Is flossing really that important? Published Sept. 16, 2022 By Dr. (Maj.) Spencer Lee, DDS, MS 88th Dental Squadron WRIGHT-PATTERSON AIR FROCE BASE, Ohio – Let’s face it: No one likes to floss, not even myself — and I’m a periodontist (gum specialist)! However, I tell my patients it’s one of those adult things we’re supposed to do every day. That statement, however, doesn’t make the chore any easier. The need for flossing? In a previous article, “Don’t skip flossing, the other half of oral care,” I tackled the why and mechanics behind dental flossing. In a nutshell, it’s the most effective way of removing plaque from the inner sides between teeth, where the toothbrush can’t reach. I emphasized: “Proper flossing technique consists of first ‘wiggling’ or ‘sawing’ the floss through the contact between teeth, taking care not to ‘snap’ into the gums. At this point, there are two areas to clean, the tooth in front and the one behind. Gently guide the floss to one side toward the gums until you feel gentle resistance. After adapting slightly to the tooth shape, proceed to swipe up (for lower teeth) or down (for upper teeth) three times to the tooth(-to-tooth) contact. Repeat for the other (paired) tooth, and then for the remaining sets of teeth in the mouth.” Flossing around natural teeth. Arrows indicate horizontal (to get floss past the contact) vs. vertical cleaning movements starting below the gums and up to the contact. Repeat for the other tooth and all other teeth pairs. (Contributed photo) Photo Details / Download Hi-Res It not only keeps cavities at bay, but also periodontitis or gum disease. For dental implants, which more and more patients have, it’s the best way to clean 360 degrees below the gum line: “…flossing around dental implants involves lassoing the floss around the neck of the implant and then crossing the ends in front. Next, you gently shimmy the two ends back and forth to allow the floss to clean out any debris at or below the gums. This technique can be challenging, so please get help from a dentist or hygienist if you have any difficulty or questions.” Flossing around dental implants. Same colored arrows indicate the direction both ends of floss should be moving simultaneously. Photo Details / Download Hi-Res Knowing that something is important doesn’t guarantee we are going to do it. That’s human nature. Instead of approaching flossing with a chore mindset, we might reframe it as preventive maintenance. Timely maintenance on our cars helps us avoid costly repairs down the road. For our bodies, exercise, a proper diet and avoiding addictive substances can help us stay fit and prevent chronic disease brought on by less-than-ideal life choices. We mostly equate daily brushing and flossing with the short-term benefits of fewer cavities, or gums that bleed less at our next dental checkup. However, there are marked health advantages to good oral hygiene later in life. Floss now, benefit later We know that no matter how poor someone’s brushing and flossing habits might be, a small percentage of people won’t get cavities or periodontitis. However, for most of us, the evidence is strong: daily removal of plaque biofilm around teeth and implants will not only help keep our teeth for the rest of our lives but may offer health benefits that go far beyond the mouth. Studies have demonstrated a link between periodontitis and cardiovascular disease. Harmful bacteria from the mouth have been found in the blood-vessel plaques of atherosclerosis. Associations have also been observed for periodontal disease and Type 2 diabetes, as well as osteoporosis and Alzheimer’s disease. Specifically for diabetes, there is clinical evidence that severe periodontitis is associated with worse blood-sugar control. Conversely, treating periodontitis in patients with diabetes may in the short term provide a modest improvement of half a percent in A1C values. For a more thorough exploration, the BBC article “Why bad teeth are harmful to your health” by Martha Henriques does an excellent job of discussing these at length and I wholeheartedly encourage readers to access it. Surprisingly, our oral health may also affect the next generation. Bacteria strongly associated with tooth decay and rapidly progressing periodontal disease can be transferred from parents to children. In addition, there is an association between periodontitis and premature birth and low birth weight. Flossing an investment As with financial investments, it’s best to start early. With time and consistent contributions, we can build a nest egg that will pay dividends in the future. Think of flossing as not just an investment from a tooth-and-gum standpoint but also for our future overall health. So why is it so hard? We all have our individual hurtles to overcome. Effective flossing takes time and patience, things many of us are short of at the end of the day. It’s easy to view it as just one more thing to do. What’s my advice to make it easier? Set the goal and make it happen. Start by making it easier on yourself. Identify a regular activity during which to do your flossing — whether reading a good book, surfing the web, binge-watching on your favorite streaming service or listening to a loved one. These are perfect opportunities to pull out the floss and go to work. Because I want my kids to have good oral-hygiene habits, sometimes I’ll race them while we floss. This, of course, is followed by an inspection to see if any plaque was missed. The competition is motivating and fun, but the point is to do the job right consistently. You may need to expend a little mental and physical effort at first to make sure your technique is consistently sound (see quoted sections and figures above; get feedback from a dental professional). After the habit is established, it becomes routine and part of what you do. Think about that. You’ll be adding a healthy habit that has short and long-term benefits for your mouth and body. That is empowering. If you’re not familiar with retired Adm. William McRaven’s University of Texas at Austin commencement speech in 2014, I encourage you to give it a listen. He suggests starting the day with making your bed and how it “reinforce(s) the fact that the little things in life matter.” Might I add that ending your day with flossing is in that same vein. So happy flossing!