Comment / Dr Ros Davis
It would appear that people are really thrilled that they may not need to floss their teeth! There have been articles left, right, and centre following the breaking news that there may be no good evidence that flossing our teeth has any benefit. If you are not familiar with this topic, I refer you to my previous discussion “Our Theory on Flossing”.
Where Is the Formula for Perfect Oral Health?
On September 1st 2016, The Sydney Morning Herald published an article by American Paediatrician Aaron. E. Carroll entitled “There’s actually little evidence for the usual wisdom about teeth”, which was originally printed in The New York Times. In the article. Carroll reflects on the fact that despite rarely flossing and not brushing particularly diligently, he has only one filling in his mouth compared to his wife who is meticulous with her oral hygiene but has more fillings than he can count. This prompted him to consider the traditional guidelines for oral hygiene and to contemplate whether “some of the things we do make no difference at all, and perhaps, should be reconsidered”. To summarise his article in a nutshell: he has come to the conclusion that there are many factors at play that determine one’s oral health, and there doesn’t seem to be enough evidence to indicate that flossing is one of those factors.
He’s right about a lot of things in this article. The point he seems to miss, though, is that we haven’t entirely figured out the formula for perfect oral health, and that is why we continue to encourage patients to control one of the most important risk factors of all; the amount of plaque on their teeth. As Carroll mentions in his article, there are many elements that contribute to the development of dental problems; diet, growing up with fluoridated water, the bacteria acquired from one’s mother, and salivary composition. A complex interplay between these elements determined that his wife has had lots of fillings, and he has had none. But which one is the most influential? Is it that his wife sucks on sugary mints when she is at work, or that she grew up on a remote farm where only non- fluoridated tank water was available? Is it that she has never drunk much water and tends to have a dry mouth, while his mouth is full of watery saliva all the time? Is it a little bit from column A, and a little bit from column B? We simply don’t know yet.
So Why Should I Floss?
What we do know is that everyone is faced with these different risk factors in their lives. We know that someone who has all the worst risk factors working against them, can minimise their oral harm by carrying out good oral hygiene practices. Doctors often refer to the “chairside” assessment of a patient as one of the most informative aspects of their examination – is the patient pale, sweaty, red, swollen? Simply, how do they look? As dentists we carry out a chairside assessment too based on what the teeth, gums and anatomical structures of the mouth look like. There’s no study needed to prove that people who floss have a healthier looking mouth – their gums are pink and smooth, and don’t bleed to touch. Perhaps a scientific experiment hasn’t been conducted to adequately prove this yet, but we see the evidence there in front of us every day. In short, if we don’t know that magical formula for perfect oral health yet, why not do everything possible to control the easiest risk factor for dental disease – the amount of plaque on the teeth. Simply, if the bacteria don’t have plaque to feed off, you’re very unlikely to get problems! A toothbrush can’t reach between the teeth, so do yourself a favour and use floss or an interdental brush. Minimise as many risk factors as you can, and you’ll spend less time in the dental chair.
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