Jawhari: Floss, Drugs and Cocoa Puffs

Patients lie. Some more than others. In 2008 a survey found that four in 10 patients stretched the truth when in the dental chair. Patients lie because they do not want to be judged, lectured or perceived as unhealthy—a reprehensible sin in our magazine world of sleek models with perfect teeth. I get it. I am guilty of the practice myself. A condemnatory episode when I was honest with a doctor has hooked me to white lies in the presence of white coats.

However where a doctor may not think to question your actual number of sexual partners or hours of moderate exercise per week, your dentist won’t take your word for it. Even as it fibs, the mouth is remarkably honest and notoriously telling. Your teeth stain, they form cavities, they wear away, they collect layers of sticky plaque, they get loose, they fracture and fall out. As a novice dental student, if you’re opening wide for me, I can already identify your daily coffee habit as well as the absence of a flossing one.

Earlier this month, The Associated Press (AP)published a news article that “disproved” the medical benefits of flossing. The report was met with disbelief among the dental community. The merits of flossing daily are documented patient to patient, even if the published research on these benefits is lacking. It is difficult to find funds, participants and the time frame to collect accurate data on flossing, especially since it would require a dedicated follow-up regimen and devout participant compliance. Deficient and defective research has unfortunately led the federal government to omit flossing from its updated health guidelines.

This is not a technical outline on the goods of oral hygiene—of which flossing is a significant part. Refusing to floss is not only off-putting but unhealthy. It leads to tooth loss, cavities, staining and worst of all stinky breath, which leads to a consequential lack of potential mates. No one wants to kiss you if you aren’t cleaning your teeth. You don’t need research to tell you that.

This is a plea for readers to pause and consider the advice they’re gleaning from news sources that should know better. In AP’s anti-flossing video, the two dental specialists on camera are periodontists, or gum doctors. When patients do not floss, they are more likely to get gum disease and will need to be referred to a periodontist for an expensive consult. Yet the only conflict of interest the video discussed was that of the companies that produce floss. As if your $1.50 for a roll of the good stuff equates to a periodontist $350+ treatment once your teeth are left loosely hanging in painful, bleeding gums. Have I scared you into flossing daily? Good.

Similarly, the evidence that flossing is “weak, very unreliable” was cited from poor research projects with few subjects, omitted variables, and participants who likely did not floss correctly during the study. Or participants who—remember, four out of 10—lied about how often they were doing it.

Amateur Youtube vloggers and catchy click-bait ads—usually with a hook like, “Doctors Hate Her For This One Simple Trick!”—do enough to misinform the public without the weighted addition of sources like AP. This is not to say that the Youtubers are inherently wrong for promoting alternative methods. Holistic medicine and new treatments certainly have a place in the modern medical era, and even I am no stranger to trying things my patients swear by, so long as they follow through with standard care. But if we are so bent on oil pulling and home-brewed peroxide rinses without any research backing us up, then it is remiss to omit flossing—a harmless centuries old practice with several benefits. Patients who refuse to acknowledge traditional medicinal benefits—while citing poor research as proof—are just as ignorant as the doctors who refuse to concede that an alternative approach might be of value.

In the grand scheme, why fuss over a little waxed thread held taut between two flipped birds? It may seem insignificant—even a bit laughable—that articles like AP’s are enough  to convince  everyone, from the casual reader to the stubborn, noncompliant patient, that good medical advice can be taken lightly—or totally ignored—without consequences. It is irresponsible journalism. The people who benefit from you not flossing are the ones pushing the bad advice and profiting in the end. Good dentists want your to keep your natural, healthy teeth from your tooth fairy days till your grinning golden years. And good journalists consider the outcome of pushing inconclusive research and alternate agendas on their readership, because ultimately those viewers who are not savvy or open-minded enough to do the digging themselves pay the price when its their health in the headline.

Sarah Jawhari is a dental student at Case School of Dental Medicine. She flosses and reads research papers daily—though not simultaneously—and encourages you to do the same.