In the news recently, floss has got some very bad press, and we have noticed in our practices that some patients have stopped inter-proximal cleaning all together, following this flurry of headlines. This is very concerning, particularly in relation to patients with gum disease.Here are some of the facts to counter the misinformation out there, and that we hope will be beneficial to other young dentists in practice, as well as helping you to advise your patients effectively.
What was all the fuss about flossing?
After health officials in the United States dropped their recommendation to floss, Public Health England (PHE) is now reviewing its guidance on the benefits of flossing.
The story first emerged following an ADA (American Dental Association) news inquiry about why flossing was not included in federal dietary guidelines released in 2015, when the practice had been included in past guidelines.
The Associated Press noted the omission in an August news story that questioned the benefits of using dental floss and the UK press also picked this story up.
Following this, the ADA then released a statement, reiterating its recommendations to maintain oral health, which include “brushing for two minutes, twice a day with a fluoride toothpaste, cleaning between teeth once a day with an interdental cleaner and regular dental visits advised by your dentist.”
The ADA also has now stated that interdental cleaners, including floss, “are an essential part of taking care of your teeth and gums.”
I’m confused: do I need to floss or not?
In the UK, the emphasis is usually on using interdental brushes as a first choice, with floss as an option when the spaces between teeth are small. Flossing technique is then very important and patients should be alerted to this.
However, there is some evidence that flossing around dental implants can lead to damage to this fragile soft tissue, and interdental brushes or waterpiks are the interdental cleaners of choice here.
But more research is needed to determine the best technique to clean around implants in the longer-term. A Cochrane Review is currently looking at the effectiveness of the various techniques, their conclusions will hopefully help us to advise our patients better.
It is vital that the latest evidence base for many of our procedures is constantly reviewed so that we can offer the best care for our patients.
It is also crucial to know that severe periodontitis is recognised as the sixth most prevalent disease worldwide. The 2009 UK Adult Dental Health Survey showed 37% of the adult population suffer from moderate levels of chronic periodontitis (with 4-6mm pocketing), while 8% of the population suffer from severe periodontitis (with pocketing exceeding 6mm). Severe periodontitis has been found to affect 11% of adults worldwide.
Flossing is still currently recommended by the NHS to prevent periodontitis, and that dentists should advise if cleaning between the teeth is needed.
Updated guidance on perio
The British Society of Periodontology has recently updated it’s ‘Good Practitioner’s Guide to Periodontology’, and it’s highly recommended reading.
The diagrams, photographs and summaries are an excellent aide memoir for anyone revising and preparing for their undergraduate or postgraduate examinations. It goes into detail regarding aetiology, prevention, diagnosis, treatment and long-term maintenance care. It includes helpful advice on using a ‘guiding approach’ rather than ‘directing one’, to encourage your patients to floss, if needed.
It also has information regarding dental implants, which is something young dentists will definitely encounter during their careers.
Top tips for patients on brushing
If you patients are confused, you can use our helpful top tips on brushing, and our teeth brushing myth busters, which includes the flossing question.
Giving your patients the right information and communicating effectively with them to ensure they follow your guidance, are all key to ensuring their oral health is protected.
Rob Chaffe and Ronan O’Flynn
BDA Young Dentists Committee
BDA Young dentists: your views
At the 2016 British Dental Conference and Exhibition, you told us that the voice of young dentists was not getting heard enough, so we are offering you a chance to discuss your views and share your experience.
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