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18 November 2010

Flossing sucks, amirite? So I was a the dentist a month ago, and she threatened to do terrible things to me and my teeth. She only relented when I agreed to start flossing every day and come back in December. So the appointment is fast approaching, but I'm still not flossing.[More:]So, bunnies who floss religiously, how do you get into the habit and motivate yourself to keep doing it? It's just that at the end of a long day, the last thing I want to do is spend an extra 5 minutes in the bathroom grooming my teeth. I have a whole bag of those flossing sticks, which is supposed to make it easier than the floss-wrapped-around-the-finger method, but I still can't motivate myself to do it. Any tried-and-true tips or tricks?
I'm with you. Got the prethreaded things, don't really do it.
posted by Madamina 18 November | 23:23
I love flossing. Looooove it. You need some Reach Gentle Gum Care. It is like a soft towel of flossy goodness.
posted by ThePinkSuperhero 18 November | 23:32
Actually, the official name is Reach Gum Care with Fluoride.
posted by ThePinkSuperhero 18 November | 23:32
put em by your bedside? it ain't like you gotta stare at your teeth while flossing
posted by Firas 18 November | 23:33
at the end of a long day, the last thing I want to do is spend an extra 5 minutes in the bathroom grooming my teeth.

I hear you. The good news is, you really don't have to floss just at the end of the day. You can do it in the morning or after lunch or in the afternoon if you want. Maybe make it part of your routine during the day or at work. It's probably most beneficial if done at night, so stuff isn't sitting in your gums overnight, but on the other hand doing it daily at ANY time is MUCH more beneficial than not at all.

Another idea: don't confine flossing to the bathroom. I know it depends on who you live with and whether this would gross them out, but I used to floss while vegging out watching TV. I don't have TV any more, but you can also do it while reading online or watching a movie or whatever else that doesn't require your hands. Whenever you're done, just get up and brush a minute, and you're golden. You don't have to stand in the bathroom for ten minutes at eleven at night, which is the real motivation killer.
posted by Miko 19 November | 00:18
The only motivation I've found helpful is how fast and easy my time at the dentist has become since I started flossing. Even after just two weeks of flossing. And a lot of my gum sensitivity went away.

Without that feedback pretty quickly after I started flossing regularly, I'm not sure I would have kept it up. Maybe just think of it as an experiment for the next couple weeks to see how different your next experience at the dentist is?
posted by occhiblu 19 November | 00:47
What got me flossing was the dental hygienist telling me I didn't have to be perfect. If I flossed only 4-5 days a week, that was better than not flossing at all.

Keeping dental floss next to the computer also helps, as long as you don't try to floss and type at the same time.
posted by maudlin 19 November | 00:49
I started using the Reach Flosser - it has a long handle like a toothbrush and changeable pre-threaded insert things. I floss in the shower, just after I brush in the shower, while my conditioner is soaking. It's great! I won't floss unless I have it.
posted by rhapsodie 19 November | 00:52
Are you using old-fashioned floss, or the easy-glide stuff? I use Glide, which is a lot easier to use. The old-fashioned twiny kind gets stuck and shredded and is so frustrating that I would put it off most days. I switched about 15 or 20 years ago, and I've never switched back.

I recently asked my dental hygienist if I should switch back to the old-fashioned kind, if it's more effective. She pointed out that even if it would be more effective (which she wasn't prepared to stipulate), flossing regularly with the easy-glide kind is better than flossing sporadically with anything else, and that she's perfectly happy with the results I get from easy-glide floss. She stresses that ANYTHING that gets you in the habit is desirable.
posted by Elsa 19 November | 01:27
I hate flossing. I have a small mouth with oddly-spaced teeth and I find using the flossing thread to be really difficult because it's hard to reach my back teeth.

But I found a Reach battery-powered flosser (which they don't make any more) in a pound shop. I love it. I was worried that I wouldn't be able to get the replacement flossing bits for it, as they're not sold in the UK but I've picked up enough while I'm in the States to last me for ages.
posted by Senyar 19 November | 03:44
I'm pretty skeptical of the benefits of flossing: is there any actual evidence for it?

A quick Google doesn't find much. This roundup suggests there's a benefit for "professional" flossing in children with low fluoride exposures, but no evidence for adults, no evidence for self-flossing.
posted by TheophileEscargot 19 November | 05:33
I've gone round and round with my dental hygienist for years, but I refuse to floss. I cannot STAND that sensation of something moving between my teeth, especially when it has to be forced in because my teeth are so close together. The flossing is THE WORST part of getting my teeth cleaned, worse than the polishing with that awful vibrating thing, worse than picking at my gums with metal tools. Worse than fillings, even. I get my teeth cleaned twice a year, I use the brushes I'm told to use, I'm diligent about brushing, and that's gonna have to be good enough. I will not floss.
posted by JanetLand 19 November | 06:37
Floss hater here. I'm like the cancer patient smoking through his tracheotomy opening, my floss hate is immune to the consequences. In my case, those consequences are as follows: Yesterday, I had two teeth pulled. Last month, I had one of my front teeth pulled. 6 months before that, I had another pulled. That's 4 implants I'll be getting. (I already have 2 bridges and an assortment of crowns and root canals.

Let's ignore the expense (something like a year of college) and focus on the physical. Just yesterday's physical: the discomfort, even under 4 shots of xylocaine, the inability to eat, the various pills I'm taking, the need to wear a denture for 6 months as the bone grafts heal. I should mention what it looks like to have your face all swollen and have people ask you why continually. I could go on but you get the point.

But maybe it would have all happened anyway? Even if I flossed 3 times a day. One factor is genetics. My dentist says I have the bad kind of mouth bacteria that requires eternal vigilance, same as the price of liberty (same as in town.) She thinks that flossing works (she also has the bad genes and the bad bacteria) and I believe her (though still hate it.) Yes, there are those who say otherwise, just like there are climate change deniers, but the scientific community is on the flossing side right now. So, if we believe her, what do we do?

There are those who believe you can eat whatever you want and not gain weight. They write books and people who want it to be true buy them. The consequences are not instant enough for one to immediately experience it as cause and effect. Who believes sex causes babies? OK, I'm really rambling here, I'll blame it on all the dental meds I'm taking and the trauma I went through yesterday. Maybe flossing won't make a difference (I'm even supposed to floss under by bridges! No one ever told me!) but do you want to take that bet and end up like me?
posted by Obscure Reference 19 November | 07:57
Flossing improves your breath.
Healthy teeth are better for your heart.
Sometimes I use pre-threaded flossers while driving. Sorry, other drivers.
If you really can't make yourself floss, chew gum with xylitol. Gum helps clean yr teeth and xylitol prevents cavities.

The breath part is my best motivator.
posted by theora55 19 November | 07:59
I'm pretty skeptical of the benefits of flossing: is there any actual evidence for it?

I have seen the benefit play out in my own repulsive mouth. I went in to the dentist's some time ago and was warned that I had some nasty stuff going on (gum recession, incipient infection, other disgusting things that trigger my dental phobia and so I have more or less forgotten them as a self-protective measure) and that if I couldn't clean up my act, I was going to need [invasive procedure I have also forgotten, the horror the horror].

That's when I started flossing regularly. That's the only really substantial, regular change I made in my dental care, and at my check-up a month later my hygienist gave me a gold star for such a marked change. I knew she was going to commend me before I went in, because I could see the change for the better just by looking.

That's right: a mere month of flossing made a noticeable difference, even to a naked and untutored eye. I'm a believer.
posted by Elsa 19 November | 08:05
(I'm even supposed to floss under by bridges! No one ever told me!)

Amazing the stuff no one tells you, right? I finally realized that my parents had not trained me properly in basic dental care and --- at that scary visit full of dire warnings --- I asked my hygienist to spend five minutes training me as if I were a child in flossing and brushing. Am I doing it right? Is the floss at the right depth and angle? Is the brush supposed to go here, or here?

It really did make a difference in my mouth. (I acknowledge your point that difference mouths are different, and that it might not make such a difference in someone else.)

Sometimes I use pre-threaded flossers while driving. Sorry, other drivers.

At least you're in the car, sealed off! There's a woman on my bus schedule who flosses on the bus. That is officially Not Okay.
posted by Elsa 19 November | 08:13
Do you think you would be more likely to use a water pik? My hygienist told me the other day that would be a perfectly acceptable alternative to flossing.
posted by amro 19 November | 08:39
Yeah, the breath part is my motivator, too.

Don't floss for a few days, and then floss and *smell* the floss. That's contributing to your breath. And if doesn't get you to floss... well maybe you are a mutant with no mouth bacteria? :)
posted by gaspode 19 November | 09:22
My new year's resolution this year was to floss more. And I have. The thing that did it for me was timing how long it takes me to floss, and then see if I can beat that.

But that might only help if you're freakishly competitive.
posted by punchtothehead 19 November | 09:37
I'm pretty skeptical of the benefits of flossing: is there any actual evidence for it?

I just did a quick Google and found a BUNCH of things - what were your search terms?

The main reasons to floss don't seem to be caries risk, as the study you linked is concerned with, but preventing the buildup of tartar which can then provide harbor for bacteria that cause gingivities, which can destroy gum tissue and have implications for inflammatory/heart diseases, and also the loss of bone around the submerged tooth.
posted by Miko 19 November | 10:40
Do you have links Miko? I searched for evidence flossing and got a bunch of studies, but nothing very conclusive.

The thing is, like doucheing or male circumcision it's a "hygiene" thing which mostly seems to be confined to certain cultures and regions, which makes me wonder if it's actually worthwhile.
posted by TheophileEscargot 19 November | 10:52
You don't need to do it in the bathroom. Do it watching TV.

I wish to hell that I'd gotten the flossing habit earlier. I would have avoided a lot of cavities. Most of mine were between the teeth.

Just looking at the stuff that gets flossed out is motivation enough for me. After a lot of problems in the past 10 years, I've become a stickler for keeping my mouth clean.
posted by DarkForest 19 November | 10:54

I did a quick PubMed search for "dental flossing" and then limited it to reviews.

" Professional flossing in children with low fluoride exposures is highly effective in reducing interproximal caries risk" BUT ."self-flossing has failed to show an effect"

Contrary to that, from a periodontal disease risk assessment study out of Harvard: Patients are encouraged to become actively involved in periodontal disease management by following a daily three-step regimen of brushing, flossing and rinsing with an antimicrobial mouthrinse.

But again (and this is a systematic review)
In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence.

I'm cherry picking of course, but a cursory glance through results would seem that the rigorous meta-analyses and systematic reviews show either a minor or no health benefit to flossing.

Looking at the studies which were not analyses of other studies, most, regardless of their actual conclusions (remembering I glanced at the abstracts and of course didn't read the papers) still recommended flossing. Conservative management and all...
posted by gaspode 19 November | 11:49
Very interesting, gaspode! Are these the far end of the bell curve, or is this a more-or-less representative sampling?

I'm trying to make sense of the dramatic and sudden improvement I saw when I re-adopted regular flossing; I wonder if the flossing was the most noticeable part of a more subtle overall change in my routine that caused the rapid improvement. Or possibly some people are more responsive to it than others, or possibly some people are more proficient at it than others (which seems to be suggested by the distinction in the first article between self-flossing and professional flossing).

There is no way I'm going to stop flossing.
posted by Elsa 19 November | 11:56
More or less representative (for the 10 minutes or so that I was looking through)

And hells, I'm not stopping flossing either. I like it. I think that it makes me pay more overall attention to my oral health as well, which may factor in.

Also, no overall benefit in a large population (as you know) doesn't mean that individual people don't find great benefits.

(triple negative, woot!)
posted by gaspode 19 November | 12:16
Ah, I think it might be hard to find stuff with "Evidence flossing" because that's not necessarily the way a web site would write about research that supports flossing. I think it's easier to go at the question, and then look for the supporting studies cited.

Sorry, I didn't have time to do links before because I was going into a meeting.

like doucheing or male circumcision it's a "hygiene" thing which mostly seems to be confined to certain cultures and regions, which makes me wonder if it's actually worthwhile.

Well, experience suggests that it's more than cultural. Before we had widespread flossing even in the US, most people over 60 or so had whole sets of false teeth and/or multiple bridges. Chances are most of our grandparents did (all four of mine did). Gum disease and bone loss are contributors to the loss of teeth or the need to extract them to prevent further infection.

There are certainly cultural implications, in that if your diet is fairly pure as it might be in some cultures, you may not have as many tooth problems in general, and there are genetic components to dental health as all health. But I don't think it's an arbitrary thing that's cultural alone. It seems to me that when I think of populations where dental hygeine isn't widely practiced, when I think about the kids I've taught whose very occasional and emergent access to dentistry didn't include training on flossing or access to twice-yearly cleanings, and I think about their families who had even less access to social-service-based dentristy than their children had, I remember a lot of people with compromised teeth.

Some sources:

Study of Twins Confirms Importance of Dental Flossing: Those twins who did not floss had significantly more of the bacteria associated with periodontal disease when compared to the matching twin who flossed in addition to tooth-brushing with toothpaste

Prevention of Periodontal Disease, Health Agency of Canada: Gingivitis develops in healthy adults after 10 to 21 days in the absence of personal plaque removal... A recent two-week clinical trial with adults found that while twice daily toothbrushing alone produced a 35% reduction in gingival bleeding, toothbrushing and flossing at home resulted in a 67% reduction. [good citations in this manual]

The Effectiveness of Dental Floss in Reducing Gingival Inflammation [PDF]

Preventive Behaviors as Correlates of Periodontal Health Status: Subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores

I think that's about all the reading on dentistry I feel like doing today, but you can Google for lots lots more. I used terms like "effectiveness flossing" "flossing study" "flossing research" "flossing abstract." I'm left wondering, who the heck is willing to volunteer for dental research? YEEEeeesh! In one of these studies they had two groups of people floss, and then tested whether their gums bled less by poking their gums with a sharp stick. I mean, come ON!
posted by Miko 19 November | 12:18
the rigorous meta-analyses and systematic reviews show either a minor or no health benefit to flossing.

I saw one of those meta-analyses and it used only 11 studies. What I think confounds the data is that many studies specify that the flossing has to be GOOD. And (as I know from the rigorous instruction me dentist gives me) most people don't know how to do it right, or what exactly they're supposed to be trying to achieve. Somehow you have to control for quality. A lot of studies do that by making the dental hygeinist the one who's flossing, and those show improvement, but then they aren't able to speculate about how that translates to home flossing.

I'm with Elsa. There've been times i ignored flossing, but in recent years my dentist, who I really think is great, has drilled it into me (pun intended! ha ha!) that it's a requirement if I want to keep seeing him. And since I've been religious about it, my gums are a LOT healthier. They aren't red and tender and angry. Stuff isn't hanging out between my teeth for weeks. And once you do it for even a couple weeks, the bleeding stops and the tenderness goes away completely. At this point my mouth doesn't feel totally clean unless it's flossed. And the studies suggest that's because it isn't.
posted by Miko 19 November | 12:22
It is better to have loved and flossed than never to have loved at all.

I don't mind
Not knowing what I'm headed for
You can take me to the skies
It's like being flossed in heaven
When I'm flossed in your eyes

Marshall, Will and Holly
On a routine expedition
Met the greatest earthquake ever known
High on the rapids
It struck their tiny raft
And plunged them down a thousand feet below
To the Laaaaaaand
of the Floooooosssseddd!

The flossing puns will continue until you comply with your dentist's orders.
posted by Eideteker 19 November | 12:45 recent years my dentist, who I really think is great, has drilled it into me...

I see Miko's on board with my threat already.
posted by Eideteker 19 November | 12:47
Changing faces, trading places
Nothing lasts anymore
it's hard when you try
Star-flossed lovers
run for cover
I don't know if it's right
but I know how I feel

So we cheated and we lied and we tested
And we never failed to fail, it was the easiest thing to do
You will survive being bested
Somebody fine will come along, and make me forget about loving you
In the Southern Floss

posted by Eideteker 19 November | 12:59
I started flossing daily right after college when my mom had dental implants done for every one of her teeth. Yikes. I didn't want to be that person.

My biannual dental checkups last about 20 minutes at most, and about 1 minute of flossing every morning is my routine. I do keep a spare floss roll in the car for that random thing-in-your-tooth lunch, but it's rare that I have to use it.

I gotta say it would gross me out to be in a room with someone flossing their teeth if it wasn't the bathroom.
posted by chewatadistance 19 November | 13:05
Think I wanna drive your Benz, I don't
If I wanna floss, I got my own
Even if you were broke
My love don't flossed a thing

I can do this all day. Well, all of my lunch break.
posted by Eideteker 19 November | 13:07
Yeah, meta-analyses that are done properly can be tough because the papers they review have to meet strong experimental design criteria. If we look at the one that cited 11 articles, you see that

"1166 MEDLINE-Pubmed and 187 Cochrane papers resulted in 11 publications that met the eligibility criteria"


Anyway, yeah, quality of flossing, as Elsa said is probably the big variable.
posted by gaspode 19 November | 14:00
eponysterical chewatadistance.

The problem with studies using flossing or not flossing as a parameter is that slipshod floss isn't considered. I'm sure these studies involved self-reporting and no one watched everyone floss daily.

I know my level of dental care varies from day to day depending on my mood or schedule. To say flossing doesn't remove plaque is demonstrably wrong (though you can say that slipshod flossing doesn't). You can get disclosing liquid (what hygienists use to reveal the presence of plaque) and try it yourself. The only possible argument they could make is that the plaque difference isn't significant for healthy gums.
posted by Obscure Reference 19 November | 14:12
I'm sure these studies involved self-reporting and no one watched everyone floss daily.

No, they mostly didn't seem to rely on self-reporting, at least in the ones I found (and there were more I didn't link, but the ones I did link aren't self-reporting). What they do is say that when a dental hygeinist does it (presumably with good technique) it works, and in supervised and/or clinical studies it works, but unfortunately it's not supportable to extrapolate that to how well it works in a random population of lackadaisical flossers who might not be doing it right.

I'm pretty sure I have good technique after all the attention my dentist's offce has paid to teaching me, and in any case, even lackadaisical flossing just has to be better than none at all for removing spots where bacteria could grow.
posted by Miko 19 November | 14:40
The problem with studies using flossing or not flossing as a parameter is that slipshod floss isn't considered.

It shouldn't really have to be considered, since a study is of a statistical group, not an individual.

Say 70% of the flossers are slipshod, and 30% are doing it properly: when you analyse the statistics, on average the floss group should still show an improvement thanks to that 30%.

Also, you might expect even slipshod flossing to have some partial effect which would show up statistically, rather than be completely useless.
posted by TheophileEscargot 19 November | 15:02
Oops, maybe you're right that the 11 studies that made it through the screening were self-reported. i didn't look at those so I don't know. Sorry I misunderstood there.
posted by Miko 19 November | 15:02
I have so many other health issues it's a nice thing that I have good teeth. My dentists and hygienists have admitted that I'm one of the few who don't need to floss, but they still tell me to floss "because you should". T'hell with that.
posted by deborah 19 November | 15:02
This thread has inspired me to buy floss on the way home!
posted by youngergirl44 19 November | 15:08
Also, you might expect even slipshod flossing to have some partial effect which would show up statistically, rather than be completely useless.

I think genetics is the dominating factor and they should probably limit the studies to those with bad genes. And I'm willing to bet that most flossing is done incorrectly. For example, you're not supposed to use the same floss (or the same area on that floss, at any rate) that you used between two teeth to then floss between two different teeth. It just spreads the germs. And there's the under the bridge issue I mentioned.
posted by Obscure Reference 19 November | 15:42
You know what my motivation to floss is? A crush on my dentist. I suggest that if you have trouble motivating yourself to floss, you find a dentist that you think is hot to impress with your flossing skillz.
posted by amro 19 November | 15:49
What worked for me was Oral B mint flavored waxed ribbon floss. It's about the most expensive floss there is, but I like the blue plastic container it comes in, that has just a touch of sparkle in it, and I like the mint flavor. Not all mint flavored floss is pleasant but I like this one.

I floss with it pretty regularly, and I'd never been able to get flossing with other flosses. I feel sort of dumb about it - I mean, I'm the guy who needs the special dental floss, that's sort of lame - but whatever works.
posted by ikkyu2 19 November | 23:14
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