Woman using dental floss to help keep healthy teeth and smile

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MEDFORD, Mass. — Michael Scott from “The Office” famously made a New Year’s resolution to start flossing. Unfortunately, it didn’t go well because when he flossed at 12:01 a.m., there was “blood everywhere.” Surveys show dismal daily flossing rates and numerous confessions of people misleading their dentists about their habits. However, dentists can often tell the truth from just a glance at a patient’s teeth.

Dental experts have always emphasized the benefits of flossing, especially in removing harmful dental plaque beneath the gum line, which can stave off long-term dental problems. Supporting this advice, a recent study from researchers at Tufts University School of Dental Medicine (TUSDM) found that individuals who mastered and consistently used the correct flossing technique exhibited fewer signs of potentially severe dental diseases compared to those who didn’t.

“Flossing is beyond just putting a piece of floss between your teeth to get a piece of food out,” says periodontist and study lead author David Basali, DG19, MSD19, who conducted the work while a resident in the TUSDM periodontology program, in a university release.

This research was inspired by a controversial 2016 Associated Press article that highlighted the lack of long-term evidence supporting flossing benefits. Dental experts countered by stating that since severe gum disease takes years to manifest, conducting a multi-decade controlled study would be not only challenging but also unethical.

“In the aftermath of the 2016 AP coverage, studies were done showing that most people really aren’t flossing accurately,” notes Basali.

This made earlier data on flossing’s effectiveness seem unreliable, given the myriad of techniques people employed.

To address this, Tufts researchers decided to focus on a clear indicator of potential gum disease: bleeding gums. They studied 36 individuals with gingivitis, an initial stage of gum disease experienced by roughly half of all U.S. adults. Symptoms include gums that bleed upon touch or during brushing. Participants were divided into two groups: one received training in a flossing method known as the “adapted horizontal vertical flossing technique” (AHVFT), documenting their daily flossing, and another group continued with their usual flossing habits.

Eight weeks later, the trained group showed a significant 70-percent decline in bleeding gums, in stark contrast to the 30-percent reduction in the control group.

“This is the first study of which we are aware to prove that a person using floss with a specific technique will have less gum infection than a person who just does what they normally do,” says study co-author Paul Levi, D66, DG71, who has taught periodontology at TUSDM for 20 years.

Woman using dental floss on her teeth and gums
(Photo by Unsplash+ in collaboration with Josue Michel_

To give a brief overview of what happens in our mouths: bacteria thrive, breaking down nutrients in our saliva and gum fluid. These bacteria produce sticky and harmful substances known as dental plaque and biofilm. This can lead to tooth decay and gum inflammation, resulting in periodontal diseases. These diseases not only harm gums and bones, jeopardizing teeth stability, but can also have repercussions for overall health.

Proper flossing targets these harmful substances, not just obvious food remnants. The AHVFT technique, endorsed by the American Dental Association, not only removes harmful bacteria effectively but also prevents unintentional gum damage, which can lead to further problems.

“Sometimes we see patients traumatize the gum line with improper flossing technique, which can create clefts by cutting the gum and can lead to gum recession,” says study co-author Irina F. Dragan, DG15, MSD15, DI19, a faculty member at TUSDM. “The AHVFT assures that the floss is well-adapted to the side of the tooth to prevent floss cuts.”

By the study’s conclusion, 88 percent of participants trained in the AHVFT technique mastered it, underscoring the ease of learning this potentially tooth-saving method.

The study is published in the Journal of Dental Hygiene.

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