From the Guidelines
Interdental flossing is not recommended as an effective method for removing plaque and improving oral health, based on the lack of clinical evidence supporting its effectiveness compared to other oral hygiene tools. The most recent and highest quality study, 1, found that interdental brushes were more effective in removing plaque than dental floss, with a 32% increase in plaque removal when used in addition to toothbrushing. In contrast, dental floss did not show a significant additional effect on biofilm removal.
Key Points:
- Interdental brushes are more effective than dental floss in removing plaque and improving oral health 1
- Toothbrushing alone is insufficient to remove all plaque, with a mean biofilm reduction of 46% after brushing with an electric toothbrush 1
- Chemical agents, such as chlorhexidine and essential oils, can be used adjunctively to toothbrushing to improve oral biofilm removal and clinical indices for oral and periodontal health 1
Clinical Implications:
The lack of clinical evidence supporting the effectiveness of interdental flossing suggests that other oral hygiene tools, such as interdental brushes, may be more effective in removing plaque and improving oral health. Therefore, interdental brushes are recommended as a more effective alternative to dental floss for removing plaque and improving oral health. Additionally, the use of chemical agents adjunctively to toothbrushing may be considered to further improve oral biofilm removal and clinical indices for oral and periodontal health.
From the Research
Clinical Evidence for Interdental Flossing
The clinical evidence supporting the effectiveness of interdental flossing for oral health includes:
- Reduction in gingivitis: Studies have shown that flossing in addition to toothbrushing can reduce gingivitis compared to toothbrushing alone 2, 3, 4.
- Reduction in plaque: There is weak, very unreliable evidence suggesting that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months 2, 3.
- Improvement in gingival health: Professional and supervised flossing have been shown to improve gingival health compared to a negative control rinse 4.
Limitations of Current Evidence
- Methodological deficiencies: Studies have identified methodological deficiencies, including the lack of validated measures of flossing skill and over-reliance on self-reported flossing behavior 5.
- Limited data on caries prevention: None of the included trials reported data for the outcomes of caries, calculus, clinical attachment loss, or quality of life 2, 3.
- Inconsistent reporting of adverse effects: There was some inconsistent reporting of adverse effects in the included trials 2, 3.
Factors Influencing Flossing Behavior
- Perceived barriers: Non-habitual users of floss or mouthrinse were less likely to believe in the intangible benefits of flossing or rinsing and more likely to perceive barriers to using floss or mouthrinse 6.
- Risk perception: Risk perception of developing oral disease was not shown to predict product usage, and respondents viewed their risk of developing gingivitis as relatively low despite clinical diagnosis 6.