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Dorian's Corner - Commentaries / Opinions

Don't floss: Everything that's wrong with everything

Over the past 6 decades, I have heard the results of so many studies that say, "Do this, don't do that." Every few years they flip flop. For example, coffee will now prevent more diseases than it ever created, if you drink this exact amount.

The US consumer, like a flock of sheep, runs as a flock first this way to the cliff's edge, because research says this, then that way. Mothers have no idea how to protect their kids.

How qualitative are studies? The federal Food and Drug Administration (FDA) has strict standards for making recommendations to doctors. But maybe not so much in dentistry. The American Dental Association (ADA) is an industry association, not regulated by the FDA. But compared to psychology and economics, where 50% of studies can't be replicated, at least that's something.

The FDA quietly abandoned its recommendation to floss. The ADA hasn't. The dental industry has provided no definitive medical proof that flossing prevents anything. But dentists continue to push flossing at every contact with consumers. Who is right?

Let's have a look at dentistry, the business that tries to put itself out of business with preventive medicine.

The public voted that the toothbrush was the most important invention ever: Toothbrush trounces car as top invention. Interestingly they didn't vote toothpaste as most important, but maybe it wasn't on the menu. Teeth problems have bedeviled people since the beginning of human time. Cavity abatement and tooth replacement have a long checkered history, that often did more harm than good, such as the use of lead, and of other chemicals that destroy teeth.

The larger dental industry is a lesson in market manipulation. The ADA provides some grounding, but how much it is influenced by manufacturers claims isn't known. The floss issue questions if the ADA can do, or evaluate, serious medical research. The ADA became well known to the public when it declared Crest toothpaste "an effective decay preventive dentifrice," back in the early 1960s. It puts its seal of approval on mouth wash for supposed effectiveness. It still recommends flossing on weak evidence.

The studies that have been done on flossing have been totally inadequate. No long term studies have been done, and studies have not been closely supervised to see if subjects all do it the same way. Studies have been targeted on removal of matter, rather than to see if they actually prevent cavities. So the ADA and others are fed self serving studies by manufacturers and others, which don't target oral health, but study factors that may or may not contribute to oral health, and the goal may be achieved more effectively by other methods. What we are seeing over and over again in the wider medical market is that health studies indicate that many so called preventive measures aren't effective.

So here is what happened with mouthwash. Companies have never been able to build a solid case for all consumers to use mouthwash. They resorted to shaming, which is what the cosmetic industry is really good at. Halitosis (giving it a name makes it sound worse, like a disease or something) can drive other people away. Yes, people do notice bad breath, but, here is the thing. Bad breath isn't eliminated by washing away or killing germs in the mouth, no matter how effectively it does so. Causes of bad breath include "food, tobacco products, poor dental hygiene, health problems, dry mouth, mouth infections, dental problems, or medications." Not the mere existence of germs.

Want to eliminate "morning breath?" Rinse out your mouth with water, or brush your teeth, or drink a cup of something.

Every day marketers pile on more shame about products. Today it isn't enough to have unnaturally white teeth, you have to compare to a piece of very white paper to see if you have achieved snow white teeth. In reality, very few people are ever going to achieve snow white teeth without going to a dentist and having it painted on. The quest is just a marketer manipulating you to sell their product.

Anyway, since I was a marketing manager for a couple of companies, I can guess what goes through product manager, CEO, sales, and marketing minds. "Mouthwash sales are lagging, and we haven't found a way to build up that market. So here is a toothpaste additive, a hardener that helps restore teeth, we can add to make the product appear worthwhile." Then the sales manager says, "It's already in toothpaste, so why would they buy it?" So clever people that they are, they took it out of toothpaste and tried to make people think mouthwash was a valuable product.

So here you have millions of consumers who were denied something useful, so companies could try to sell something useless. People hate mouthwash! Thankfully they put the hardener back in toothpaste. Now you can harden your enamel at about the same pace that you remove it with whiteners.

Does recommending ineffective preventive measures actually help? Maybe - no one is really sure. But what they achieve is to undermine funding for studies that might lead to actual effective preventive measures, and cost the consumer a lot of money for useless things. Not that companies care. They are in business to make money, not guarantee results.

I have to ask if the dental community, and the medical communities, even care about consumers at all. A recent study indicated that half of people would have difficulty coming up with $400.00 in an emergency. Have you ever looked at a menu of services offered by dentists? How about $1500.00 when you damage a tooth, to get a root canal, grind off the tooth, and put on a crown. Very specialized work becomes the source of major revenue for multiple practitioners, and becomes more so every day. At one time dentists did root canals as a matter of course, plus did the rest of it. Often root canals are not even needed. But specialists and services make a lot more money.

OK, I'm not going to even imply, "don't floss." I'm not a medical professional. I don't even know if flossing is helpful for most people, and the ADA seems to recommend these products if you can't brush effectively, or if your dentist recommends them for something specific. If you don't brush your teeth effectively and use a toothpick to remove debris lodged between teeth, floss probably has some value, and may have some anyway. No one knows for sure

From the looks of things we aren't going to know. The research standards at the ADA are too lax. Research appears to center on specific conditions, not on disease. Create a product that you can show softens plaque, and get an ADA stamp of approval. But does it actually prevent tooth decay? So why deny capitalism its finest hour, when a sucker is born every minute.

ADA on mouthwash