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Second Opinion: To Floss or Not to Floss? That Isn’t the Question by Michael I. Barr, DDS

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Editor's note: Ssecond opinions are common in health care, whether a doctor is sorting out a difficult case or a patient isn't sure what to do next. In Dentaltown magazine, the first opinion always belongs to you, the reader, and our Second Opinion column allows your fellow dental professionals to share their thoughts and ideas about timely topics—providing you with a "second opinion." Some of their observations might change your mind, while others end up further solidifying the position you already held. Either way, the goal in the end is to create discussion and debate that enriches our profession.

Unless you were asleep at the wheel last week, you probably heard or saw some of the headlines that created a huge buzz: "Flossing Doesn't Help! Your Dentist Is Wrong!"

Dentistry's message of health was again foiled by a sensationalized story. (It's bad enough that we're perpetually portrayed as buffoons and socially inept characters in Hollywood productions!)

The media jumped at an opportunity to make everyone feel good about their dereliction of duties. The report's false implication that "flossing doesn't work" resonates with the public because it confirms and justifies the decision not to floss in the first place. Essentially, it excuses someone's lack of diligence with oral hygiene — a "Get Out of Jail Free" card, if you will.

And now, it opens the opportunity for patients to throw the report at their dentists or hygienists at their next visits. In fact, some of us may have already faced that confrontation! (I did today with one patient … the only one so far, thankfully.)

"What we meant was …" won't work
The American Dental Association contacted the U.S. Department of Health and Human Services to address its exclusion of flossing. In its official statement, the ADA clarified that flossing was still considered a beneficial hygienic practice.

Someone on the Dentaltown message boards lamented that the ADA statement didn't make the news. But the news business is all about buzz. Eyeballs equal ad revenue. Titillating headlines like "Your Dentist Was Wrong—Floss Doesn't Work" resonate with viewers and readers. For proof, look at the social media firestorm that this single Associated Press report created.

Meanwhile, the ADA's rebuttal brings none of that. It's boring. It's not a headline that will bring eyeballs. That means no revenue, and that the ADA's statement won't see much play—if any—in the media.

How to tell your patients the truth
So, how do dental warriors in the trenches deal with the inevitable onslaught of questions—or smug declarations—from patients?

I've already heard a few suggestions for replies, and they range from the crude ("There's no evidence that wiping your butt ‘works,' either, so why don't you stop that, too?") to the cerebral ("An absence of evidence is not evidence of absence"… but I'd save that one for the PhDs in your practice).

I've also seen dental professionals on the "interwebz" say that patients might be persuaded to floss if they took a week off, then flossed once and took a whiff of the used material. Ewww!

I believe that your approach shouldn't be a cookie-cutter answer. Each patient is different and you should adjust your answer accordingly. A relaxed, conversational tone will be better than a rigid, rehearsed answer delivered in a defensive manner. Don't be a dentist—be a human (who happens to be an expert).

We might explain that this story was based not on a study but a review of previous studies. Those previous studies may not have proved that flossing was efficacious, but they didn't disprove it, either. To effectively conduct a double-blind, longitudinal study on flossing would be entirely impractical, if not full-on impossible.

Following up with the facts
Dentistry has a vast repository of anecdotal proof of the benefits of flossing via our collective clinical experience and observation. We know when a patient flosses or doesn't, and to us the benefits are self-evident. There's a reason that most of us haven't had to perform restorative procedures on virgin caries or periodontal therapy for our team of assistants, hygienists and front desk … and it's not because we have the "secret sauce" or hoarded an entire supply of cavity vaccines for ourselves.

We can also explain that any interdental hygiene tool helps. It doesn't have to be floss—patients can use proxabrushes or other gizmos. They should just use something, whatever works in their hands. Without it, they're missing two of the five sides of the tooth. Or, you could tell them that without daily interdental cleaning, about 40 percent of each tooth surface gets missed. For a full-body equivalent, that's like not washing your face and both legs whenever you're in the shower. (We don't need a study to prove that washing your face and legs is better for your health.)

In the end, this is another situation where we need to assert ourselves as the experts on dental health. Be confident in your knowledge, your clinical experience and your observations. Look your patients in the eye and leverage your existing doctor-patient relationship. Be conversational, not confrontational. And don't forget to smile!



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April 2024
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