Dr. Christopher Cutler

To Floss or Not to Floss

The federal government recently dropped the recommendation of dental flossing from their dietary guidelines. Dr. Christopher W. Cutler, chairman of The Dental College of Georgia Department of Periodontics and the college’s associate dean for research, helps separate truth from fiction in the flossing debate.

What is the purpose of flossing?

To remove bacterial plaque under the gum line and between the teeth, sites a toothbrush cannot access.

Why was the flossing recommendation dropped from U.S. dietary guidelines?

The highest level of evidence, the randomized controlled clinical trial, to prove that flossing is more effective than brushing alone, has not yet been done.

Do you support the removal of flossing from U.S. dietary guidelines?

While we always emphasize evidence-based approaches to disease prevention and treatment, in this case, I disagree. I know from decades of research that bacteria under the gum line and between the teeth must be disrupted or removed regularly to prevent organized biofilm from forming and to prevent inflammation that damages the soft and hard tissue around the teeth.

Are there acceptable substitutes for flossing?

Working an interproximal brush dipped in antiseptic mouth rinse between the teeth is another good approach. But flossing is an easy and inexpensive way to achieve the same result.

What do you recommend?

I recommend flossing every 24 hours right before bed and before brushing. Slip the floss under the gum line and wrap it around both sides of each tooth, producing a “shoeshine rag” motion to remove the bacterial plaque.

How can people optimize their oral health and minimize their risk of periodontal disease?

The key is prevention: Floss daily, brush twice a day, and see your dentist regularly. In addition to poor oral hygiene, smoking and poorly controlled diabetes are the major risk factors for periodontal disease. Periodontal disease threatens tooth loss and increases the risk of heart disease by about 30 percent, so prevention is key.

Upshot: Keep flossing.

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