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A String around Your Finger: Do We Really Need to Floss?

Course Number: 550


As dental healthcare professionals, patients rely on us to understand the current scientific literature and be able to filter the important take-home messages for their oral health. Particularly when inconsistent or incomplete messages are present in the lay media, dental healthcare providers must be resources to inform and coach patients to establish best practices for their oral health. The confusion associated with the changes in the 2015-2020 Dietary Guidelines for Americans and its reporting in the lay media caused many unsubstantiated conclusions that were not supported by current research.18,19 While the “Flossgate” controversy resulted in some splashy headlines and sensational news segments, the underlying science is less titillating. We currently lack the randomized, longitudinal studies necessary to make definitive conclusions about the effectiveness of flossing as a preventative measure for dental caries and periodontitis.2 There are, however, data to suggest that biofilm removal through toothbrushing and interdental cleaning improves oral health outcomes, including the reduction of caries and periodontal diseases. Furthermore, evidence also suggests that for patients with periodontitis, the use of interdental brushes, where feasible, may provide additional benefit beyond that of toothbrushing and flossing alone.6,7

Caries and periodontal disease are prevalent, serious diseases that represent a huge burden to the health and well-being of the population as well as a cost burden on society. While professional dental prophylaxis has been shown to improve plaque levels and gingivitis in the short-term, these improvements cannot be maintained without subsequent optimization of home care by the patients themselves.

Clinical Recommendations:

  • Both dental caries and periodontal disease are mediated by a microbial dysbiosis and adequate patient-delivered biofilm control is the primary method of prevention for both diseases. Careful evaluation and diagnosis of patients as well as coaching patients to perform adequate oral hygiene and limit sugar intake is critical to disease prevention and management.

  • Individualized risk-assessment and oral health and hygiene recommendations should be designed for each patient to insure optimal oral hygiene outcomes. Ongoing evaluation of gingival inflammation and plaque/biofilm control is critical to the continuous improvement and/or maintenance of a patient’s oral hygiene.

  • Oral hygiene education should utilize psychological interventions that tailor approaches to patients’ needs and desires.