Remember when Jessica Simpson made those comments about never brushing her teeth? (“I just use Listerine,” she said, “and sometimes I’ll use my sweater.”)
Remember that South Korean TV show guest whose claim to fame was not brushing for a decade or more? (“I do not understand why people should brush teeth, as it is not like others will look into your mouth,’ said Ji Hyun Ji, a/k/a “Cutey Yellowish.”)
Now meet the dentist who says that you don’t need to floss.
Dr. Ellie Phillips claims “that rather than flossing or using brushes, all you need to do is use three different mouthwashes – one before brushing, and two after.” On what grounds?
She says that flossing – and that goes for whichever gizmo, gadget or bit of tape you choose to use – will do nothing to reduce your risk of tooth decay.
The science, she says, is on her side. Only one study has shown a benefit, and that involved a group of schoolchildren who did not floss themselves, but instead had their teeth flossed by a hygienist five days a week for two years.
And a study published in the British Dental Journal in 2006 found no difference in the number of cavities suffered by adults who flossed and those who did not.
OMG! “Science!” She must be right!
Well, the research may be, but as more than one dental professional has noted, her conclusions don’t really follow.
As our patients and regular readers know, the point of brushing and flossing is to break up the microbial colonies – biofilm (plaque) – that form on your teeth between cleanings. Decay is caused not by the bacteria but the highly acidic metabolic waste they generate. Gum disease is caused by the microbes themselves. Destroying their colonies through the mechanical action of brushing and flossing keeps them from destroying your oral tissues.
Christina Chatfield, an independent dental hygienist based in Brighton [UK], who is nominated for hygienist of the year, says effective flossing should help reduce both tooth cavities and gum disease. She argues that the reason studies have shown it to have little effect is that too few people actually do it properly. [emphasis added]
“The majority of those who do use floss (which I believe to be around five percent of the population), don’t use it effectively, so it is of minimal benefit to them,” she says.
Maybe that lack of effective flossing is why Phillips thinks that just killing the microbes with mouthwashes is preferable. But no mouthwash – chemical or herbal – can kill all microbes, nor target only “bad” bacteria.
“The bacteria around teeth that cause gum disease are extremely protective and hard to shift – they don’t even respond to antibiotics,” says Christina Chatfield.
“The idea that these bacteria could be shifted by mouthwash alone is ludicrous. The only option is to shift them physically, and even with the most thorough flossing some get left behind.”
Interproximal (“proxy”) brushes, research has shown, may “shift” even more than flossing. Vigorous rinsing? Not so much.
Or to put it another way: If you don’t floss, use a proxy brush or otherwise clean between your teeth, you neglect almost 40% of your total tooth surface area. You wouldn’t wash only 60% of your body while showering, would you? So why clean just 60% of your teeth?
That said, an aseptic (germ-free) mouth is neither possible nor desirable. As Dr. Aaron Weinberg, dean of the School of Dentistry at Case Western Reserve, puts it, “You don’t want a sterile mouth; you want a mouth that has primarily good bacteria in it, in order to keep exogenous microorganisms out and prevent them from colonizing the mouth.” Flossing helps achieve that.
Phillips has one other recommendation: sucking lozenges or chewing gum sweetened with xylitol. This could have some benefit, as the substance does seem to have anti-cariogenic (anti-cavity) properties. And – whadayaknow? – she sells her very own brand of lozenges and gum!
In the words of one commenter on the Wealthy Dentist’s coverage of this story, “Does anybody else notice that her website is devoted to selling her products to the public, or is it just me?”