Federal health expert drop flossing from health guidelines
arstechnica.com
arstechnica.com
Basically, yes, flossing helps, but self-flossing really doesn't do anything more than just brushing daily.
I'm a little disappointed at the number of comments here along the lines of, "Well, it's obvious! Why do we need to study it?" That's a very unscientific attitude.
Beyond that, I am not sure what you are getting at. The point of the post I posted and the original article here is that self-flossing as an augmentation to brushing does effectively nothing. What you stated corroborates that. Am I missing something?
I can't find a PDF of the original study, but in the review, they mention that one quadrant of the mouth was professionally flossed. This presumably lets them do within-subject comparisons: are there more/less cavities (or whatever) within the flossed portion?
This should remove confounds like 'ate more sugary things'. It's possible, of course, that kids brushed more on the flossed side (or the unflossed side), but you could presumably quantify that too.
But if you dig into it, it's horrifying how little "evidence" goes into treating a lot of common medical conditions. For another trivial example, the stuff in Sudafed PE (phenylephrine) http://www.sciencedirect.com/science/article/pii/S1081120610... is much worse than the psuedophedrine it replaced.
I wish the NIH (and other funding agencies) would consider running big, confirmatory trials on a lot of "obvious" things that affect people every day, the money clearly isn't there and it's politically difficult to get it there: There are a fair number of ignorant Congressman in the US who love to rant about 'wastes' of government money on studies like these.
"Phase 1 results showed a difference between phenylephrine and placebo that was 64% of the difference between pseudoephedrine and placebo, substantially greater than the 17% difference observed for all phases. "
Edit: Phase 1 may mean "Testing of drug on healthy volunteers for dose-ranging", from wikipedia:
https://en.wikipedia.org/wiki/Phases_of_clinical_research
Here's the paper:
http://www.vcc.at/documents/get/47/A%20Placebo-Controlled%20...
That study uses a crossover design, which means that everyone gets all three treatments (in this case, phenylephrine, pseudoephedrine, and placebo), but in different phases. You might get the placebo this week and the pseudoephedrine next week, while I get the opposite. Each one of these time steps is a "phase".
A similar study might use a "batch design" instead, where the subjects are each tested once, after being given a single treatment. They might put you in the pseudoephedrine group, while I get the placebo.
Crossover designs have a big advantage in that are more robust to individual variability, and thus have more statistical power to detect differences. In essence, the crossover design allows you to compare the average of each subjects' difference between conditions while the block designs force you to examine the difference between the average scores of each group.
This power comes at a price--you have to be careful that the different treatments do not interact so you can correctly associate causes and effects. None of the treatments remain in the subjects' system for a week, but they are worried that people might remember* how well pseudoephedrine worked and "downgrade" the other treatments. One way to check this is to analyze the first phase of your data, where each subject has had only one treatment, as a batch design, which is what they reported there.
* The measurement here is a self-reported scale of nasal congestion. Note that they don't do this for most of the quantitative/physiological measurements.
Yet plenty of people seem to have fallen over each other to share that article (and this article). It seems anything that says you can have your cake and eat it too will have plenty of social media shares. In this case, it looks like flossing may be lightly studied, but is still good for us. Perhaps we can change that famous old adage to, "if it sounds too good to be true, it's probably clickbait".
Here's another piece of research on flossing, "In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss." [2]
That's on a study of 319 people, flossing regularity is based on surveys and dental health based on examinations.
[1] https://www.bulletproofexec.com/is-chocolate-good-for-you-he... [2] http://onlinelibrary.wiley.com/doi/10.1111/j.1752-7325.1995....
As for the paper you cited, it seems (from what is publicly available) to conflict with the Cochrane review he cites. I can;t tell if the review looked at that particular paper or not.
So i'm kind of skeptical of the effect.
Edit - I always wonder what kind of toothbrush other people use. I've always used electric ones so I wonder if that helps.
A few people are certainly "gifted" teeth-wise (I know another case), but not going to the dentist for 25 years would be disastrous if applied on large scale.
Well that's the problem, we don't have better evidence.
We actually have had it for quite a while. The CAMBRA MOOC is put together by a dentist/statistician and lays out a point system based on correlation between patient behaviors/health and carries. It has been iteratively corrected based on effective and ineffective results when modifying behavior according to the system.
Notably in that system, floss is not given a point. Whatever effect it may have is either too weak or better described by other factors flossing correlates with.
When points like that come up, the teacher stresses that the system is only measuring odds of near term carries, so flossing may be effective for something else with regards to oral health or preventing one of the negative factors.
Focusing on flossing itself, as person who started doing it regularly only as adult, I think that researching on how frequently one should floss (or not) is in a way like researching how frequently one should change underwear. It may make sense theoretically, but ultimately all it requires is just to pay attention.
I never noticed the bleeding and/or irritation of the gums (which dentists always mention) until I started flossing regularly.
Now I do feel a difference (as a matter of fact, I floss irregularly, depending on how the gums feel). Of course, I'm pretty sure I could survive without flossing at all.
This is in line with what dentists generally suggest. Given that flossing can be ultimately considered as simply extra cleaning, and that the presence (or not) of the effects can be easily observed, a couple of weeks of flossing should be enough for anybody to make a solid judgment more than any theory.
Same here. Never understood how people can physically floss. Maybe those with undeveloped teeth can do it, others, I don't see how it's even possible.
For some teeth, I have to force it a little, my teeth are pretty close too. Its so worth it though: much better breath, clean feel, minimized risk of cavities.
Of course people's teeth are different. I know some prefer these, where you push it in from the side. http://www.tepe.com/uk/products/interdental-brushes/
Having a loop allows to have a firm hold on the floss and adjust tension. I use it with both hands though. And I waste very little floss because I can rotate the loop and use every inch of it.
Like you, I have good teeth (never had a filling) and on average have visited the dentist about once every 10 years.
Like you I also used to never be able to get floss in between my teeth, but after a dental checkup some years back the dentist cleared all the plaque buildup and from then on getting the floss between my teeth was no problem, and I've been flossing regularly since.
Once the plaque builds up and hardens, it's very difficult to break it up with just floss and you'll have difficulty getting floss in.
For what it's worth, my teeth definitely feel cleaner after flossing, and if I miss a couple of days they start to feel dirty.
But now I have discovered floss tape; it's just what it sounds like, a thin strip of tape that you can slide between your teeth to floss. Now I can actually floss and it makes a big difference to how clean my teeth look and feel. I'm in the UK and the product I use is Oral-B Satin Tape - worth trying or finding an equivalent if you have teeth very close together.
I floss daily and sometimes twice a day. I keep floss at my desk at work and some mouthwash to kill some of germs that get stirred up. It is easy to fit that in when thinking through a problem.
I also take vitamin C twice a day. My dentists always comment on the good health of my gums and say "you take vitamin c don't you?" At 62 I want to maintain my gum and teeth health.
Amazing that people are wondering what the "scientific" value in getting food particles out of your mouth.
I did well, for a while, too. Then I had a lot of chemo. First year post, I had 14 cavities requiring fillings. Now I have 3 crowns.
Floss your teeth, preferably with a water pick. Older you will thank younger you.
Sheesh, shouldn't they ideally never-bleed? Just what is it you're ingesting (or not ingesting)?
It was the same with flossing. When I started flossing I didn't say anything, and she hasn't commented that I need to floss since.
Flossing is an obvious way to disrupt pathogenic bacterial colonies by abrasion. I think irrigation is much better, as it reaches deep pockets below gums. But it doesn't replace flossing entirely.
Those two, coupled with regular brushing of teeth, gum and tongue, plus oral probiotics should keep issues at bay.
In particular, my experience with probiotics is that tartar calculus fell apart within a few months. I have never had a cavity.
Sadly most dentists don't place too much emphasis on these as it goes against their business model: drill, fill and bill.
If your mouth has an unhealthy microbiome, you might need to place a lot of emphasis on killing bad bacteria initially. For this purpose, salt water or mild antibiotics (chlorhexidine) for 2 weeks combined with double dose of probiotics should do the trick.
Obviously, sugars feed bad bacteria, which metabolize it into acids to erode your enamel. Avoid entirely.
Here's some research that claims flossing actually causes problems.
"Dental flossing can produce bacteraemia in periodontally healthy and periodontally diseased individuals at a rate comparable with that caused by some dental treatments for which antibiotic prophylaxis is given to prevent IE." http://onlinelibrary.wiley.com/doi/10.1111/j.1600-051X.2008....
But in general, interdental flossing is very good against contact cavities [1]. Perhaps deep flossing is leading to bacteraemia. I have always found hard and awkward to perform deep flossing, and that's why I use oral irrigators instead. However, maybe irrigation also leads to bacteraemia. I've seen some references supporting that too.
I brushed mostly regularly the second half of this period, I never flossed. I'm a computer geek, I can get caught up in code for days without brushing my teeth but try to do it regularly.
The result was 13 years of plaque and two visits to a dentist to clean it all out.
Dental plaque is a coating over your tooth and your gums will grow over this coating. So I think it's pretty obvious that dental plaque can cause cavities between your gums and your teeth, infections in your gums and all this will in turn lead to periodontitis.
And also you have saliva glands at the bottom of your mouth that bring with them additional minerals and stuff that get stuck to your teeth, forming plaque. So the front bottom teeth are even more important to floss.
Now I floss regularly and I'm proud to have actually made it one of my daily habits.
I'm terrified to ask what you did the first half of that period.
"Since doctors began saying that a string-based tooth scrapping was good for oral health, a handful of studies have been conducted. However, they all fall far short of what’s needed to make a convincing argument. A 2011 review of a dozen randomized controlled studies concluded that, “Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.”
The US Agriculture and Health and Human Services departments quietly removed the flossing recommendation from the latest version of dietary guidelines.
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If anyone thinks that this is because the study's parameters are too narrow to show an effect, that is not the case. Other studies have successfully shown the benefits of flossing... if the dentist is the one performing it. But they haven't been able to show similar results when regular people do the flossing.
"Maybe the evidence that flossing reduces tooth decay or gum disease does not hold up because we are all such poor flossers. Superflossers, like the zealous hygienist at your dentist’s office, aim to “hug the neck of the tooth” and get below the gum line, Dr. Hujoel said.
But we common folk, staring woefully at our bathroom mirrors, tend to lightly give it the once-over.
A review of six trials found that when professionals flossed the teeth of children on school days for almost two years, they saw a 40 percent reduction in the risk of cavities.
So maybe perfect flossing is effective. But scientists would be hard put to find anyone to test that theory."
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Honestly, I'm not surprised at all. Years ago, my dentist strongly urged me to get my asymptomatic wisdom teeth removed. I then went home and did my own research on this subject. And what I found was the complete opposite of my dentist's recommendation.
But a new study of more than 6,000 patients in Greece found that only 2.7 percent of the teeth had a cyst or tumor. An older study, often cited by critics of routine extraction, found that only 12 percent of 1,756 middle-aged people who had not had impacted wisdom teeth removed experienced a complication.
Numerous comprehensive reviews of research, conducted by independent bodies not affiliated with oral surgeons, have concluded that there was no evidence to support routine prophylactic extraction of impacted but healthy wisdom teeth.
Britain’s National Health Service stopped paying for the procedure if there was no good reason for it after an analysis by its Center for Reviews and Dissemination at the University of York concluded in 1998 that there was no solid scientific evidence to support it. Also that year, the Royal College of Physicians of Edinburgh said that for patients who do not have a condition related to third molars or whose teeth would probably grow in successfully, removal is “not advisable.”
In 2005, a review by the respected Cochrane Collaboration said the number of extractions could be reduced by 60 percent if they were done only when patients were in pain or developed a condition related to wisdom teeth. The group also said there is “reliable evidence” that suggests that removing wisdom teeth does not prevent or reduce crowding of front teeth.
In 2008, the American Public Health Association dismissed arguments typically made for removing wisdom teeth: that adjacent teeth might be damaged, or that the teeth may harbor bacteria that cause periodontal disease. The association approved a policy saying these concerns do not justify the risks of surgery, which include possible nerve damage, complications from anesthesia. loss of the sense of taste and, very rarely, death.
“The few studies of long-term retention of impacted teeth have shown little risk of harm,” the association concluded.
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I've since brought this up with a few other friends who are dentists as well. They always start off by haranguing me for doing my own research, instead of following my dentist's recommendation. Then once I show them all the above evidence, which they have never seen before, they change their minds and accept that I'm probably right.
With a track record like that, I wouldn't be surprised at all if flossing turns out to be yet another sacred cow that's virtually pointless in reality.
I do have to say kudos to the dental field though. At least they are making efforts to validate their recommendations, using empirical studies. I wonder how many of the recommendations given by programmers/teachers/fitness-trainers etc are similarly flawed.
http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavi...
I've always had bad, painful dentist visits until my mid-20s. They were quite bloody. Since I started flossing, my dental visits are not painful, and my gums never bleed. When they do the gum measurements, I now get 2s and 3s instead of 4s and 5s.
The only change I made was flossing. I don't argue that it reduces plaque or has all of these life-changing benefits, but it stops my gums from bleeding and makes dentist trips a breeze. That's enough for me. Maybe others won't get the same benefit.
Given how bad inflammation has proved to be lately (be it because the inflammation itself is bad or because what is causing it is bad doesn't matter much to me if it's bad either way), it's at least plausible that flossing may have an effect on gum disease, but also plausible that it's an entirely situational thing. A habit may be better than never doing it, but you may just need to do it when the situation calls for it.
Ultimately I carry the floss around because regardless of whether it has long term benefits provable by science, it definitely can have short-term benefits of having less inflamed and at times slightly-painful gums because it's trying to use the immune system to remove a chunk of food better physically removed.
Some mouths probably need it more than others, and it appears that mine is one of them. Is flossing the best option for inter-teeth cleaning? Maybe not. However, even after a good brush I can pull bits of food out by flossing, and I don't think anyone will disagree that it's a good thing to leave it in there.
I spent years between dental visits when I was between my parents health insurance and getting a job that actually covered dental. By that time, it was almost too late.
I had severe Periodontitis and was told that if I didn't do something within a few years, my teeth would start falling out. I had a root planing surgery and some other procedures done to save my teeth. My dentist said I was given another chance, but in order to save my teeth, it was paramount to floss every day.
I started flossing and at first my gums bled like crazy, but over time, the bleeding lessened and after 6 months of flossing and several more visits to the dentist, my gums were almost fully recovered and my teeth were effectively saved.
Since then I still floss daily and see my dentist every 6 months like clockwork. Since I started flossing my teeth, my teeth cleaning appointments are literally 30-40 minutes. I can get in and out and its completely painless.
All of this I attribute to flossing daily.
That's derived from the idea that brushing is not about cleaning the teeth. It's about disrupting bio-films and depositing fluoride on the teeth. That's the reason why dentists recommend not rinsing your mouth after brushing. If brushing were about cleaning then clearly you would want to rinse to remove everything from your mouth. But since brushing is more about applying fluoride to your teeth, it makes more sense not to rinse as that would remove all the fluoride that you just worked to apply. (The recommendation is to brush, then take a teaspoon or two of water into your mouth to form a toothpaste slurry, swish around, then spit.)
I thus argue that flossing should come before brushing because flossing would remove the food from between your teeth, allowing fluoride to penetrate those areas.
And with regards to Listerine/mouth wash, the alcohol based stuff causes mouth cancer and hasn't shown any benefit to the reduction of cavities (I don't recall its effectiveness with respect to bad breath or gum disease). There is fluoride based mouthwash, which dentists do recommend to certain patients, but for most people there's no point since they're getting all the fluoride they need from the toothpaste. And of course there are mouth washes medicated for specific conditions, which again will be recommended by your dentist when needed.
There's a clear line of research showing benefits in mouthwash: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948552/ It's true that the fluoride in mouthwash does little, and there are some stupid mouthwashes that don't have any real ingredients, but essential oil mouthwashes (like Listerine) and several others (as mentioned in the review) have been shown to have significant gum benefits.
There's also some interesting research with tetrapotassium pyrophosphate and tartar buildup: http://periogen.com/periogen-studies.html Although I expect these studies are manufacturer-funded and thus overstate the effect, it seems pretty hard to deny that it helps.
Note: I'm not a dentist either, but I read this book my dentist recommended: https://amzn.com/B009LPLMRU. It's well-referenced for everything except water fluoridation and her conflict of interest (xylitol products).
The AP article explains that flossing had to be dropped from the federal guidelines as those are required to be backed by research.
The groups that claim it is good for you all have a financial reason to claim it. Not alone wrong, but wrong in the absence of quality research backing the claims.
Research is strong evidence that points towards something. Lack of research doesn't mean complete lack of a-priori knowledge. If something is obviously good for you, then that's probably a good start for recommending it.
That said, they should get more studies done.
You could also be a bad flosser, so even the study could be flawed.
I think it is quite obvious that people who floss also brush their teeth more regularly, and that is enough to give them healthier smiles.
(Regarding the benefits of flossing, I'm agnostic.)
They definitely and easily see a difference seen between those who floss and brush and those who just brush.
Also, those who use Sonicare, especially when used properly around the gumlines, also tend to have healthier mouths than those who brush with an old brush.
The one thing that can throw a wrench in this whole thing is smoking. Smokers' mouths are disgusting basically no matter what.
Point being, I love research, but I trust those who put their hands in tens of thousands of mouths more than skeptics on ArsTechnica article comments.
You mean healthier teeth?
On the note of tongues, using a tongue scraper is a great way to get rid of nasty bacteria that causes bad breath and spreads to the rest of the teeth/gums. Cheap and effective.
Gist is that tongue cleaning yields less bacteria (that's one major cause of bad breath), but they still recommend both brushing and tongue cleaning since the reduction of tongue bacteria didn't reduce plaque. I never claimed that it did though.
Tongue scrapers are cheap and awesome. It's amazing what kind of disgusting stuff you'll scrape off that thing. I'll nearly guarantee you better breath unless you have some serious other problems, like periodontitis.
A second source on elderly: https://www.ncbi.nlm.nih.gov/pubmed/16677187
"These results suggest that tongue care is essential for preventing oral disease and needs to be part of any oral care programme in elderly people."
Uh... yes, it does. See https://en.wikipedia.org/wiki/Contraposition
For all we know, sugary carbs that tend to get stuck between teeth do their damage in minutes or a few hours and flossing at night won't help. Or flossing too soon removes enzymes in your saliva that protect teeth from buildup or disease.
Public policy needs research. Human history is absolutely stacked with "obvious" truths turning out to be harmful falsehoods.
So you have a good point, there are always new things to discover, but this is obvious in a way that's understood and doesn't in any way call into question the legitimacy of dentistry.
Perhaps you can get a layer of magic plaque that protects the teeth. Who knows. Mine just get worse. They used to feel dirty without a brush. Now they feel horrible without a brush and floss. Sometimes I just wish for all my teeth to be ripped out.
But cavities are not the only problem you can have in your mouth.
Food particles left in the mouth for long periods can cause an inflammatory response in the gums. This can lead to bone loss in the jaw. And that can cause your cavity-free teeth to fall out.
Flossing through the space between tooth and gum can potentially remove such particles, which would help prevent gum disease. But it might not be necessary to do it every day. Once a week, maybe? After eating jerky or popcorn?
I have no idea how often it is necessary to floss to achieve a statistically significant reduction in any of the oral diseases, or how much of a difference there may be between flossing twice a day and flossing once a month.
My dentist recommends flossing whenever I brush. While the recommendation to floss is probably well supported, I suspect that the frequency may be more based on psychology than anything else. They just attach it to the brushing habit. Perhaps it would be better to attach it to "whenever you trim your fingernails", or "whenever you shave your legs", even though those are not related to oral hygiene.
Brushing and flossing are basic tenents of dentistry, and they haven't done the science?
The word is "tenets".
How do we know something is 'obviously' good for you without research? NOTHING Is so cut and dry that you can make that statement. For example: organic food. Obviously, must be amazing for you. Got two great buzzwords in it: organic and food. Therefore, amazing for you. Does the research bear this out?
Similarly, homeopathy, reiki, psychic surgery, acupuncture.
Vaccines: foreign substance entering our body. Therefore, terrible for you. Stands to reason right?
How could you make such a sweeping statement claiming the higher ground that we must exist in such an enlightened age that we don't have to continually fight the battle for evidence based activities in all activities?
So I could argue that even research results aren't sufficient proof for efficacy. For example, why should a "significant result" be a better argument than personal experience?
Meh, 2/10. Not that slippery.
"As for me, all I know is that I know nothing."
--Socrates
Research is just another tool. It happens to be a really good one, and when research contradicts common sense and intuition, research usually wins. ("Usually" because it can be flawed, just like anything else.)
But in the absence of research, we can still do better than just saying "uh, I dunno" in many cases.
The alternative isn't reasoning based on buzzwords, it's based on thought and available evidence. No, that's far from perfect, but it's also not going to lead you into homeopathy, reiki, psychic surgery, or acupuncture. Flossing has a plausible mechanism of action, unlike any of your examples. If it turns out that this plausible mechanism of action doesn't actually have any long-term benefits, then that sucks, but it doesn't mean we should give up on thinking about anything that hasn't been researched.
I'm sure there are plenty of medical journals documenting the effects of getting abrasive substances in your eyes.
Also, I doubt any of those documented effects are from properly designed studies, nor do they examine a long-term daily treatment regimen. Are you just assuming that daily treatment would be bad based on what happens after one instance, plus common sense and intuition?
She had been compulsively flossing, but this device has reduced that desire.
Most patients, even if they bother to get the minty-waxed out the box, are exceptionally heavy-handed and macerate their gums like they’ve been chewing on bare vacuum cleaner flex. Even in controlled studies, after instruction, the patients taking part couldn’t floss properly. I know of no dentist who flosses. Not one.
UK dentist, writing in the Guardian
https://www.theguardian.com/commentisfree/2016/aug/03/dentis...
It runs counter to my sceptic nature, I like to question everything, but I'm slowly starting to learn that sometimes you just have to take an expert's advice.
I'm sure any half-way decent dentist can see pretty quickly how well you take care of your teeth, in the same way a seasoned programmer can often point out a beginner's bad code or a civil engineer warn about the wrong way to build a bridge or a house on a swamp.
So although dentists could notice if you have good dental hygiene I'm not sure they can spot easily if you floss or not. It might just mean that in US good dental hygiene means that you floss, but converse might not be true.
It's all the sauerkraut. It acts as a natural floss.
Can we agree that the dangers of not flossing and the dangers of leaping from a plane without a parachute have little in common?
Except everyone just ate sugar in mass quantities and we never moved forward (and probably moved backwards)
We not only need to know if it works, we need studies to know how well so we can compare it to other methods people actually will implement.
No disagreement on sugar either, definitely unhealthy in excess (in particularly when artificially added disproportionately to the other nutrition within the food).
This study [1] and the response from the CDC is very similar to the OP's article: despite research showing the recommendation is wrong, $BIG_AGENCY refuses to change its recommendation over fears of looking like boneheads.
[1] http://www.webmd.com/food-recipes/news/20140402/cdc-salt-gui...
So studies showed flossing helps prevent gum bleeding. This is not what the article reports.
Are there studies of effectiveness of tooth brushing? Imagine the control group - people who don't brush their teeth at all!
So in my case _something_ was needed for the gum's health, but flossing itself proved to be useless.
http://www.forbes.com/sites/rosspomeroy/2013/10/17/dentists-...
I read the conclusion so that flossing is useless, because it isn't done correctly or it is just a wrong way to clean teeth.
I've had a similar personal experience. My dentist asked me to floss because my gums were bleeding. I flossed for few years, but it didn't cure my bleeding gums. Then my dentist suggested using interdental brushes. I did it for a while and it helped. My gums are no more bleeding.
So, I say no to flossing, yes to cleaning teeth with better means.
Hooks right up to your faucet or shower head, has multiple tips, and is effectively an endless and super-quiet WaterPik.
I do own a WaterPik-like device, but I use saline water and a special adapter for sinus irrigation (making it a post-modern Neti Pot I guess). OralBreeze, brushing and sinus irrigation every day. Helps fight bad breath — post-nasal drip contributes a lot to bad breath, as does rotting food stuck between your teeth. For me, it's helped reduce the incidence sinus infections, too. Plus the more advanced "Neti" usage involves allowing the saline solution to flow out of your mouth, so if you're prone to tonsil stones, it can help reduce those.
My dental hygienist recently told me that I have to shove bits of wood between all my teeth twice a day. I asked why I hadn't heard this before and for how long, and she said "for the rest of your life because it's good for you". Hmm.
Instead of talking about flossing you could talk about keeping a pet rock in your pocket and it'd also be "low risk, low cost ... we know there's a possibility that it works".
Got me paradentosis and almost lost me my teeth.
It's completely anecdotal, but I recomend flossing.
Isn't risk something that should be determined by study? I can think of a couple ways that flossing may actually damage a mouth.
You use them exactly like a toothpick but they have a nice big grip and you can get 90 degree versions with long handles for your back teeth.
A pack will easily last a year.
Cannot be bothered flossing (and I salivate a lot which makes it harder) but intradental brushes are now part of my daily routine.