Ineffectiveness of flossing, a key Prevention Workshop finding, becomes hot topic on social media

One of the key issues discussed at the EFP’s XI European Workshop in Periodontology, which was dedicated to ‘Effective prevention of periodontal and peri-implant diseases’, has become a hot topic on social media.

Debates about the efficacy of flossing have been raging on Twitter and Facebook, following the publication of an article in UK newspaper the Daily Mail headlined ‘Flossing your teeth can be a waste of time – and do more harm than good, leading dental expert claims.’

The online version of the article amassed 764 comments and had been shared 6,300 times on Facebook within 12 days of its publication, while a new Facebook page called ‘New study claims flossing your teeth is a waste of time’, created on October 22, received 3,300 “likes” in only five days.

However, some of the claims made in the article and on social media were at variance with the specific conclusions and guidelines issued by the ‘Prevention Workshop’, which took place in November 2014.

Researchers at the workshop concluded that there was insufficient evidence of efficacy to support the use of dental floss for cleaning between teeth and that the method of choice with most evidence for efficacy in removing interdental plaque removal was the use of interproximal brushes.

The workshop – which produced four consensus reports after considering 16 systematic meta-reviews and meta-analyses – challenged the dental-hygiene community to accept evidence that shows interdental brushes (IDBs) have demonstrated effectiveness in reducing plaque and inflammation, while there was no evidence of the effectiveness of flossing, which could not be recommended “other than for sites of gingival and periodontal health, where IDBs will not pass through the interproximal area without trauma.”

“We found no evidence that the use of dental floss in patients who have gingivitis or periodontitis confers any benefit whatsoever in terms of efficacy,” said Iain Chapple, chairman of the Workshop working group which reviewed years of studies on the efficacy of inter-dental mechanical plaque control.

“The flossing story appears to be a big myth,” he continued. “We are going to have to get over the fact that this is what the evidence tells us and start recommending interdental brushes instead of floss for patients with gingivitis and those with a history of periodontitis, provided they fit between the spaces.”

Prof Chapple, who is also chairman of the EFP’s scientific affairs committee, did not completely reject the use of dental floss, which he said could play a role “where we have no gaps between the teeth and we have a healthy situation, and when in that situation it may not be possible to use other devices.”

Commenting on the Daily Mail article, he said: “The working group opinion and overall consensus was that flossing could not be recommended where interdental spaces were large enough to accommodate interdental brushes, but it may have a role where spaces were too tight to accommodate interdental brushes”.

According to Prof Chapple, misinformation has also arisen concerning the use of chemical mouth rinses, which the workshop found to provide clear and significant additional benefits when used adjunctively to mechanical cleaning in the management of gingivitis and plaque control.

The periodontist quoted by the Daily Mail advocated a specific brand of mouthwash and warned against using mouthwashes with alcohol because of a “potential risk of oral cancer”.

But Prof Chapple noted that the workshop had not been able to recommend any specific formulation and that “a recent systematic review (Gandini et al 2012) found no evidence for the presumed association between the daily use of chemical mouth rinses and oral cancer.” 

Watch Iain Chapple's complete video by clicking here.

The conclusions and guidelines from the Workshop were published in a free, open-access supplement of the April 2015 issue of the Journal of Clinical Periodontology.

For more information about the conclusions and guidelines of the XI European Workshop in Periodontology, please visit the Prevention Workshop website, prevention.efp.org.