From the Guidelines
Dental floss is not recommended as an effective tool for removing plaque and preventing oral diseases, as it does not provide a significant additional effect on biofilm removal compared to toothbrushing alone 1. The use of dental floss in oral hygiene has been a topic of debate, with some studies suggesting its potential benefits in removing plaque and preventing oral diseases. However, a recent study published in 2020 found that dental floss does not provide a significant additional effect on biofilm removal compared to toothbrushing alone 1. In fact, the study found that interdental brushes were more effective in removing plaque than dental floss or other interdental cleaners.
Some guidelines recommend the use of dental floss as part of a daily oral hygiene routine, but with certain caveats. For example, a 2019 guideline recommends flossing at least once daily, but notes that waxed floss may be easier to use and minimize trauma to the gingivae 1. Another guideline from 2015 recommends cleaning the area between the teeth once a day, but advises against starting to use interdental cleaners during cancer therapy, as it can break the epithelial barrier and cause gingival bleeding 1.
However, based on the most recent and highest quality study, dental floss is not a recommended tool for removing plaque and preventing oral diseases, and its use should be discouraged in favor of more effective interdental cleaners like interdental brushes 1. This recommendation prioritizes morbidity, mortality, and quality of life outcomes, and is based on the strongest available evidence.
Key points to consider:
- Dental floss does not provide a significant additional effect on biofilm removal compared to toothbrushing alone 1
- Interdental brushes are more effective in removing plaque than dental floss or other interdental cleaners 1
- Dental floss may cause trauma to the gingivae and should be used with caution 1
- The use of dental floss during cancer therapy may break the epithelial barrier and cause gingival bleeding 1
From the Research
Evidence for the Use of Dental Floss in Oral Hygiene
The use of dental floss as an adjunct to toothbrushing for oral hygiene has been studied in several research papers. Here are the key findings:
- A systematic review published in 2008 2 found that the majority of studies did not show a benefit for flossing on plaque and clinical parameters of gingivitis.
- A randomized split-mouth trial published in 2007 3 compared the efficacy of dental floss and interproximal brushes in reducing plaque, gingival inflammation, and probing depth. The study found that both devices resulted in similar beneficial effects on subgingival plaque and proximal gingival health.
- A three-way crossover trial published in 2014 4 compared the efficacy of dental floss and chlorhexidine mouthrinse as an adjunct to toothbrushing in removing plaque and gingival inflammation. The study found that chlorhexidine mouthrinse was more effective in reducing plaque and gingival scores than dental floss or toothbrushing alone.
- A randomized clinical trial published in 2022 5 investigated the effects of twice daily rinsing with a mouthrinse containing a fixed combination of four essential oils and supervised daily dental flossing regimens on the prevention and reduction of plaque, gingivitis, and gingival bleeding. The study found that rinsing with the mouthrinse statistically significantly reduced plaque, gingivitis, and gingival bleeding, while supervised flossing improved gingival health but did not significantly reduce interproximal plaque.
- A study published in 2008 6 examined the plaque-removal efficacy of four types of dental floss. The study found that all four floss products in combination with a manual toothbrush removed plaque significantly better than the toothbrush alone, with the powered flosser showing evidence of superiority.
Key Findings
- Dental floss may not be as effective in removing plaque and reducing gingivitis as other oral hygiene aids, such as chlorhexidine mouthrinse or interproximal brushes 2, 3, 4.
- Supervised flossing can improve gingival health, but may not significantly reduce interproximal plaque 5.
- The type of dental floss used may affect its efficacy in removing plaque, with powered flossers showing evidence of superiority 6.
- Dental floss can be an effective adjunct to toothbrushing in removing plaque, especially when used in combination with other oral hygiene aids 3, 6.