A Hygienist's Nightmare: The Media says "Goodbye" to Flossing

Ahhh, the media. It can help us educate our patients or it can really make our jobs much harder. Many of you may have seen the Daily Mail’s article or the Today Show’s segment (see below) on the demise of the need to floss.  If you didn’t actually see it, you may have had a patient come in debating with you about flossing since the Today Show said that it wasn’t necessary. I thought I would take a minute to review the research and explain the ways it was misquoted. I hope by arming you with the proper facts, it will help you to correctly educate your patients on the newest findings in proper interdental care. 

 

First, I saw many comments about the country from which the Daily Mail received its information. Many disregarded it because it came from Britain. Let me just say, even though the research was not conducted in the U.S., it is still valid research based on evidence. In fact, most of the information came from the European Federation of Periodontology. Let me assure you that they are as valid and as important as any U.S. periodontology associations. So, be careful to not disregard research findings just because they were not done in this country.

Second, the Today Show reported that flossing was not beneficial to patients. Of course, as hygienists, we know that flossing is beneficial; however, the research is showing that not every patient needs to be flossing. This is where the research was not presented correctly on the Today Show. The research is saying that most people are ineffective when flossing and that floss is not removing as much biofilm as other interdental devices like interdental brushes. Therefore, encouraging a patient to perform a task that is difficult and they are not going to do correctly, will not benefit them. This does not mean that they should skip interdental cleaning completely. It means, find the product that they can use effectively, i.e. interdental brushes, oral irrigation, or floss. Just get them performing some type of interdental care that works for their capabilities and level of motivation! 

The European Federation of Periodontology reported, after an intense review of the research, that floss is not as effective in larger interdental spaces. So, if your patient has a class 1 embrasure space, motivated with good dexterity and lacks a presence of inflammation, then by all means, encourage flossing! However, if your patient has a presence of inflammation, has larger embrasure spaces and is not efficiently able to use the floss, then encourage the use of interdental brushes. The science shows that interdental brushes can disrupt more biofilm than floss.

You can check out the four articles that I've noted below that were recently published so you can see where the idea originated and you can have the correct research to inform your patients. I hate how this new understanding of interdental care was presented to the public before our profession has even had time to grasp it. A very big paradigm shift is causing us to turn away from what we have known and encouraged for our whole careers, flossing. Yet, from frustration comes change. I hope this will encourage everyone to stay up-to-date with the most current recommendations so as to arm yourself against the sometimes misguided media and the questions that patients will ask and challenge you with because of it. 

Professional Articles on periodontal disease prevention 

    1. Tonetti MS, Chapple IL, Jepsen S, Sanz M. Primary and secondary prevention of periodontal and peri‐implant diseases. J Clin Periodontol. 2015;42(S16):S1-S4.
    2. Poklepovic T, Worthington HV, Johnson TM, Sambunjak D, Imai P, Clarkson JE, Tugwell P. Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. The Cochrane Library. 2013.
    3. Sanz M, Bäumer A, Buduneli N, Dommisch H, Farina R, Kononen E, Linden G, Meyle J, Preshaw PM, Quirynen M. Effect of professional mechanical plaque removal on secondary prevention of periodontitis and the complications of gingival and periodontal preventive measures. J Clin Periodontol. 2015;42(S16):S214-S220.
    4. Tonetti MS, Eickholz P, Loos BG, Papapanou P, Velden U, Armitage G, Bouchard P, Deinzer R, Dietrich T, Hughes F. Principles in prevention of periodontal diseases. J Clin Periodontol. 2015;42(S16):S5-S11.

 Good luck and be sure to contact me if there are any ways TePe can help you!


3 Comments

Dr. James Huang
Dr. James Huang

July 12, 2018

This is something that most dentists are not exactly happy about. We champion brushing the teeth 3 times daily, and people would often times mention that they could go without it just fine in their lifetime. We stress the importance of dentist visits at least twice a year for check up and cleaning, but people do away with it. And now this, debunking the essence of flossing. I think people only need to consider one thing before they give up on flossing, and that is trying to smell the floss after they have used it on the hard to reach areas of their teeth, and they will know that it is important. Thank you for sharing the article, I believe the research body is doing their best but there are a lot of other factors in play here.

Dr. Nozaki
Dr. Nozaki

July 12, 2018

That story was a little shocking to hear as a fellow practitioner. Thank you for sharing your comments regarding that and I do agree that it has a huge impact on our careers as it does not exactly provides support on the claim other than being just that, a claim. What I do believe will make it more believable for our patients to continue flossing is that at the end of the day once you are done flossing and you smell the one you used, you could tell it took out a lot of stuff out that could have been a cavity build up. Hygiene is routine, what’s next shows telling us that showering is actually a waste of time?

Alan Mead
Alan Mead

October 29, 2015

Can you imagine trying to squeeze a little nuance out of the Today show people? Maybe an explanation of individual risk factors? Nope. It will never happen. It’s a better story to suggest that no one needs to floss any more.

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