Flossing Myths, Evidence, and Humor

Patti DiGangi, RDH, BS


A patient tells a dental hygienist or dentist, “I always use a really firm bristled toothbrush to toughen up my teeth and gums.” Another patient may say, “I quit flossing because it always makes my gums bleed.” Both patients may have problems with their teeth and gums. Is flossing really effective, or is it ROMA thinking? 

What is ROMA? I’ll get to that shortly. In the meantime, a quick Google search of “floss doesn’t work” brings 678,000 results in 0.50 seconds. Oh, what damage that 2016 news story caused! This feels like an arrow in the heart of many dental professionals. Woe is me for dentistry. Stop the insanity! This can’t be true—except that it is!

Perhaps it’s time for dentistry to take a breath, step back, and examine the basis for our ire. Maybe it’s time to laugh. There is a continuing body of evidence to support the value of humor. The positive effects of humor are real. A good laugh can improve health—maybe more than flossing.

Three Sides to a Coin

The old saying that there are 2 sides on a coin often is thought to mean that 2 ideas can be regarded as 2 parts of the same thing. One side of the coin may be a strong view that we have on a particular situation. It may be built on myths, urban legends, or habits and tradition. The other side of the coin could be built on current scientific evidence. Yet, a coin does not have 2 sides. It has 3: the head, the tail, and the edge.

So to answer the question, “What is ROMA?” it is the third side of the coin. If we could stand on the edge of the coin, perhaps we would see both sides more clearly from a new perspective and recognize the humor and even silliness of our very human thoughts, beliefs, and behaviors.

ROMA can be an abbreviation for:

  • Results Oriented Management and Accountability;
  • Robust Open Multi-Agent Systems;
  • Rental, Owners, Management Association;
  • And more.

Those are not the meanings in DentalCodeology: ROMA Manual on Dentistry. (Language Warning) ROMA stands for Right Outta My Ass.

This language is not trying to be politically incorrect, nor is it meant to offend. The purpose is to take a lighthearted approach to dentistry while challenging assumptions and traditions and looking at the evidence. But you may be asking yourself what ROMA has to do with the flossing controversy. Let’s look at the coin.

One side of the coin is evidence-based dentistry (EBD). It integrates the dental professionals’ clinical expertise, the patient’s needs and preferences, and the most current, clinically relevant evidence. EBD doesn’t need to be boring. Sitting on the edge of the coin can make it fun!

Flossing has been touted as the holy grail of dental home care. Many of our patients use the old phrase “Just say no.” Most dental professionals know that some patients could sell them back the floss we have given them at case price.

Here’s the third side of the flossing coin: A 2015 American Academy of Periodontology flossing survey found the following ROMA-worthy findings:

  • 27% percent of adults admit to lying to their dentist about how often they floss.
  • Another 36 % would rather do an unpleasant activity instead of daily flossing.
  • 14% of American adults would rather wait in a long checkout line.
  • 9% would rather sit in gridlock traffic for an hour or do their taxes.

As humorous as those results are, they are opinions. What is the evidence on the efficacy of flossing? The following are the conclusions of several systematic reviews from the ADA Center for Evidence Based Dentistry:

  • Routine instruction to use floss is not supported by scientific evidence.
  • Results need to be extrapolated for typical floss-users, since self-flossing failed to show an effect.
  • Flossing was not associated with fewer caries for any group.

So could that reporter might have been right? Perhaps. Take a step back, take time to challenge your assumptions and traditions, and look at the evidence. And while you are at it, take some time to laugh.

Maybe the real question we need to answer is not if flossing works, but rather how flossing can work if patients avoid it like the plague, and how we can change that.

Just another dental perspective from the third side of the coin, courtesy of ROMA.

Ms. DiGangi believes dentistry is no longer just about fixing teeth. Dentistry is oral med­icine. Her work helps dental professionals embrace the opportunities and understand the metrics that ac­curate insurance coding provides. The ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for its CDT 2018 Companion. She holds publishing and speaking licenses with the ADA for Current Dental Ter­minology and a license for SNODENT diagnostic coding. She is the author of the DentalCodeology series of easy-to-read bite-size books. Her latest book, DentalCodeology: ROMA Manual on Dentistry, was cowritten with Benson Baty, DDS. She can be reached at patti@dentalcodeology.com.

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