Review of the Month: To floss or not to floss, that is the question…

634px-Dental_floss_(whole)In honour of National Smile Month (May 20 to June 20, 2013), the Cochrane Oral Health Group Review of the Month is Flossing for the management of periodontal diseases and dental caries in adults. Does using dental floss every day help to prevent gum diseases like periodontitis, and tooth decay?

What was the research?

A systematic review of the evidence to find out whether using dental floss in addition to brushing teeth helps to prevent gum disease and tooth decay in adults.

Who conducted the research?

The research was conducted by a team led by Dario Sambunjak from the School of Medicine at the University of Split in Croatia, on behalf of the Cochrane Oral Health Group. Jason W Nickerson, Tina Poklepovic, Trevor M Johnson, Pauline Imai, Peter Tugwell and Helen V Worthington were also on the team.

What evidence was included in the review?

Data was extracted from 12 randomised controlled trials, which had included 1,083 people as participants. The trials looked at using dental floss plus toothbrushing compared with toothbrushing alone.

What did the evidence say?

There is evidence from 12 trials that flossing reduces gum disease. There is very weak evidence that flossing plus toothbrushing may reduce the amount of plaque (a biofilm caused by bacteria) in your mouth, but no trials reported on whether flossing prevents tooth decay.

How good was the evidence?

The trials were generally consistent in their findings, but the reporting of the methods in some cases was not clear enough to decide whether or not there was bias. The quality of the evidence was generally low.

What are the implications for dentists and the general public?

Despite the uncertain or low quality of most of the studies, these results support the use of regular flossing with toothbrushing.

What should researchers look at in the future?

Well designed and conducted randomised controlled trials are needed, specifically trials which run for longer periods. Trials which run for longer than three months may help to determine whether flossing prevents tooth decay.


Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews 2011 , Issue 12 . Art. No.: CD008829. DOI: 10.1002/14651858.CD008829.pub2