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A String around Your Finger: Do We Really Need to Floss?

Course Number: 550

Patient Attitudes and Practices Towards Oral Home Care

Patient compliance with overall oral hygiene recommendations has been shown to be fairly low. Only 60.5% of children ages 3-15 report brushing their teeth (or having their teeth brushed) twice daily62 and only 51% of adults reported brushing twice daily.63 Furthermore, 23% of Americans have gone two or more days without brushing their teeth in the past year and 37% of adults ages 18 to 24 have gone that long without brushing.63 Even when individuals do brush, they may not be following the recommended time or methods. It has been reported that the average individual performs 45-70 seconds of toothbrushing daily, far below the ADA’s recommended two minutes twice daily.16Additionally, while the most recommended method of toothbrushing by dental healthcare professionals is the Modified Bass technique,64 patients often employ other techniques, notably the scrub brush technique, and distribute the brushing unevenly throughout the mouth, which may lead to decreased efficiency of biofilm removal during toothbrushing.65

Interdental cleaning is also not universally employed by individuals. Despite evidence to suggest that daily flossing reduces bacteremias associated with dental biofilm and inflammation,66 patient compliance with regular and sustained daily use of dental floss for interdental cleaning has been estimated to be as low as 2%.17 But reporting of flossing prevalence varies considerably; a 2014 national public opinion poll, the 2014 Delta Dental Oral Health and Well-Being Survey reported that 41% of Americans floss at least once daily, and 20% never floss.63 And amongst individuals with risk factors for periodontitis, female gender, higher income, and non-smoking status were associated with an increase in daily flossing.67Additionally, individuals report they dislike flossing. In a survey from the AAP, more than 35% of respondents stated they would rather perform an unpleasant task, like filing their tax return or cleaning their toilet, than floss.18 Methods of aiding planning and developing self-efficacy have been used to increase flossing behaviors in individuals with moderate success,68 but floss usage remains lower than recommended.