BBC Future | 27 May 2014

Medical Myths - Does flossing your teeth prevent

tooth decay
Can flossing reduce the ris! of tooth decay "hen you ta!e a close loo! at
the evidence# it$s not %uite as &&&&&&&' ()*+,-./*0 as you 1ay thin!'
Dentists say elite athletes could stand a 2etter chance of 3inning gold 1edals
if they loo! after their teeth'
4/o3 often do you floss your teeth5 -t$s a %uestion al1ost al3ays as!ed 2y
dentists 3hen you are in the chair' "e$re advised that 3e should floss our
teeth as 3ell as 2rushing &&&&&'' (*"60 a day' But are 3e really clear on
the e7act 2enefit this 1ight 2ring
*he idea is that flossing &&&&&'' (86"0 your ris! of tooth decay and gu1
disease 2y preventing the 2uild-up of pla%ue' 9la%ue is the &&&&&&'
()*-C:0 fil1 of 2acteria fuelled 2y the car2ohydrates 3e eat' -f left to 2reed#
these 2acteria eventually 2egin to 2rea! do3n the tooth$s surface# leading to
painful &&&&&& (C,;<0 that need filling# or even to the &&&&&&
(+<M6;<0 of the tooth if the decay is too 3idespread' 9la%ue 2egins to
refor1 the 1inute you re1ove it# and if not re1oved it can lead to gingivitis#
3here gu1s 2eco1e infla1ed and &&&&&& (B866D0 easily' -n a 2=-
year longitudinal study of 1en in >or3ay# teeth surrounded 2y infla1ed gu1s
3ere 4= ti1es 1ore li!ely to 2e lost 2y the end of the study than teeth
surrounded 2y healthy gu1s'
"e !no3 a tooth2rush cannot address the pla%ue pro2le1 co1pletely# as it$s
so hard to reach areas 2et3een the teeth' *he idea of using flossing to reach
the rest is credited to a dentist fro1 >e3 6rleans called 8evi )pear 9ar1ly#
3ho reco11ended using sil! for the purpose 2ac! in 1?1@' But it$s not only
hu1ans 3ho do it' 8ong-tailed 1aca%ues at the Buddhist shrine of 9rang )a1
Aot in *hailand ta!e strands of long hu1an hair and 3ind the1 round their
fingers to get to those hard to reach parts of their 1ouths'
*here$s plenty of evidence to suggest that flossing reduces pla%ue levels# 2ut
3hat evidence is there that flossing can reduce the ris! of 2oth tooth decay
and gingivitis "hen you ta!e a close loo! at the research# it$s not %uite as
straightfor3ard as you 1ay thin!'
, revie3 of flossing in children found it could reduce decay# 2ut in adults it$s
not 2een as easy to de1onstrate' , revie3 pu2lished 2y the respected
Cochrane Colla2oration in 2012 gathered all the e7isting research on flossing
and found Bust 12 trials# 1ostly conducted in the C)# 3here adults 3ere
rando1ised either to 2rush their teeth as usual or to floss in &&&&'' (,DD0'
*hey 3eren$t i1pressed 3ith 3hat they found' Co12ining the results of the
studies and re-analysing the1# they found a possi2le s1all &&&&&''
(+<DCC<0 in pla%ue# 2ut the studies$ evidence 3as graded as 3ea! and very
unrelia2le' 4"e are una2le to clai1 or refute a 2enefit for flossing plus
tooth2rushing#5 they said' , reduction in pla%ue 3ould suggest a reduction in
tooth decay in the long-ter1# 2ut not a single long-ter1 rando1ised controlled
trial had 2een done (the longest 3as nine 1onths0' >one had included an
&&&&&'' (,))<))0 of tooth decay 2ecause it 3ould 2e too soon to see
any difference'
.ap in the literature
*he &&&&&& (F->D0 for gingivitis tell us 1ore' Flossing does help reduce
the ris!# if only 2y ?D' *his 3as at least so1e positive ne3s for flossing fans#
in contrast to an earlier revie3 fro1 200? 3hich found it couldn$t de1onstrate
any 2enefits for regular flossing'
But the %uality of the evidence 1a!es it hard to co1e to any strong
&&&&&&' (C6>C8CD<0' Cochrane +evie3s not only su11arise all the
data availa2le# 2ut they rate the research according to ho3 3ell it 3as
designed and conducted' *hey Budged that 1any studies didn$t co1e up to
scratch# ran!ing the %uality as 4lo35'
,s poor as the evidence 1ight 2e dee1ed to 2e# it$s still all 3e have to go on
at the 1o1ent' )o you could argue that if it 1ay 2e useful for us# 3hat$s the
har1 in getting everyone to floss any3ay )elf-inflicted da1age could 2e the
reason# and so1e studies have investigated this' 6ne found that three of the
EF people ta!ing part had da1aged their gu1s one 1onth into the study# 2ut
2y t3o 1onths# t3o of these people no longer had pro2le1s' ,nother found
t3o people had da1aged their gu1s 2y using a type of auto1atic flosser# 2ut
not in %uite the right 3ay'
-f you 3ant to !no3 the right 3ay to floss# here$s a guide' ,nd in the a2sence
of any forthco1ing evidence that could &&&&&'' ()*+6>.0 the case
either 3ay# if you are going to floss at least 1a!e sure it doesn$t do you 1ore
har1 than good'