Flossing is important.  Yes, you need to floss! The benefits of flossing are clear. It helps prevent cavities in between the teeth; decreases risk of periodontal disease; and lowers risk of gingivitis and bleeding gums.  It also helps rid of bad breath and improves the appearance of your teeth by removing trapped food and biofilm.  A flossing study done on twins in 2006 confirmed the benefits of flossing.

Yet, on August 2016 the US Department of Health and Human Services and Agriculture cites that flossing has been dropped as part of daily recommendation.  Their reasoning is “scant evidence that flossing does much to keep teeth and gums healthy.”

The primary problem with such recommendation of not to floss is the US Department of Health’s studies’ methodology is flawed. As a dentist in private practice with a background in epidemiology and biostatistics, asking a patient not to floss for an extended period of time would not be considered unethical. Why? Because flossing has clearly shown to decrease cavity and gum disease risk. As a dentist who has a moral conscious with my patients’ best interest in mind, how can I feel right in asking my patients not to floss? By me asking my patients not to floss is like me telling you when you go to the bathroom it’s okay to wipe the butt cheeks and to not wipe the crack! Asinine!

In my private practice I see patients who do not floss regularly or at all, and they usually fall into 3 groups.

The first group is in the minority. These patients have very low prevalence rate of gum disease and little to no cavities. They don’t floss, and seldom brush. These people are rather the lucky ones who are blessed with a naturally low count of oral bacteria. With so little microflora, one can not brush and not floss and have a perfectly good set of teeth and gums. But again, these people are in the minority. I estimate <1% of the population fits this criteria.

The second set of these patients who don’t floss regularly are by far with the highest rate of periodontal disease, and many have severe bone loss with teeth needing extraction. Teeth that need to be removed not because of cavities, but because of periodontal disease from bacteria not removed from flossing. These patients brush quite frequently, but the lack of flossing has caused bone loss and frequent gum bleeding when brushing. A deep cleaning or more frequent cleanings may be required to resolve said gum and bone issues.

The third set of patients who don’t floss have very high rates of cavities. Generalized multiple areas between their teeth have tooth decay. Many fillings are needed, and unfortunately even with new fillings, if flossing does not begin, new cavities can start underneath the new fillings. Some teeth end up needing to be removed, especially primary teeth.

I personally myself attempted not to floss my own teeth. This week, I decided to only brush and not floss. Yes, a dentist who decided to experiment on himself and not floss! First day, by not flossing it saved 2 minutes of my time and I felt free. 2nd day, more free time. 3rd day, however, my gums started to bleed! So I thought okay, maybe I can try to resolve my bleeding gums by brushing more frequently. So that day and morning after, I brush for 3-4 minutes instead of my usual 2 minutes. 4th day and 5th day, my gums continue to bleed and I noticed I have bad breath now. By this time I had enough of my gums bleeding, and I surely did not like the bad breath. 2 days after I started to floss again, my gums stopped bleeding and the bad breath went away. Cavities were not visibly detected before or after the experiment.

The moral of the story and my flossing experiment? Albeit my experiment only had a sample size of 1 and lasted only a few days, my lack of flossing increased my gum bleeding and caused bad breath. By flossing daily again, my gum bleeding and bad breath went away.

So yes, daily flossing is important and continues to be a recommendation I give to all of my patients. One could take a chance and try to fit in the <1% of the population who without brushing or flossing have no gum or teeth issues. But for the 99% rest of us, we require constant oral care through daily brushing and flossing. So please, do yourself a favor, and brush and floss 🙂

Warm regards,

Peter Chien, DMD, MPH