The effect of flossing on the oral microbiome, gum disease, and bad breath | Hacker News Reader

The effect of flossing on the oral microbiome, gum disease, and bad breath

bristlehealth.com

35 pointsdavid_l_lin19 comments

One data point. I have had difficult to control plaque for at least two decades. According to my dentist others have continuing problems with cavities. I don't.

For the past three years I've used an Oral B electric toothbrush without any improvement.

And then last January I made two changes that have made a huge change in my plaque situation (verified by my hygenist of three years).

First I upgraded my electric toothbrush to the Oral B 4000, which has noticeably more power, at Christmas. And second I changed my brushing technique. Instead of brushing flat against my teeth I now brush the gum line at my teeth and rotate the brush head to a 45 degree angle down at the gums. I then move the tooth brush back and forth over sections of teeth. Typically side or front though the backs if the front teeth require a slightly different approach.

After these changes my hygenist noticed a big improvement in my gums. I also reduced my flossing but when I do floss now theres very little pain, bleeding or swelling unlike before.

Your mileage may very but if you have plaque problems you might save on hygenists.

This is an excellent anecdote for exactly why we are building Bristle. We're finding more and more that oral health is not a one-size fits all. I'm glad you've been able to find something that works for you.

If you look closely at the data from the blog, there are flossing "responders" and "non-responders". I'll have some follow-up data published about this soon, but we've been able to define oral microbiome archetypes that we're using to predict which oral health regimens may actually work for you. There are some people who never floss and still never get gum disease or caries, and unfortunately some who do everything they can with no improvement.

> Oral B 4000

Which one? The Pulsonic (sonic) or the Smart (rotating)?

The Smart.

I did similar changes, with noticeable but modest results.

It was when I added 2x100mcg of vitamin K2 per day, that I saw a huge difference - possibly to the point that technique doesn’t matter anymore.

YMMV. Do not trust medical or nutritional anecdotes from the internet. For all you know, I’m a dog.

cofounder at Bristle here. Unfortunately there is a lack of data around the efficacy of behavioral, lifestyle, and product interventions on oral health despite decades of dentists telling their patients to "brush and floss more". We decided we would share some of our findings with the community in an effort to shed some light on the importance of the oral microbiome in oral health.

Useful and to-the-point information. Thanks for sharing.

Hi there David, as someone who isn't great at flossing but is interested in finding a more palatable approach (pun intended). Is there much research on the difference of using a good water flosser vs string? Or is it more so that any form of flossing is significantly better than none.

Hi! That's a great question that we've heard more than once. We're compiling the data, and so far we simply don't have enough data around water flossing vs string to draw any conclusions. In general, it definitely appears that any flossing is better than none with a caveat:

There are flossing "responders" and "non-responders" that we are looking into and hopefully we'll have another post to share soon. It appears that the oral microbiome may be able to predict whether flossing (or perhaps water flossing) actually improves your health because for some it does not have as much of an effect as others.

Flossing is hard to get started, but when you learn how to do it, your fingers become quick and experience, you can floss completely in 2 minutes, while thinking about something else.

Rinse with some water in your mouth before flossing to get any chunks out, then rinse again after flossing to get the chunks out that were dislodged during flossing.

Don't bother with water flosser etc, you won't need it if you do as i suggested you can remove 100% of particle matter without another gadget, charger and expense etc

Also just floss using the normal string dont bother with picks, floss holders etc, its so much easier to use string when you get experienced with it. Do it! It's worth it!

Are you aware of Dr. Ellie Philipps? She wrote several books. She’s big on microbiome, brushing at the gum line and xylitol, among other things. Did you ever talk to her? I think she’d love contact yo researchers like you. She also has quite a following from her books, I believe.

A few years back there was an interesting online course on CAMBRA (Caries management by risk assessment). Basically they went with a correlative approach to estimating oral health outcome to assign points to behaviors and test them by intervention.

I found it interesting that they seemed unable to assign any points to flossing. Basically any points they attempted to assign were better allocated to correlated behaviors. If you floss you probably wouldn't miss brushing for example..

Personally I feel uncomfortable if I don't floss and it seems odd to me that food particles between teeth wouldn't contribute to cavity formation.

My experience is interdental toothpicks (the wooden triangular ones) made the biggest difference of all:

- no flossing -> gums bleed regularly, getting worse as time since last dental hygienist visit approach six months.

- semi-regular flossing -> gum bleeding mostly stops, still need to visit hygienist every six months.

- daily flossing plus wooden interdental toothpicks -> no gum bleeding, even though my last dental hygienist visit was now 18 months ago.

What prompted the behaviour change to adding toothpicks:- switching to a dental practice whose hygienist was (a) very expensive; and (b) charged by the minute. There was a direct correlation between how I cared for my teeth and the cost!

What sustains the behaviour change:- Each time I use the toothpicks, I can feel the food particles they dislodge, even if I have just cleaned my teeth.

If your gums are delicate/already having issues then picks and damage them further.

With just the string dental floss, when you get good with it, you can get all sorts of angles, clear out all chunks in combination with water in the mouth hard suction rinsing, and scrape along the sides of teeth to clean them better.

I never flossed because the floss usually got caught and shredded on the edges of amalgam fillings. Interdental picks made of plastic, with ridges for lifting out crud, made life a lot easier.

I just knew the recent (a few years ago) announcement that dentists no longer recommended flossing (allegedly for lack of positive effect) was subterfuge to drum up more business.

My memory of that wasn’t that dentists stopped recommending flossing, it was just an acknowledgment that there hadn’t been any research that showed a positive effect. And not that the research had failed, there just hadn’t been any at all. I think most dentists continued to recommend flossing.

"A systematic review of 12 randomized control trials, published in the Cochrane Database" hasn't found strong evidence.

Agreed. I think there does have to be more science done, and at the end of the day I do think flossing helps. However it is a little weird to me that this study just seems to throw out the meta analysis of the other 12 studies and not have a discussion about where those studies went wrong. I also think any study done by a company without blinding etc is going to be prone to a lot of bias.

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