In Defense of Flossing: Can We Agree It's Premature to Claim Flossing is Ineffective to Prevent Dental Caries?

Current evidence pertaining to the effectiveness of flossing and caries prevention is potentially being misinterpreted by health oversight bodies, which may have significant implications for current and future public flossing guidelines. We identify and discuss several methodological deficiencies, including the lack of validated measures of flossing skill, over-reliance on self-reported flossing behavior, and the lack of current guidelines on how to interpret and apply evidence-based findings to specific clinical scenarios that are present in the studies of flossing effectiveness included in the Cochrane Review. As such, we argue that it is premature for health oversight bodies to conclude that flossing is ineffective in the prevention of dental caries. Our research group, which is funded by the National Institutes of Health (NIH), is developing a valid and reliable provider-observed measure of tooth brushing and flossing skill that may help promote higher quality flossing evidence in the future.