Is Flossing Really Necessary?

Are electric toothbrushes more effective? Does mouthwash do anything? Many patients don’t know the answers to such questions, thanks in large part to the abundance of conflicting medical information. Enter a new study from the University at Buffalo, which aims to separate fact from fiction in determining which oral hygiene tools actually prevent gum disease.

It turns out only a handful of at-home tools provide additional protection against gingivitis and periodontitis beyond brushing one’s teeth with a basic manual toothbrush.

At the moment, says Frank Scannapieco, principal investigator and SUNY Distinguished Professor in the UB School of Dental Medicine, there’s insufficient evidence to support most other oral hygiene interventions.

These findings, he says, will help dental practitioners and the public identify best practices for preventing gum disease, which affects nearly half of adults 30 and older in the United States, according to the Centers for Disease Control and Prevention.

Tooth brushing is the cornerstone of daily oral hygiene, says Scannapieco, adding that interdental brushes and water picks performed better than other interdental devices at reducing gingivitis. He says both should be used in combination with daily tooth brushing to prevent gum disease.

Among the mouth rinses examined, those based on CHX, CPC and essential oils (such as Listerine) were proven effective at significantly reducing plaque and gingivitis. Toothpicks were also found to be useful, but only as a tool for monitoring gum health.

Triclosan-based toothpastes and mouthwashes are a flat-out no, researchers say, as they’ve been linked to cancers and reproductive defects.

The researchers found little evidence that any of the following had a significant effect on reducing plaque or gingivitis beyond basic tooth brushing: powered toothbrushes, dental floss, probiotics, dietary supplements and all other mouthwashes.

But don’t throw away that floss just yet. “While floss has not been subject to rigorous evaluation by clinical trials, it is useful to remove interdental plaque for people who have tight space between their teeth,” says Scannapieco, adding it can also help prevent cavities between teeth.