Flossing and the Art of Scientific Investigation

Nov 29, 2016

By Jamie Holmes

It’s bad enough that expertise is under attack these days from populist political movements that dismiss specialist opinion as just another establishment ruse. But lately expertise is being criticized from another direction, too — from would-be defenders of science.

Consider the recent controversy over flossing. In August, a widely read Associated Press report suggested that, contrary to the advice of dentists everywhere, flossing didn’t necessarily foster good oral health. The report looked at 25 studies that had generally compared toothbrushing and flossing with toothbrushing alone and concluded that the evidence for the benefits of flossing was weak.

In response, the Department of Health and Human services, the American Dental Association and the Academy of General Dentistry reaffirmed the importance of interdental cleaning. But confusion persists: A lot of people now mistakenly think that “science” doesn’t support flossing.


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5 comments on “Flossing and the Art of Scientific Investigation

  • Consider the recent controversy over flossing. In August, a widely read Associated Press report suggested that, contrary to the advice of dentists everywhere, flossing didn’t necessarily foster good oral health. The report looked at 25 studies that had generally compared toothbrushing and flossing with toothbrushing alone and concluded that the evidence for the benefits of flossing was weak.

    We brush our teeth to remove food and plaque between the teeth, on tooth surfaces and at the gum line. If left there, acidic residues will promote tooth decay. Flossing after eating often dislodges food particles trapped between the teeth. But where is the evidence? Duh, it’s you, dummy. You feel the irritating food particle pop out from between your teeth onto your tongue (or shirt). Hey, it works!



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  • The truth about flossing:
    You don’t have to floss all your teeth…
    just the ones you want to keep!

    I’m a dentist. The lack of RCTs of the effectiveness of parachutes is a good analogy.
    Steve



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  • Is there a lack of critical thinking in dentistry?
    As a dentist I noticed a lack of critical thinking within the field of dentistry – especially within the Cochrane Oral Health Group, which only considers RCTs as a means to answer research questions. This ignores the fact that certain research questions can sufficiently be answered on a lower level and also ignores the fact that RCTs are not always possible. RCTs and related systematic reviews are a great tool if the cause-effect relationship is in doubt (e.g. Homeopathy) and if two comparative treatment alternatives can be randomly allocated in a masked (blinded) way (e.g. drug trials, sham operations, etc.).
    The possible impact of plaque on oral health has already been demonstrated on a lower level in a classic experiment by Löe et al. in 1965. (Loe H, Theilade E, Jensen SB. Experimental Gingivitis in Man. J Periodontol. 1965 May-Jun;36:177-87).
    The more important question is, does floss help/improve plaque removal (not if you don’t know how to use it)? Is it the only way to remove plaque (obviously not)?
    James Randi’s comment about Benveniste’s famous “high-dilution” experiment, which supposedly supported Homeopathy, is valid here as well: “Look, if I told you that I keep a goat in the backyard of my house in Florida, and if you happened to have a man nearby, you might ask him to look over my garden fence, when he’d say ‘That man keeps a goat’. But what would you do if I said, ‘I keep a unicorn in my backyard’?” (Maddox J, Randi J, Stewart WW. “High-dilution” experiments a delusion. Nature. 1988 Jul 28;334(6180):287-91).

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