Dentists insist flossing will keep our teeth sparkling and free from decay, as well as keeping our gums healthy.
Regular flossing has even been said to protect us from heart disease.
Yet, for most of us who try wrestling with the tape, it only results in a cricked neck and bleeding gums.
And now, according to a provocative new book, Kiss Your Dentist Goodbye, it seems that dedicated followers of flossing could actually be wasting their time.
The book is causing waves because it’s written by U.S.-based Dr. Ellie Phillips, who was among the first women dentists to train at Guy’s Hospital in London.
Dr. Ellie Phillips 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.
So is Dr. Ellie Phillips right? Surprisingly, it seems she may be – but only up to a point.
“In all fairness, there is no evidence that flossing is effective in preventing tooth decay in the long run,” says Dr. Graham Barnby, a dentist from Marlow, Bucks, who is also a member of the Simply Health Advisory Research Panel, which analyses the latest research and medical thinking.
“So in a sense, she does have a point. Yet although the benefits of flossing may be limited with tooth decay, flossing does have a role in the prevention of gum disease.”
Tooth decay occurs when acid in the mouth eats away at the teeth. This acid is found in foods, but is mainly produced when bacteria in the mouth “digest” sugar – hence the reason sweets rot our teeth.
Gum disease, on the other hand, is caused by plaque – a film of bacteria on the teeth which, if not removed with brushing, irritates the gums, causing them to bleed and recede.
If left, the plaque hardens into tartar, which irritates the underlying bone of the gums and, in severe cases, can lead to wobbly teeth.
Some studies have even linked gum disease to heart disease, as the same bacteria found in the mouth have also been found in the heart.
Christina Chatfield, an independent dental hygienist based in Brighton, 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.
“The majority of those who do use floss (which I believe to be around 5% of the population), don’t use it effectively, so it is of minimal benefit to them,” Christina Chatfield says.
“To remove plaque, you need to hook the floss like a C around the tooth, so it hooks out the plaque from between the contact points of the teeth.
“I liken bad flossing to trying to clean a bottle neck with a piece of string floating in the middle – which, in effect, is all most people achieve.”
Dr. Nigel Carter, chief executive of the British Dental Health Foundation, says flossing is definitely not a waste of time – provided you’re doing it properly.
“We certainly shouldn’t be encouraging people not to do it,” he says.
“If you don’t clean between the teeth, you’re cleaning only 60% of the tooth’s surface.
“The dental profession has been pushing it for 20 years, yet we’ve got only 5% of the population to do it – because it’s fiddly.
“Most dentists recommend interdental brushes – small brushes that can get right below the gum line.
“They are much easier to use, and get into the curves of teeth so it’s easier to clean each side of the tooth.”
According to a provocative new book, Kiss Your Dentist Goodbye, it seems that dedicated followers of flossing could actually be wasting their time
However, Dr. Ellie Phillips argues that rather than flossing or using brushes, all you need to do is use three different mouthwashes – one before brushing, and two after.
People often clean their teeth immediately after eating, yet this can lead to the teeth wearing away, she says, because food softens teeth.
Instead, she recommends using Ultradex mouthwash before brushing, which stops this happening. It contains chlorine dioxide, which studies show may help remove bacteria.
After brushing teeth, Dr. Ellie Phillips advocates Listerine, to enhance the cleaning process, and then a fluoride rinse such as Fluorigard to help strengthen and repair teeth.
In addition, she advocates using lozenges or chewing gum containing the sweetener xylitol, which has been found in tests to reduce tooth decay.
So does Dr. Ellie Phillips’ method work?
“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.”
But could xylitol still be the secret to a healthy mouth?
Xylitol, a naturally occurring sweetener found mainly in the bark of the silver birch tree but also in the fibres of many berries, fruits and mushrooms, works by suppressing production of harmful bacteria in the mouth.
“There are clearly dental health benefits with xylitol, therefore products that contain it can help fight tooth decay,” says Dr. Nigel Carter.
Hundreds of studies show it is a proven force against tooth decay. A study of 80 adults who, for three weeks, were given xylitol gum to chew three times a day after meals revealed that the gum brought about a dramatic decline in bacteria numbers.
In Scandinavia – which is a major producer of xylitol thanks to its high numbers of birch trees – xylitol lozenges are popular.
“The lozenges have about 100% xylitol, but in the chewing gums you’ll get only about 30%,” says Dr. Nigel Carter.
“Many dentists now recognize the benefits of xylitol and encourage their patients to use it.”
He adds that many European countries use xylitol in sweets instead of sugar. In Spain, for instance, around 70% of confectionary is sugar-free, whereas in the UK it is closer to 30%.
Peppersmith mints and gum are made with pure xylitol (these are available at most large supermarkets and in Holland & Barrett), and you can also buy granulated xylitol in the sugar aisle of supermarkets. Lozenges can be bought online and in some health food stores.
The recommended dose is about 5g a day. Regular intake of xylitol can cause flatulence and diarrhoea, but Dr. Nigel Carter says this effect will only be temporary.
Professor Stephen Porter, director of the Eastman Dental Institute in London, cautions that xylitol lozenges should be avoided by some groups.
“It’s certainly not suitable for children or the elderly, because it can have a laxative effect and cause tummy upsets.”
Rather than mouthwashes and sweets, most dental professionals say it is simple measures that will help protect dental health.
“That means avoiding sugary snacks between meals as sugar leads to more acid which then attacks the teeth, and you want to limit the time that this happens,” says Prof. Stephen Porter.
“You also need to brush and floss thoroughly to clean plaque off, and use fluoride toothpaste to help strengthen the teeth.
“You don’t need fancy equipment – just dental tape and a toothbrush will do fine
“Above all, people must remember that flossing will do them absolutely no harm whatsoever, and will actually most probably have an awful lot of benefits.”
Statistics show only 6% of adults were edentate, or had no teeth, in 2009, compared with 37% in 1968. Yet according to the Adult Dental Health Survey, only 10% of us have “excellent” oral health and 83% have some level of gum disease.
Dentist Dr. Susan Tanner says: “With the right advice, routine and technique, you should be able to have healthy teeth all your life.”
Dr. Simon Khoury, a private and NHS dentist from Bath, agrees: “Some of my patients don’t have a single filling.”
So how can we make teeth last for ever? We asked the experts…
1. GET THE CORRECT TOOLS FOR THE JOB
A. DITCH FANCY PASTES
“Fluoride is the most important component of toothpaste and in the prevention of tooth decay,” says Dr. Will Carter, cosmetic dentistry specialist at the Queensway Dental Clinic in Teesside.
“Whitening pastes can be abrasive, making teeth prone to staining and they can’t whiten significantly as no more than 0.1% bleach can be added.
“Don’t bother with enamel building paste,” says Dr. Jeremy Hill of The Centre of Dental Excellence in Essex.
“Ingredients to remineralize teeth are too small to make a difference.”
B. THE BUDS AND THE BEES
After brushing, Harley Street dentist Dr. Dana York says put bee propolis liquid along the gum line.
“Propolis is gathered by bees from buds and bark to disinfect the hive. It keeps decay at bay.”
TRY: Bee Health Propolis Tincture, 30ml, nutricentre.com
C. TONGUE TWISTER
“To some extent the tongue is self-cleaning,” says Dr. Asif Chatoo, orthodontist at the London Lingual Orthodontic Clinic.
“However, the deep grooves means it stores bacteria that could damage teeth. Try a scraper.”
TRY: DenTek Tongue Cleaner, thehealthcounter.com
D. WHICH MOUTHWASH?
“Don’t use mouthwashes containing alcohol as these have been linked to an increased risk in oral cancer,” says Dr. Mark Hughes at the Harley Street Dental Studio.
Ones containing chlorhexidine can stain teeth, he says.
“It’s an antiseptic found in Corsodyl, and should only be used if your dentist instructs you to.”
TRY: One containing fluoride.
E. CHEW GUM
Some US pastes contain xylitol, a sugar-free sweetener. It can reduce decay by binding to bacteria, weakening its bond to the teeth.
“Orbit Complete, a sugar-free gum, also contains xylitol,” says Dr. Uchenna Okoye of London Smiling.
TRY: Spry Toothpaste with Xylitol, healthstore.uk.com
2. MAKE SURE THE TIME IS RIGHT
A. USE A STOPWATCH
We should brush for two minutes, twice a day, but a quarter of adults brush once a day or less.
“Studies show we do it for only 45 seconds,” says Dr. Mark Hughes. Yet two minutes of brushing will remove 25% more plaque.
B. BRUSH BEFORE BREAKFAST
“Brushing after breakfast is one of the biggest fallacies around,” says Dr. Uchenna Okoye, and Dr. Dana York agrees.
“Brush as soon as you wake up then you don’t have any bacteria in your mouth when eating,” he says.
“As soon as the bacteria has something on which to feast, you are more likely to develop tooth decay,” Dr. Uchenna Okoye adds.
“Any acidity in food softens enamel, and brushing teeth after may damage teeth.”
C. GO ELECTRIC
“I’d love to say otherwise but it is worth investing when it comes to brushes,” says Dr. Mark Hughes.
“A £10 [$15] toothbrush that vibrates will be more effective at plaque removal than manual brushing.
“Expensive sonic toothbrushes, which can cost up to £250 [$400], are even better. They can create more than 30,000 strokes a minute. Electric ones operate between 2,500 and 7,500 vibrations a minute. Sonic vibrations also clean under the gum.”
D. BE GENTLE
“Never use a hard brush. Plaque is quite soft and can be dislodged with gentle movements,” says Dr. Uchenna Okoye.
“Opt for a medium firmness with a rounded filament,” says Dr. Nigel Carter, chief executive of the British Dental Health Foundation.
E. BRUSH UP ON YOUR TECHNIQUE
Studies suggest that 80% of adults don’t brush their teeth correctly – poor technique can damage gums.
“I regularly have to correct my patients,” says Dr. Mark Hughes. Here is his quick guide…
Use a pea-sized amount of toothpaste on the brush.
– Start at the back of the upper teeth. With the brush head at an angle of 45 degrees so the bristles face up, use gentle rotating motions. Do not saw back and forth.
– Brush along the gum line.
– Do the same with the bottom teeth and on the inside. Afterwards, don’t rinse – residual toothpaste on the tooth surface makes it more resistant to decay.
– If using an electric brush, do not rotate it but instead steadily move it along the gum line.
3. CUT DOWN ON SUGAR AND WINE
A. BLEEDING GUMS CAN BE A GOOD SIGN
If you don’t floss, you are leaving 40% of the tooth surface untouched. “Flossing removes plaque and debris,” says Dr. Uchenna Okoye.
“It also helps prevent and treat bad breath. Just smell the floss after it has been used. I recommend a waxed tape rather than floss as it has a wider surface area.”
“Use an interdental brush for bigger gaps,” says Dr. Nicola Owen, of the Dental Phobia Clinic, Manchester.
“If your gums bleed it’s a good sign as you’re reaching areas where there is a build-up of plaque. It should stop after a few days as plaque is cleared.
“If it doesn’t, see your dentist as you may have a deeper problem.”
Dr. Federico Tinti, periodontist at London Smiling, adds: “Water-picks – also known as hydro-flossers – which emit a jet of water to remove trapped debris, are not as effective as old-fashioned floss.”
B. LEARN TO RELAX
“Tooth grinding – bruxism – is common,” says Dr. Asif Chatoo.
“It causes cracking and chipping of teeth and receding gums,” says Dr. Uchenna Okoye. Headaches are another side-effect.
Dr. Asif Chatoo recommends a tooth shield. “It’s a smaller version of the ones boxers wear to stop teeth grinding. Try to get a custom-made one as they are more comfortable.”
C. HIDDEN SUGAR
Sweets and sugary drinks cause tooth decay, but Dr. Simon Khoury says we also need to be aware of sugar in foods such as tomato ketchup and baked beans. Meanwhile, wine is acidic and will gradually erode the teeth. The key is not the quantity of sugar you eat but how often.
“It’s a great reason to avoid snacking,” says Dr. Uchenna Okoye.
“It takes an hour for mouth pH to rebalance after eating.”
4. BRACE YOURSELF…
A. STRAIGHT TEETH LAST LONGER
Braces are not just about vanity as straighter teeth are simply healthier for your body. So, it’s time to see an orthodontist…
“Crooked teeth lead to more decay,” says Dr. Asif Chatoo.
“Straight teeth are easier to clean so you are less likely to get gum disease,” says Dr. Simon Khoury.
“Food can get into awkward places in crooked teeth, meaning that bacteria collects.”
B. FILLINGS: WHITE OR SILVER?
There have been concerns about the health risks of silver amalgam fillings, which contain mercury.
Dr. Stuart Johnston, of the British Dental Association, says: “Amalgam fillings were banned in some European countries but this was because of the environmental impact of mercury waste being washed down the plughole.
“It’s nothing to do with health. In my mind amalgam is safe and effective.”
White fillings are made of glass particles, synthetic resin and a setting ingredient and last five to eight years, compared with eight to 12 years with amalgam.
The laws changed last week. It is now illegal to whiten the teeth of those under 18 and single-session whitening treatments are banned. Beauticians are no longer allowed to carry out whitening.
D. FALSE ECONOMY OF VENEERS
Dr.Jeremy Hill, of The Centre of Dental Excellence, Essex, says veneers can damage the tooth as treatment involves drilling on to the surface.
“One in ten people with veneers needs a root filling because the process irritates the nerve and affects the tooth.”