Last week, the Associated Press reported that there’s little scientific evidence to show regular flossing is important for plaque reduction. Reluctant flossers rejoiced: If the government had no data to prove flossing prevents gum disease and tooth decay, then why do it?
But in the wake of the revelations, the American Dental Association has stood its ground. In a statement, it said it would continue to call for the use of “interdental cleaners” as part of a regular oral hygiene regimen.
Floss, according to the ADA, is really the only way to efficiently remove food and debris from between your teeth that can ultimately lead to the plaque buildup that causes tooth decay and gum disease. (These recommendations have been handed down from past surgeon generals and the Centers for Disease Control and Prevention, among other groups, which continue to support the importance of flossing.)
As a practicing physician who has lost a tooth herself, I have to agree that this is not the time to abandon flossing. With our subpar oral hygiene trends, Americans don’t need an excuse to become lazier about our morning and evening routines than we already are.
Oral health is actually a significant public health challenge, not just here in America but across the world — if for no other reason than the simple fact that tooth decay and subsequent tooth loss negatively impacts overall quality of life. And so this is a case where the burden of proof must be forgiven: The potential benefits of flossing are clear, and the risks are few.
The state of oral health in America is pretty bad
Recent estimates suggest that only about 60 percent of Americans visit a dentist every year, and surveys have found that about 30 percent of Americans are not regularly brushing their teeth. This is particularly problematic given that the World Health Organization estimates that nearly 100 percent of adults worldwide have dental cavities. The CDC estimates that nearly 50 percent of Americans have some sort of gum disease.
Cavities can progress rather rapidly to other problems once they get past tooth enamel. And despite regular dental screenings, when one cavity gets missed and then rapidly progresses past the enamel, you can get what dental experts tell me is known as “spontaneous nocturnal pain.” This nocturnal pain is a sign of irreversible pulpitis, which is dental speak for: It’s time for a root canal.
How I lost a precious molar to gum disease
I grew up in a home where my parents always made sure I went to the dentist. But thanks to a sweet tooth and a mediocre dental hygiene regimen in college, I got a few cavities. And 10 years ago, after waking up in unbearable agony from a toothache that just would not let up, I had a root canal done.
After it was over, I continued my regular dental hygiene regimen and dental check-ups every six months. But then one day, I noticed swelling along my gum line by the molar where I’d had the root canal done.
An endodontist soon told me that my root canal had failed and I now had a giant abscess sitting underneath my crown. Even after multiple rounds of powerful antibiotics and repeat root canals, my tooth could not be salvaged.
I have always had dental insurance, and mine paid for the root canal. Without insurance, a root canal will cost upward of $1,500. The only other solution? Have the tooth removed. If your medical insurance covers extractions, then you are in good shape, except for anesthesia (in my case it was an out-of-pocket expense of about $700).
After the tooth has been removed, you’re looking at dental implants (if you want to ensure a normal bite and good jaw health). Mine cost close to $3,000, which came out of my pocket as well. But I am positive that if I had been better about my overall dental hygiene regimen in college, including flossing regularly, then maybe that cavity would never have formed in the first place and I wouldn’t be waiting to be fit for a crown that will screw into my new dental implant.
I’m lucky to have dental insurance -- the CDC has found there are three times more adults without dental insurance than without health insurance. And the absurd cost of oral health care for those without dental insurance explains why 40 percent of low-income adults in US are likely to have untreated tooth decay, compared with 16 percent in higher incomes.
Most of these patients will force themselves to ignore their nagging toothache if they’re rationing funds to ensure that they can afford other medications. And this is why, unfortunately, oral health often takes a back seat to other matters of health.
What can oral health say about overall health?
Little research has been done on what oral care can tell us about one's overall health, although one study did find that tooth loss may be associated with increased coronary artery disease and another found gum disease is risk factor for coronary disease. There is also some evidence that gum disease can worsen glycemic control in people with Type 2 diabetes by exacerbating the underlying inflammatory state that aggravates insulin resistance. It makes sense that people with chronic diseases like diabetes and chronic kidney disease may suffer from more complications from oral diseases.
But if we head in a direction where people start to care even less about their oral hygiene, then how much worse does our oral health stand to become?
Future research in the realm of oral health could work toward better establishing the benefits of cleaning between your teeth. But for now we don’t need a large body of evidence to tell us that flossing could help alleviate bacteria that contributes to plaque buildup and subsequent tooth and gum disease. Taking a few seconds to floss every night is well worth it to save you from the risk of tooth loss.
Farah Naz Khan is a doctor and a writer in Atlanta, Georgia. Find her on Twitter @farah287 or via her website FarahNazKhan.com.