From the Guidelines
There is limited data supporting the practice of teeth flossing as an effective method for removing plaque and preventing oral diseases, with some studies suggesting that interdental brushes may be more effective 1. When considering the removal of dental plaque, a biofilm that is a primary cause of tooth decay and periodontal diseases, the most recent and highest quality study 1 indicates that tooth brushing alone is insufficient to remove all plaque, and the addition of dental floss does not show a significant additional effect on biofilm removal. However, the study does suggest that interdental brushes can remove 32% more plaque than toothbrushes alone 1. Another study 1 from 2001 mentions that flossing appears to be equally effective as professional tooth cleaning in improving the efficacy of high-concentration fluoride compounds, but this is not directly related to the removal of plaque. Given the importance of removing plaque to prevent oral diseases, the use of interdental brushes, in addition to toothbrushing, may be a more effective approach than flossing 1. It's also worth noting that the incorporation of chemical agents, such as chlorhexidine, essential oils, triclosan, and cetylpyridium chloride, into toothpastes or mouthwashes, may help boost oral biofilm removal and improve clinical indices for oral and periodontal health 1. In terms of morbidity, mortality, and quality of life, preventing oral diseases through effective plaque removal is crucial, and using the most effective methods available is essential 1. Some key points to consider when removing plaque include:
- Using an interdental brush to remove plaque from between teeth
- Brushing teeth regularly with a toothbrush
- Using chemical agents, such as chlorhexidine, to boost oral biofilm removal
- Maintaining good oral hygiene practices to prevent oral diseases.
From the Research
Data Backing Up Teeth Flossing
- There is evidence to suggest that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone, with a statistically significant benefit at 1,3, and 6 months 2.
- Flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months, although the evidence is weak and very unreliable 2.
- Interproximal devices, such as interproximal brushes, are more effective for reducing interproximal plaque and gingivitis than flossing or brushing alone 3.
- The use of flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma, and IDBs are the device of choice for interproximal plaque removal 4.
Limitations of Flossing
- There is no robust evidence base for the use of local or systemic anti-inflammatory agents in the management of gingivitis, and flossing has not been shown to have a significant impact on dental caries 4, 2.
- The evidence for flossing is limited by the small number of high-quality trials and the variability in study design and outcomes 2, 3.