In Defense of Flossing: Part II-Can We Agree It's Premature to Claim Flossing Is Ineffective to Help Prevent Periodontal Diseases?

Abstract

Periodontal diseases (PD) are complex, multifactorial disorders. Effective daily plaque control promotes gingival/periodontal health. Recent meta-analyses and other reviews have found inconclusive evidence to support that tooth flossing promotes gingival/periodontal health. Ideally, the claim should have been that, “at present, we do not have high-quality evidence from well-designed randomized clinical trials (RCTs) to determine whether flossing lowers the risk for periodontal diseases.” Rather than “not proven to be effective,” the lay public may now think that flossing is “almost entirely unhelpful and/or unnecessary.” How does the dental community communicate the nuances of this topic? Herein, we examine the key structural issues underlying this area of research. We assert that effective flossing between specific teeth can promote gingival/periodontal health. Further, we explore the nuances of for whom this may be true and untrue, why our evidence is lacking and what can be done to clarify the effectiveness of flossing on clinical outcomes.

A provider‐observed tool to assess Oral Hygiene Skill Mastery (OHSIM) in human immunodeficiency virus‐positive (HIV+) adults

“…In relation to flossing, prior meta data (Cochrane Reviews, etc.) on this topic have not used a reliable and valid measure of oral hygiene skill, such as OHSIM; thus, many studies have relied on self‐reported behavior, which is a weak foundation for evidence‐based dentistry . Future studies, using OHSIM could help generate stronger evidence for claims related to toothbrushing and flossing efficacy.…”

“…Of interest, PD is currently one of the most pervasive oral complications of human immunodeficiency virus‐positive (HIV+) adults, a group in which poor oral health is common . Exposure to low nadir CD4 (<200 cells/μL) ever can contribute to gingival recession, an important component of PD, which could then complicate plaque control . Deficits in oral health can be especially detrimental for HIV+ adults, as it can interfere with antiretroviral therapy (ART) compliance, reduce nutritional intake, lower self‐esteem, and diminish quality of life, thus, negatively impacting the overall health…”

“…Meticulous dental plaque control is a well‐established method to lower the risk for PD and its progression and can improve PD‐related outcomes in HIV+ adults . Oral health self‐care depends on behavior.…”

“…3,4 Exposure to low nadir CD4 (<200 cells/ L) ever can contribute to gingival recession, 5,6 an important component of PD, which could then complicate plaque control. 7 Deficits in oral health can be especially detrimental for HIV+ adults, as it can interfere with antiretroviral therapy (ART) compliance, reduce nutritional intake, lower self-esteem, and diminish quality of life, 8,9 thus, negatively impacting the overall health. 10 Meticulous dental plaque control is a well-established method to lower the risk for PD and its progression 7,11 and can improve PD-related outcomes in HIV+ adults.…”

“…7 Deficits in oral health can be especially detrimental for HIV+ adults, as it can interfere with antiretroviral therapy (ART) compliance, reduce nutritional intake, lower self-esteem, and diminish quality of life, 8,9 thus, negatively impacting the overall health. 10 Meticulous dental plaque control is a well-established method to lower the risk for PD and its progression 7,11 and can improve PD-related outcomes in HIV+ adults. 12 Oral health self-care depends on behavior.…”