established co-incidence between heart disease, mortality, and inflammation and bad oral health. And there are good reasons to believe it is not simply an issue of correlation without causation as local even mild infection can cause many downstream effects throughout the body. And anyways, it's just so much better to have a clean mouth.

Moral of the story: flossing probably has nothing to do with dental health, as long as you brush your teeth and don't eat a lot of sugar.

It is unwise to extrapolate from your personal experience. Especially when there is plenty of research available on the effect of flossing on one's dental health.

I'll see your anecdote and raise you one ;-).

I never used to floss, and would regularly have cavities to deal with (pretty much every visit to the dentist). When I started flossing religiously that ceased. I've had one filling (and that for a tooth cracked when I accidentally bit down on something hard) in the last decade.

For me, there's a pretty clear benefit to flossing. I imagine there's a lot of variation in its usefulness, depending on things like diet, mouth shape & size, what kinds of bacteria you host, etc.

You are a statistical outlier, and your conclusion is completely unfounded.

I get it. When our experience is exceptional, we see the need to share, but you're taking away the entirely incorrect lesson from your own experience, and from the author's blog post.

The author was using flossing as a metaphor for a common oversight: just because things are one way today doesn't mean they'll always be. Well, duh. Yet, we all forget it. It's the same reason that investment advice is given with the caveat that past performance is not to be used as a determinant of future results.

I disagree with the author's approach though. I've also never had a cavity in my life. Just turned 36 today. I also have excellent gum health. I floss, at most, once a month. The difference between my experience and the authors is that I continue to go to the dentist every 6 months.

My dental health is fine without flossing, so why should I floss? The author's contention is that this could change at any time. I agree, which is why I get regular dental check-ups. The assertion that I should floss anyway is just acceptance of dogma. I don't buy it. The important part, in my view, is that you always keep an eye on conditions. At the first sign of change, I will adapt my routine to accommodate.

Genetics, and how much flouride you got as a child, also make a big difference. Some people have to fight against tooth decay a lot more than others. (I'm more in your category, but have to be careful about my gums.)

Actual moral is probably that some people have better teeth than others.

I guess the molar of the story is clear.

Great comment!

If you experiment with various size interdental brushes (search on Amazon), you will quickly realize that there can be a lot of differences in dental spacing. Some people might mostly have tiny spaces between their teeth, while some have larger spaces, which will collect much more food residue. Leaving that residue in place can cause your gums to bleed pretty fast, which means you will have problems.

Moral of the story: get to know your own teeth well and take care of them in the way that's best for you. You might not even realize how much food is constantly stuck between your teeth, if you never used an interdental brush. Flossing is complementary to them.

Or maybe the moral is that young people are generally healthy and thus are not a great population to study when judging the efficacy of health habits?

Out of sheer curiosity: do you never get food stuck between your teeth? I don't floss too often, but whenever there's something stuck between my teeth that I can't get out with my tongue, it drives me nuts and really distracts me. Do you never eat popcorn and chicken and pork?

Ah, but do you use toothpicks?

One DH told me that toothpicks are better.

Flossing isn't about your teeth so much as it is about your gum health. Nasties that get in your gums will get into your blood stream, and there's a high correlation between gum inflammation and generalized inflammation, even heart attacks. Some researchers even believe that inflammation that starts in places like your gums is a cause of heart disease, rather than just a comorbidity. This is not a very "out there" hypothesis, either.

Don't skip flossing just because you haven't had a bunch of cavities. Your teeth may be special, but is your heart?

OT, but just to understand: are you referring to the Focal Infection Theory when talking about gum infections causing heart disease?

I ask because Wikipedia[0] believes that the theory is still quite "out there" but I'd be happy to learn from more up to date/reliable sources.

[0] http://en.wikipedia.org/wiki/Focal_infection_theory

I can't remember which book I read it in, but no, it wasn't about the focal infection, but rather the inflammation markers. Inflammation changes blood chemistry (blood cell mix, the "stickiness," and other chemical markers) and there's good reason to believe there's no such thing as "local" inflammation when it's an internal organ (vs, say, a rash on your elbow). And like circulating hormones in response to a grievous injury, these changes can cause a cascade effect.

Meh, observational data sucks. And the cohort studies (with treatments) don't seem to have been compared with a control group. Just before/after. Way more important to be lean and active.

Interestingly, there haven't been many (any?) studies looking at the efficacy of flossing for prevention of carries (cavities). What evidence is available suggests that flossing can reduce gingivitis (gum disease).

Relevant Cochrane review: http://summaries.cochrane.org/CD008829/flossing-to-reduce-gu...

While the current consensus among American dentists is that flossing helps prevent cavities, this (like what seems to be a frightening amount of what dentists believe about dentistry) is not actually founded on or backed up by scientific evidence. There is slightly stronger evidence that flossing helps against gingivitis (http://www.ncbi.nlm.nih.gov/pubmed/22161438).

As for dentists handing you a bill that would pay for a used car? There's an easy fix for that: ignore most of what they tell you, and get things fixed if/when they hurt. When the dentist has you sign a consent form that says "dentistry is not an exact science", take heed.

What is this "flossing" he is talking about? Nobody I know flosses their teeth, is brushing and then using mouthwash twice a day not enough?

Also, having a public health care helps with the bills, I go for a check-up every year and never had any serious problems.

It's not so much about the bills, its about the gum disease that you can get if you don't remove plaque from your teeth.

Gum disease can progress rather quickly, so your one-year time scale might not be frequent enough to catch it.

I'm now on a first-name basis with my periodontist, and a couple of years ago, I didn't know what that was.

I had no idea what flossing was either before googling it (translates to 'tandtråd' in swedish). Basically it's a thin thread or similar you use to remove stuff from between your teeth, not easily accomplished while brushing. I believe moutwash will help as well.

Incidentally I also went to the dentist lately and I rarely brush my teeth more than once per day and I never floss but they thought my teeth looked good. My girlfriend flosses and brushes her teeth like a madman but she did not get any compliments for her teeth. I think it simpy varies from person to person and it's a lot about what you eat and drink.

Where are you located? Every dentist in the U.S. will scold their patients for not flossing.

AFAIK, it is not promoted in Europe.

We're encouraged to brush after each meal, though, using fluorinated toothpaste.

I am from Poland, currently living in the UK. In neither of those countries people floss, and I have never had a dentist recommend it to me. Lots of people brush and use mouthwash instead.

In Europe (at least the parts I'm used to), many dentist don't even actively recommend flossing to their patients. Some do, but they're in a minority. The other will say it's good if you ask them, but won't try to get you to do it unless you have a specific affliction for which it is especially indicated.

adding (possibly) a couple datapoints, it's the same for my home country (italy) and where I live (hungary). Sometimes they suggest you floss, mostly they don't.

The same goes for France and Belgium.

I hate flossing. My teeth are packed tightly together. Getting the floss between them is tough so I tend not to do it I have to.

I recently picked up a waterpik off of Amazon for about $40. It's essentially a water pressure based flossing system. I love it! It's easy to use and gets those spaces that are hard to reach with floss.

If you struggle with flossing like me, I recommend taking a look. I've been very happy with the results so far.

I went through a bout with severe Periodontitis.

Just in case: http://en.wikipedia.org/wiki/Periodontitis "Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth."

My case was pretty severe. Mainly from drinking WAY too much pop and not brushing and flossing on a regular basis. It is true flossing helps your gums in a lot of ways and considering they're the main support structure for your teeth, you really should take care of them.

And even if there isn't any scientific data showing dental care and other diseases aren't related, shouldn't you just error on the safe side anyways?

An HN thread from eighteen days ago on flossing and dental care in general


accumulated a lot of interesting comments after I last checked it soon after it was posted. Going back to those comments now is food for thought as I read this thread. I'm trying out some of the ideas that come from the article that opened the previous thread, for example by changing which mouth rinse I use daily. I still floss daily, and have for years, and since I began doing that (in adult life), my dentists have generally reported that my teeth are now in better condition than they were before I started that habit.

Nutrition has a significant role in teeth health that is completely ignored by dentists. Apparently, vitamin D and vitamin K2 can do more for you teeth than regular brushing, provided that you don't keep your mouth sugared for too long: see e.g. http://www.westonaprice.org/journal/journal-spring-2007

And a pre-emptive answer to all those who will say Weston Price was a quack: No, he wasn't. Ignore the soundbites, read his studies, and modern follow-ups.

A coworker of mine from way back had a dentist who put it this way: It's simple. You just have to floss between the teeth you want to keep.

Flossing twice a day? I thought I was awesome for once a day.

My dentist gives me a guilt trip about flossing on every visit. I've always thought that was a bit odd because it would be in his best business interest for me to neglect my teeth.

He's a professional. He genuinely cares about your dental health. Most medical doctors enter the profession because they genuinely want to help people, not exploit them for bucks. And prevention is very often the best method of help.

Compare him to the programmer who creates an extensible open framework, as opposed to the guy who throws together a dense hack that only he understands. The latter could be said to be acting more in his own interest, but the former is more dedicated to his profession and the greater good.

Every time my dental hygienist asks whether or not I'm flossing regularly, I reply that if they can't already tell the answer by looking closely then there's no point in flossing!

When you neglect to care for your teeth, you probably neglect to have others care for them as well. I'll bet the dentists' best patients are the OCD types who brush and floss five times a day.

Maybe if more people floss their teeth, cleanings would go faster, allowing him to see more patients, partially making up for the scarcity of expensive dental procedures?

You found it a bit odd that he's not cynical?

Short term, yes.

Longer term, not so much. As word gets around that he isn't a good dentist, he will have fewer customers.

The article draws an analogy between flossing teeth regularly and staying on top of your game, in general.

I'm not a fan of the analogy in this case, but the tl;dr is: don't rest on your laurels when you're #1 at something. Reference: http://idioms.thefreedictionary.com/rest+on+laurels

Apparently, flossing also helps to prevent heart disease. Perhaps that's just some unfounded pseudo-science being pushed by the floss-manufacturers but in any case I imagine it can't be bad for you. Twice a day might be a little overkill, though.

It's real science. Bacteria in your mouth can enter the bloodstream through wounds and travel to your heart.

//EDIT: Apparently, although the association between gum disease and heart disease seems to be science, the causal link is not.

It's not about bacteria entering your bloodstream (if that happened you'd have bigger problems), its the inflammation caused by your body fighting the bacteria influencing other organs. Inflammation isn't an acute action, the signalling molecules involved travel around the entire body. This can cause inflammation in completely unrelated areas. The heart is highly susceptible to this since all your blood travels through it.

What about wounds caused by flossing irregularly?

Seriously, and flossing undoubtedly pushes some food particles beneath the gum line.


You sure it isn't that people who floss tend to also be people that take better care of their bodies overall, and hence the two, while correlated, aren't an example of cause and effect.

Ehm, I'll admit that at this time no causal link is established although there is a correlation [1]. I've come to realize that I don't have a good source for what I wrote earlier.

Sources like [2] do claim a causal link but I was unable to find the actualy study.

[1] http://jama.jamanetwork.com/article.aspx?articleid=193088#qu... [2] http://abcnews.go.com/Health/dental-screenings-linked-lower-...

To be clear, I don't want to discount the studies completely, because there does seem to be a little bit of smoke there.

That said any real conclusions are clearly premature for the data, as science reporting tends to be these days.

Isn't that what the Lymphatic System is for? Bacteria do not simply enter the bloodstream, that would be a serious infection.

I believe the logic goes something like this: Research shows that perio disease may be linked to heart disease [1]. Flossing has been proven to reduce your chance of heart disease so it also reduces your chance of heart disease.

I'm not going to try and dig up a bunch of studies to back this up. I drank the Kool-Aid years ago. It appears to have paid off for me in the dentists chair!

[1]: http://www.perio.org/consumer/heart_disease

Correlation. Causation. Not the same.

People who floss twice a day tend to have all sorts of good habits. In fact, they tend to be the sort of people who just plain "take care of themselves."

Agreed! For the causation you'll have to read the extensive literature on periodontal disease.

Which won't help much, given that the second line in your link is: While a cause-and-effect relationship has not yet been proven

Agreed, the cause and effect between heart disease and periodontal disease is not well proven. However, the beneficial effects of flossing in preventing periodontal disease is well understood and you're welcome to read the literature yourself if you don't believe me. I believe this is exactly what I said in my original comment.

I floss all the time because it feels amazing

Am I still on HN?

yes and not hellbanned AFAICT.

Nope. Just your standard flossing tips on HN. Nothing out of the ordinary here...

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