Overview

As a part of the update to the 2015-2020 Dietary Guidelines for Americans, the federal government omitted a recommendation for flossing previously included in the guidelines. Citing the reasons for the omission, the Dietary Guideline Advisory Committee (DGAC) stated they focused on food and nutrient intake (e.g., added sugar) and cited the 2011 Cochrane systematic review1 which concluded there is currently a lack of strong evidence to support the use of floss as a preventative measure for caries and gingival disease. The Surgeon General, Centers for Disease Control (CDC), the Department of Health and Human Services, and other federal and state health agencies continue to support the importance of flossing and interdental cleaning and that advice is available to the public through the National Institute of Dental and Craniofacial Health (NIDCR),2 CDC’s Division of Oral Health,3 and Healthy People 2020.4

Despite the support of these agencies and numerous nonprofit groups, there continues to be confusion in the lay media and the public with regard to the role of patient-administered oral hygiene for the prevention of oral diseases. Interdental cleaning continues to be an essential part of oral hygiene to maintain a healthy oral environment.5 There are 700+ identified species of bacteria and up to 1,500 putative pathologic microorganisms found in dental plaque.6-8 Many of these organisms as well as other factors including bacterial nutrients, food debris, molecules that facilitate bacterial adhesion and invasion, and other extrinsic factors in the environment and the body’s own immune response contribute to diseases of the teeth and gingival tissues.9,10 Current recommendations include brushing for two minutes twice daily and cleaning between teeth to maintain a healthy mouth and smile!11