44 replies to this topic

[Brett Black]

Flossing may overall be more of a risk to health than a benefit.

The first study shows that flossing can readily cause oral bacteria to enter the bloodstream(bacteraemia.) Second study showed that the scientific evidence does not support oral health benefits from flossing.

1. J Clin Periodontol. 2009 Apr;36(4):323-32. doi: 10.1111/j.1600-051X.2008.01372.x.
Epub 2009 Mar 11.

Bacteraemia due to dental flossing.

Crasta K(1), Daly CG, Mitchell D, Curtis B, Stewart D, Heitz-Mayfield LJ.

Author information:
(1)Discipline of Periodontics, Faculty of Dentistry, University of Sydney, NSW,
Australia.

AIMS: The aims of this study were to (1) investigate the incidence of bacteraemia
following flossing in subjects with chronic periodontitis or periodontal health;
(2) identify the micro-organisms in detected bacteraemias; and (3) identify any
patient or clinical factors associated with such bacteraemia.

MATERIAL AND METHODS: Baseline blood samples were obtained from 30 individuals
with chronic periodontitis (17 M:13 F, 29-75 years) and 30 with periodontal
health (17 M:13 F, 28-71 years) following a non-invasive examination. Each
subject's teeth were then flossed in a standardized manner and blood samples
obtained 30 s and 10 min. after flossing cessation. Blood samples were cultured
in a BACTEC system and positive samples subcultured for identification.

RESULTS: Forty per cent of periodontitis subjects and 41% of periodontally
healthy subjects tested positive for bacteraemia following flossing. Viridans
streptococci, which are commonly implicated in infective endocarditis (IE), were
isolated from 19% of positive subjects and accounted for 35% of microbial
isolates. Twenty per cent of subjects had a detectable bacteraemia at 10 min.
post-flossing. No patient or clinical factors were significantly associated with
post-flossing bacteraemia.

CONCLUSIONS: Dental flossing can produce bacteraemia in periodontally healthy and
periodontally diseased individuals at a rate comparable with that caused by some
dental treatments for which antibiotic prophylaxis is given to prevent IE.

PMID: 19426179 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm....pubmed/19426179

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1. Int J Dent Hyg. 2008 Nov;6(4):265-79. doi: 10.1111/j.1601-5037.2008.00336.x.

The efficacy of dental floss in addition to a toothbrush on plaque and parameters
of gingival inflammation: a systematic review.

Berchier CE(1), Slot DE, Haps S, Van der Weijden GA.

Author information:
(1)School of Dental Hygiene, INHOLLAND University for Applied Sciences, Amsterdam,
The Netherlands.

Comment in
Int J Dent Hyg. 2008 Nov;6(4):251-2.

OBJECTIVES: The aim of this study was to assess systematically the adjunctive
effect of both flossing and toothbrushing versus toothbrushing alone on plaque
and gingivitis.

MATERIALS: The MEDLINE and Cochrane Central register of Controlled Trials
(CENTRAL) databases were searched through December 2007 to identify appropriate
studies. The variables of plaque and gingivitis were selected as outcomes.

RESULTS: Independent screening of titles and abstracts of 1166 MEDLINE-Pubmed and
187 Cochrane papers resulted in 11 publications that met the eligibility
criteria. Mean values and SD were collected by data extraction. Descriptive
comparisons are presented for brushing alone or brushing and flossing. A greater
part of the studies did not show a benefit for floss on plaque and clinical
parameters of gingivitis. A meta-analysis was performed for the plaque index and
gingival index.

CONCLUSIONS: The dental professional should determine, on an individual patient
basis, whether high-quality flossing is an achievable goal. 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.

PMID: 19138178 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm....pubmed/19138178

Edited by Brett Black, 15 October 2014 - 02:44 AM.

[niner]

Wow, the bacteraemia paper is a bit of a worry, but the Cochrane Review conclusion is going to be a tough sell with a lot of people.  I see a significant difference in gum health if I don't floss at all.  I use an electric toothbrush, have a good diet and seem to have good gum health in general (when I was young, our family dentist said that I got that from my mom; my dad had terrible gums), so I seem to be able to go a day or two without flossing without problem, but I don't think I could stop entirely.  Sometimes food gets stuck between my teeth which is highly annoying, and flossing is the only way to get it out.

[blood]

I wonder how Brush Picks compare.
I am 'addicted', and *have* to use them after each meal:
http://www.luckyvita...picks-275-picks

 

 74499.jpg   65.25KB   14 downloads

Edited by blood, 15 October 2014 - 12:56 PM.

[shp5]

this doesn't sound good. I floss twice a week, but the stuff I get out isn't nice, so I won't stop either.

 

how bad is bacteraemia actually?

[HaloTeK]

this doesn't sound good. I floss twice a week, but the stuff I get out isn't nice, so I won't stop either.

 

how bad is bacteraemia actually?

 

If we use a water pik would we be safe?

[xEva]

I found this suspicious:

 

"Each subject's teeth were then flossed in a standardized manner."

 

Sounds like a hygienist did it to them. In my experience, whenever I was subjected to this procedure, which thankfully happened only about 3 times, they always managed to hurt my gums. I think this is because doing it to someone does not allow for the feedback people get when flossing their own teeth. So, I doubt that, without periodontal disease, flossing, when done right, would cause bacteremia -- why would it, if no injury occurred? 

[Kalliste]

The first study sounds suspicious.

Periodontally healthy might mean that they did not suffer periodontitis, but a lot of people can have thick plaque and not periodontitis.

I would like to see it done with people who have undergone a full depuration- and polishingtreatment and then learned to use floss and brushing using coloringpills.

THEN do this test a few weeks later.

It might be that these healthy individuals still had a massive bacterial flora.

 

Another possibility is that it's true, but it might be the least of two bad things.

Inflamed gums are really strongly correlated to a host of CVD stuff.

With either gingivitis or periodontitis you are getting tons of bacteria and harmful enzymes pumped into the bloodstream every day.

 

But what do I know. Biology is weird. There might be some hormetic level of bacterial plaque that the body is evolutionarily accustomed to supporting.

I'm a dental professional and I used my own coloring kit to teach myself the electric toothbrush and even then I notice that I'll develop approximal gingivitis unless I floss every other day.

I'm not going to stop flossing.

 

One take-away is that many people might be prescribed antibiotics for dental procedures and that prescription is really not necessary, since they are inducing this bacteraemia to themselves every day with the toothbrush and floss.

Edited by Cosmicalstorm, 16 October 2014 - 04:56 AM.

[Mind]

For whatever reason, my gums almost always bleed when I floss, although I try to avoid this hapenning. I really only floss to get out food/things that get stuck. Otherwise standard brushing twice a day seems to keep teeth in good health. I can't remember the last time I was at the dentist.....maybe once in the last 25 years.

[Kalliste]

Sounds like you have sub-gingival calculus Mind. That is a big risk factor for atherosclerosis and CVD in general. The bleeding is the body telling you to clean it up, go see an oral hygienist and clean it up.

 

http://www.joponline...p.2005.76.5.731

 

http://www.joponline...jop.2006.060081

Edited by Cosmicalstorm, 16 October 2014 - 06:16 PM.

[niner]

Yeah, I totally agree with Cosmicalstorm.  Mind, If I was you, I'd make an appointment for "teeth cleaning" at the dentist of your choice.  This is a relatively quick and cheap thing you can do to improve your long term health.  You probably ought to get a set of x-rays while you're there.  It would suck to lose a tooth due to something that could easily be fixed if caught in time.

[Mind]

The last time I was at  the dentist....specifically for a cleaning, because my insurance at the time, paid for it...the dentist got his mirror and pick out, looked around for about a minute, scratched with the pick once or twice and said your teeth are quite clean, let's get out the fluoride.

 

My experience has been this. When I was  teenager, I went to the dentist about once a year, twice sometimes. Almost every time they said - you have a cavity. Eventually almost all of my molars ended up with fillings. After I turned 18, I have been to the dentist once (25 years), and the dentist said my teeth were fine. No cavities, no problems. During this time all of my wisdom teeth came in and are also fine. Makes me wonder if the dentist in my teens was really all that competent. I vaguely remember in my teens listening to the dentist describe my x-rays and pointing out cavities. I could never see them in the x-ray images.

 

Which brings me to another story of a work colleague who had great teeth and rarely any troubles. She went to a dentist office in my city, they took x-rays and said she had 5 cavities. She couldn't see any cavities in the x-rays, so she went and got a second opinion at a different dentist's office and they said her teeth were fine. No cavities.

 

I don't want to broad-brush all dentist's as being corrupt or incompetent, most are great, of course, and they provide a valuable service for healthy living, for which I am grateful.

 

But in my case is "if it ain't broke, don't fix it", is the approach I am taking. My eating and dental habits keep my teeth in good shape, they are not rotting or anything. The bleeding from flossing comes from the mechanical stress of the floss, not because my gums are rotten. Because of my wisdom teeth, the rest of my teeth are slightly tighter/closer together. This makes it more difficult to get floss in between them. The extra force causes the floss to sometimes come down upon the gum and cause a small laceration. It is difficult to avoid completely.

 

I am aware of sub-gingival calculus. Thanks for all the advice.

[xEva]

Which brings me to another story of a work colleague who had great teeth and rarely any troubles. She went to a dentist office in my city, they took x-rays and said she had 5 cavities. She couldn't see any cavities in the x-rays, so she went and got a second opinion at a different dentist's office and they said her teeth were fine. No cavities.

 

I don't want to broad-brush all dentist's as being corrupt or incompetent, most are great, of course,...

 

Unfortunately, in the US, one hears of such stories way too often -- or worse yet,  is subjected to being a participant in one. They go into dentistry specifically to make money and are not shy about admitting it. And so they will drill healthy teeth just cause their mortgage payment is due. It's a shame really. I don't trust the US dentists anymore. How is it in other countries?

Edited by xEva, 17 October 2014 - 10:17 PM.

[Darryl]

The association of periodontitis with cardiovascular disease (and its sentinel erectile dysfunction) was an early indicator of how important endotoxins are to the inflammatory progression of atherosclerosis.

 

It initially lead me down the rabbit hole of Toll-like receptors, NF-κB signalling, NADPH activation, oxidative stress, and endothelial dysfunction; other pathologies like metabolic syndrome and neurodegeneration which may share much of this causal chain, and dietary factors (like saturated fats) that may increase intestinal permeability to endotoxins or (in the case of 16 carbon and longer SFAs) even activate their TLR pattern recognition receptors independently from endotoxins. Its a really fascinating story that with parallel lines of research for multiple diseases that deserves better coverage in the popular press.

 

Needless to say, while I only floss a few times weekly, I swish bacteriocidal mouthwash about every time I visit my bathroom.

 

Humphrey, L. L., Fu, R., Buckley, D. I., Freeman, M., & Helfand, M. (2008). Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. Journal of General Internal Medicine, 23(12), 2079-2086.

Sharma, A., Pradeep, A. R., & Raju P, A. (2011). Association between chronic periodontitis and vasculogenic erectile dysfunction. Journal of periodontology,82(12), 1665-1669.

Pussinen, P. J., Vilkuna-Rautiainen, T., Alfthan, G., Palosuo, T., Jauhiainen, M., Sundvall, J., ... & Asikainen, S. (2004). Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide.Arteriosclerosis, thrombosis, and vascular biology, 24(11), 2174-2180.

Schenkein, H. A., & Loos, B. G. (2013). Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. Journal of clinical periodontology, 40(s14), S51-S69.

D'Aiuto, F., Sabbah, W., Netuveli, G., Donos, N., Hingorani, A. D., Deanfield, J., & Tsakos, G. (2008). Association of the metabolic syndrome with severe periodontitis in a large US population-based survey. The Journal of Clinical Endocrinology & Metabolism, 93(10), 3989-3994.

 

Out of idle curiosity, I checked other major diseases with knowninflammatory etiologies, and  associations with periodontitis have been found with nearly every one I've checked. The paper on gum disease and pancreatitis hasn't been written yet.

 

Meyer, M. S., Joshipura, K., Giovannucci, E., & Michaud, D. S. (2008). A review of the relationship between tooth loss, periodontal disease, and cancer. Cancer Causes & Control, 19(9), 895-907.

Fisher, M. A., Borgnakke, W. S., & Taylor, G. W. (2010). Periodontal disease as a risk marker in coronary heart disease and chronic kidney disease. Current opinion in nephrology and hypertension, 19(6), 519.

Wactawski-Wende, J. (2001). Periodontal diseases and osteoporosis: association and mechanisms. Annals of periodontology, 6(1), 197-208.

McAlindon, T. E. (2008). Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. The Journal of rheumatology, 35(1), 70-76.

Kamer, A. R., Craig, R. G., Dasanayake, A. P., Brys, M., Glodzik-Sobanska, L., & de Leon, M. J. (2008). Inflammation and Alzheimer's disease: possible role of periodontal diseases. Alzheimer's & Dementia, 4(4), 242-250.

Saletu, A., Pirker‐Frühauf, H., Saletu, F., Linzmayer, L., Anderer, P., & Matejka, M. (2005). Controlled clinical and psychometric studies on the relation between periodontitis and depressive mood. Journal of clinical periodontology, 32(12), 1219-1225.de Pablo, P., Dietrich, T., & 

Edited by Darryl, 18 October 2014 - 02:55 AM.

[Kalliste]

You went to dentists who look at the crown of the tooth and want money, Mind. I have literally heard the same story a hundred times and I don't doubt it. Are you also afraid now? That's a common problem. Go see an oral hygienist then. Many dentists do not perform a periodontal examination worth the name. The gums simply do not bleed from mechanical force of flossing if healthy. You either clean the gums too rarely to heal the inflammation or you have hardened deposits in your approximal cavities that contain plenty of microorganisms.

Swishing with antimicrobial solution wont help. The bacteria are ancient warriors in the art of chemical warfare. They use the plaque to hide each other, they use quorumsensing to warn of chemical danger. They survive and the nice ones disappear leaving more aggressive species alive. This affects the gut flora negatively too, selecting the wrong bacteria for survival. Of course this does not stop Listerine and other from investing millions in marketing.

The only acceptable method is quality mechanical cleaning with individually fitted tools plus a sparse meal frequency and some fluoride to keep cavities away. The low meal frequency also seems to be the best way to keep the rest of the body in a good state, suggesting that evolution does not expect us to roll around in sugar.

Edited by Cosmicalstorm, 18 October 2014 - 06:16 AM.

[Mind]

Thanks for the tip on the oral hygienist. If I go see one soon, I will let you know what they say.

 

I am afraid of getting more teeth drilled for no reason, but that is more a function of just finding a reputable dentist.

[Kalliste]

Tell them you want your x-rays for a second opinion if they tell you that there are cavities that need to be fixed. Also consider waiting for 12-18 months and having another scan if there is any uncertainty about a cavity, they wont have old pictures of you to compare with.

Some lesions look like they need a filling but then you look again a year or two later and they have not moved at all.

You can and should ask for prices in advance, it is possible to have a periodontal examination only. But 25 years is a long time with no x-rays.

A periapical lesion can exist with little notice and will also poison you so it's nice to find them with x-rays.

Edited by Cosmicalstorm, 18 October 2014 - 01:16 PM.

[niner]

Thanks for the tip on the oral hygienist. If I go see one soon, I will let you know what they say.

 

I am afraid of getting more teeth drilled for no reason, but that is more a function of just finding a reputable dentist.

 

There are some lousy dentists out there, just like there are some lousy doctors out there.  I had a bad dentist for about ten years, and he missed the beginnings of a problem that could have been dealt with easily at the time.  (It's being dealt with expensively now.)  After I left the first not-very-competent dentist, the next one I found (picked randomly from phone book-- bad method) was an absolute clown.  I finally asked my doctor for a recommendation, and ended up going to his dentist.  He's expensive but good.  Cosmicalstorm's advice is good-- I have pretty good gum genetics, and can easily get away without daily flossing, but if I don't floss often enough, my gums will bleed when I floss them.  It's a sure sign that something's going on down there.  Healthy gums are pretty tough.

[StephCThomp]

I have long since strongly suspected that many cases of Gingivitis merely reflect underlying Scurvy or sub-clinical Scurvy. Somehow, our medical and dental profession have forgotten all about this basic and lethal deficiency disease.

 

Lack of Vit C, and Scurvy, both cause heart attacks. There we have it - perhaps.

 

My theory is that extremely bad research protocols spot an association (a correlation) between gum health and cardiac events, then make the first year 'Research 101' mistake of assuming one is caused by the other.  Perhaps both are caused by a third variable - chronic low grade ascorbate deficiency.

 

Theory aside, I'd be surprised if Mind had even sub-clinical Scurvy, being a member of this fine forum. 

[Kalliste]

I meet a lot of people with those kind of ideas in my job. Here's what people say:

"It runs in the family" "It's genetic" "It's always been like this" "I think it's because of the amalgam" "There is nothing wrong, it bleeds when I brush hard" "I have sensitive gums" "Im deficient in <insert X> and thats why it bleeds".

 

This debate is settled every time with a plaque disclosing pill (I love those) showing a nice line of bacteria along the gum lines.

Extreme cases look like this.

 

[nightlight]

For whatever reason, my gums almost always bleed when I floss, although I try to avoid this hapenning. I really only floss to get out food/things that get stuck. Otherwise standard brushing twice a day seems to keep teeth in good health. I can't remember the last time I was at the dentist.....maybe once in the last 25 years.

 

The gum bleeding may have to do with vitamin C deficiency (at lost locally). I had the same problem for years which got fixed by using a mouth rinse which combines Liposomal Vitamin C (sodium ascorbate form which is pH neutral) and baking soda. After the last brushing before bed, I use 1/4 cup of warm water, 1/2 oz of Liposomal C (containing 1 gram of sodium ascorbate) + 1/4 teaspoon of baking soda, then rinse with that for 2-3 minutes. It eliminated gum bleeding with harder brushes & flossing, firmed up gums and I have no more cold sensitivity I had on some teeth.

 

It also fully cleared up the problem which originally motivated this experiment -- the chronic low grade inflammation in the root of one molar I had for nearly 10 years. Dentist kept urging me to either have root canal or extraction, otherwise she said the infection will destroy the supporting jaw bone and lead to loss of multiple molars. A sore spot on the bone would flare up every now and then requiring antibiotics to subdue. Since I started with Liposomal C and the above rinse (1.5 years ago), the inflammation disappeared after about a week and is since gone as if I never had it.

[Mind]

Well, now I am monitoring and looking more closely, but I still don't see anything obviously wrong or any build-up of plaque. It really seems, I am usually just too careless and rough when I floss. I have a high pain tolerance and I probably just don't notice when I am using a little back-and-force motion with the floss sometimes and cause a laceration here or there. Just a couple days ago, I flossed carefully and covered all the normal places/spaces. No bleeding.

[zorba990]

The last time I was at the dentist....specifically for a cleaning, because my insurance at the time, paid for it...the dentist got his mirror and pick out, looked around for about a minute, scratched with the pick once or twice and said your teeth are quite clean, let's get out the fluoride.

My experience has been this. When I was teenager, I went to the dentist about once a year, twice sometimes. Almost every time they said - you have a cavity. Eventually almost all of my molars ended up with fillings. After I turned 18, I have been to the dentist once (25 years), and the dentist said my teeth were fine. No cavities, no problems. During this time all of my wisdom teeth came in and are also fine. Makes me wonder if the dentist in my teens was really all that competent. I vaguely remember in my teens listening to the dentist describe my x-rays and pointing out cavities. I could never see them in the x-ray images.

Which brings me to another story of a work colleague who had great teeth and rarely any troubles. She went to a dentist office in my city, they took x-rays and said she had 5 cavities. She couldn't see any cavities in the x-rays, so she went and got a second opinion at a different dentist's office and they said her teeth were fine. No cavities.

I don't want to broad-brush all dentist's as being corrupt or incompetent, most are great, of course, and they provide a valuable service for healthy living, for which I am grateful.

But in my case is "if it ain't broke, don't fix it", is the approach I am taking. My eating and dental habits keep my teeth in good shape, they are not rotting or anything. The bleeding from flossing comes from the mechanical stress of the floss, not because my gums are rotten. Because of my wisdom teeth, the rest of my teeth are slightly tighter/closer together. This makes it more difficult to get floss in between them. The extra force causes the floss to sometimes come down upon the gum and cause a small laceration. It is difficult to avoid completely.

I am aware of sub-gingival calculus. Thanks for all the advice.

I have had a very similar experience and basically gave up on dentistry because of it. Rarely any gum issues and vitamin c and rutin high doses stoped any bleeding issues long ago. Occasionaly I seem to be losing calcium from my teeth with them geting slightly transparent. Calcium lactate rinsing 1tsp per quart water seems to correct that. I have added k2 mk4 for a while now and the effect on calculus seems to be positive. Dentists also kessed me up with what I now consider improper wisdom toth extraction and only self research and a high power laser were able to get rid of years of headaches, sinus issues, and shoulder pains. But I still floss and use an irrigator.

[Kalliste]

Curcumin has also received a lot of positive attention with regards to gum disease. It also exhibits chemo-preventative effects in strong concentrations, which can be achieved via vigorous rinsing.

[Boopy!]

Love this --  and I also LOVE flossing  (weird,  I know,  but I find it oddly satisfying while teeth brushing is BORING to me.)   Ok,  so I think too much about these things.   Any study (well most studies)  can be taken with a grain of salt,  which I will then need to floss out of my teeth.   I am not yet convinced.   I very much agree that it's ridiculous how divided (insurance wise,  and other ways)  dentistry is from the medical profession as they should be part and parcel of one another.   In med school they were separate from the very first year.  I currently have two dentists.   Neither has once advised the same treatment plan  (and I like maniacally playing them against one another.)   No jk,  but man!  is it hard to find a decent dentist.  I lucked out in the tooth area in a way,  because I went through many years  (fifteen plus)   of depression and never brushed or flossed my teeth.   Plus did drugs and still grind like crazy.  Yet I had little to no repercussions which to me seems nearly impossible.  Genetics wins largely for such things --  I cannot understand how I have any teeth left at all.

[Kalliste]

I tried to stop flossing for ten days and only brush really carefully. After ten days my breath turned bad and there was a very disgusting smell when I started flossing again.

[k4ir0s]

Thanks for the tip on the oral hygienist. If I go see one soon, I will let you know what they say.

 

I am afraid of getting more teeth drilled for no reason, but that is more a function of just finding a reputable dentist.

 

You might simply have a vit C, or K deficiency 

[lunarsolarpower]

It's funny, for years we've been saying that the trace bacteremias caused by common dental procedures were of no more concern than the ones caused by daily flossing in advocating for the guidelines for antibiotic prophylaxis to be changed, and just recently, they finally were.

If you're interested in longevity a comprehensive daily oral hygiene routine is key.

https://michaellustg...an-association/

 

If you don't like floss you may be able to do an even better job cleaning between your teeth using curaprox interdental brushes. Most people would need several different sizes to reach everywhere though. Healthy gums should not bleed. If your gums are bleeding when you floss, especially if you floss consistently using good technique for two weeks, you need to see a professional and find out what's going on. I've heard the story of one famous Wall Street mogul who hated the thought of taking proper care of his teeth himself so he had his driver take him to the periodontist every day to keep up with his oral hygiene for him. Whatever you've got to do, find a way to keep things healthy.

 

http://www.curaprox....duktegruppe&g=4

[Kalliste]

Most people will be unable to use interdental brushes due to size limitations.

[nowayout]

Anybody have experience with replacing flossing with using water picks instead. 

[Kalliste]

Bacteria have spent 3 billion years playing around in water. I would not trust water to remove dental biofilms, plus it's expensive.