CDA Essentials 2016 • Volume 3 • Issue 8

9 Volume 3 Issue 7 | CDA at W ork In August 2016, there was a flood of news items about an Associated Press (AP)- initiated report which found an apparent lack of direct evidence to prove that flossing was effective. The AP reported on an article 1 that looked at two previous systematic reviews on this topic comparing the use of a toothbrush alone versus a combination of toothbrush and dental floss, the most recent one being the prestigious Cochrane Library report 2 published in 2011. FLOSSING: Yes or No? What should a dentist or dental hygienist say to a patient who questions the value of flossing? NEWS ITEMS/REPORTS • The AP presented its article as a dramatic exposé, but it did not actually reveal any new clinical findings since the 2011 Cochrane review . • The subsequent news items didn’t explain how there are multiple risk factors for developing tooth decay and gum diseases and that these diseases can take a long time to develop. • By presenting faulty or incomplete information, without proper context, to those who might be looking for justification not to floss, these stories could jeopardize the public’s oral health. WHATWE KNOW • Dental plaque can begin the processes that cause tooth decay and gum disease if it’s allowed to remain on the surfaces of teeth for more than 24 hours. • The only way plaque can be removed is mechanically, with a manual or electric toothbrush (which gets the cheek and tongue surfaces of teeth) and floss or other cleaning aids (which clean the hidden or hard-to-reach surfaces of teeth). • Although there is no 100% direct scientific evidence at this time which proves that flossing on its own reduces the chance of tooth decay and gum disease, there is strong indirect evidence that the mechanical removal of dental plaque from hard- to-reach tooth surfaces is effective in preventing these conditions. We also have evidence collected in the Cochrane Library review that people who brush and floss regularly have less gum bleeding compared to toothbrushing alone. We asked members of the Editorial Advisory Group* of the Journal of the Canadian Dental Association (JCDA.ca ) to comment on these findings and to provide advice on how Canadian dentists could talk with their patients about flossing. Here are the insights of the experts that we spoke with. *ThemembersoftheJCDA.caEditorialAdvisoryGroupare Drs.AmirAzarpazhooh,ElhamEmami,JocelyneFeine,Hugh Kim,MichaelGlogauer,DeboraMatthewsandRobertSchroth. – CDA Statement on Flossing – The Canadian Dental Association supports flossing as one step of maintaining healthy teeth and gums. Flossing is an effective preventative measure to remove plaque, the main cause of gum disease. The weakness of the evidence supporting the value of floss in the prevention of gum disease is a reflection of the difficulty of conducting the necessary studies, not of the value of flossing for the maintenance of good oral health. Brushing, flossing, eating a healthy diet, and seeing your dentist regularly are all steps in preserving a healthy mouth.