Don’t Hate the Floss Boss

By Michael Verber, DMD, FICOI

Everybody hates the annoying flossing lecture they get at the dentist.  The news media has capitalized on these feelings recently by running a sensationalized story questioning the value of flossing.  As a result, 300 million Americans threw their boxes of unused floss into the streets and started dancing for joy.  The story claims that there is little evidence to support flossing, and it is right… kind of.

There are very few well-designed studies that support flossing. The reason for this is that for over a century, it has been kind of obvious that flossing removes plaque from spots that are otherwise not cleaned by brushing or the by mouth’s natural cleansing mechanisms. Just because there are no studies that show a rake can collect leaves, it doesn’t mean that it can’t.

Here is what we do know based on the most current studies and findings:

• The plaque mass that is removed by flossing is 70% bacteria.¹
• The bacterium releases acid and toxins that cause cavities, bad breath, and periodontal disease.²
• Periodontal disease is essentially inflammation in the gums that causes loss of the supporting bone around the teeth, leading often to recession, infections, and loose or lost teeth.³
• Hundreds of studies are now published every year proving that chronic inflammation, like the type represented by periodontal disease, is a risk factor for many systemic diseases including cardiovascular disease, diabetes, rheumatoid arthritis, Alzheimer’s disease, pulmonary disease, cancer, erectile dysfunction, and dozens of others.^4-10
• The link between oral inflammation and arterial disease is so strong that the nation’s leading cardiologists are now describing oral disease as one of the single most important factors leading to strokes, heart attacks, and other vascular issues.¹¹
• The Chief Wellness Officer at The Cleveland Clinic, one of the world’s most respected medical centers, has announced that on average flossing can add nearly six-and-a-half years to your life.¹²

Forget what you hear on the news.  Don’t believe everything you read on Google.  Ignore any dental advice you get from your friends at the gym.  Listen to your dental hygienist… If you got ’em, floss ’em.

1. Marsh PD, Bradshaw DJ. Dental plaque as a biofilm. Journal of Industrial Microbiology. 1995;15(3):169.
2. Liljemark WF, Bloomquist C. Human oral microbial ecology and dental caries and periodontal diseases. Crit Rev Oral Biol Med. 1996;7(2):180-98.
3. Goh V, Hackmack PP, Corbet EF, Leung WK. Moderate-to-long-term periodontal outcomes of subjects failing to complete a course of periodontal therapy. Aust Dent J. 2016 Jul 8.
4. Wu F et al. Periodontal Diseases and Carotid Intima-Media Thickness in Bangladesh. J Clin Periodontol. 2016 Jul 9.
5. Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health. 2016 Jul 30;17(1):31. See comment in PubMed Commons below
6. Yamakawa M et al. Porphyromonas gingivalis infection exacerbates the onset of rheumatoid arthritis in SKG mice. Clin Exp Immunol. 2016 Jul 27.
7. Singhrao SK, Harding A, et al. Oral inflammation, tooth loss, risk factors, and association with progression of Alzheimer’s disease. J Alzheimers Dis. 2014;42(3):723-37.
8. Shen TC, Chang PY, et al. Periodontal Treatment Reduces Risk of Adverse Respiratory Events in Patients With Chronic Obstructive Pulmonary Disease: A Propensity-Matched Cohort Study. Medicine (Baltimore). 2016 May;95(20):e3735.
9. Zeng XT, Xia LY, Zhang YG, et al. Periodontal Disease and Incident Lung Cancer Risk: A Meta-Analysis of Cohort Studies. J Periodontol. 2016 Jun 13:1-13.

See comment in PubMed Commons below10. Kellesarian SV, Kellesarian TV, et al.  Association Between Periodontal Disease and Erectile Dysfunction: A Systematic Review. Am J Mens Health. 2016 Mar 29.

11. Bale B. Beat the Heart Attack Gene: The Revolutionary Plan to Prevent Heart Disease, Stroke, and Diabetes. New York, NY: Mosby Elsevier; 2014.
12. Roizen, M. The RealAge Makeover: Take Years of Your Looks and Add Them to Your Life. New York, NY: HarperCollins, 2004.