Written by: Robert Martino, DDS
You’ve probably heard the phrase about doing the same thing while expecting different results. Whether accurately attributed or not, it raises an uncomfortable question for dentistry.
For decades, flossing has been promoted as essential for gum health, yet periodontal disease remains widespread and tooth loss after age 30 is still frequently linked to periodontal breakdown.1-2 If flossing alone were the clear solution, population outcomes might look very different.
If a strategy is not producing widespread success in the real world, it deserves re-evaluation.
This is Not Anti-Flossing—it’s About Results
Flossing can have value when done correctly and consistently. The problem is that public health recommendations must be judged not only by theoretical effectiveness, but by real-world effectiveness.
A method that works only when performed perfectly by a minority of people may not be the best primary solution for the broader population.3
Most People Do Not Floss Properly
Flossing’s purpose is to mechanically disrupt and remove biofilm missed from tooth brushing. Proper flossing takes time, coordination, and consistency, and few patients perform it correctly. Even with instruction, many struggle to develop effective flossing habits.
Flossing Is Primarily Mechanical
It removes some biofilm but does not provide sustained antimicrobial action, significantly reduce microbial load, neutralize odor-causing compounds, or therapeutically change the oral environment. Because biofilm rapidly returns, flossing alone is often insufficient for patients with inflammation, dry mouth, systemic risk factors, or periodontal disease.
Possible Alternative: Therapeutic Rinsing
Historically, gum health advice has centered on brushing and flossing, yet gum disease and periodontal-related tooth loss remain widespread. This does not mean brushing and flossing lack value, but mechanical removal alone may not be enough. Therapeutic approaches that reduce harmful microbes, improve the oral environment, and are easier to follow consistently should also be considered.
Recent Study: Brush and Floss vs Brush and Therapeutic Rinse
A 42-day randomized, examiner-blind clinical trial compared 2 oral hygiene regimens of 71 individuals:
- Control Group: manual toothbrush, standard fluoride toothpaste, and daily flossing.
- Test Group: manual toothbrush, test fluoride toothpaste, and daily mouth rinsing.
The Results Were Significant
At Day 42, the brush and rinse group outperformed the brush and floss group across all major endpoints:
- Gingival Health (Modified Gingival Index): 845% improvement compared to those who brushed and flossed.
- Bleeding Index: The rinse group improved 6090%, while the floss group showed no significant change.
- Plaque Reduction: The rinse group achieved significantly greater plaque reduction at 64% compared to the brushing and flossing group.
Why This Matters
This study suggests a therapeutic system may outperform a purely mechanical one.
Traditional flossing relies heavily on motivation, consistency, technique, time, and manual dexterity. A rinse-based system may offer advantages because it is easier to use consistently, faster, and less technique-sensitive.
That matters because the best oral hygiene routine is not the one that sounds ideal on paper, but the one people will actually do correctly and consistently.
Mechanical vs Therapeutic
Flossing is primarily mechanical, disrupting plaque between teeth but offering little beyond physical removal. A therapeutic rinse/toothpaste system may provide broader benefits by reducing microbial load, suppressing pathogenic biofilm, lowering inflammation and bleeding, reducing odor-causing sulfur compounds, and improving soft tissue health. Rather than simply removing plaque, it may help improve the environment that allows disease to persist.
CONCLUSION
Gum disease is too common to rely solely on habits many people do not perform consistently or correctly. This study suggests a therapeutic brush and rinse approach may be more effective than the traditional brush and floss routine for reducing plaque, bleeding, and gingival inflammation. Floss still has a role, but the future of periodontal prevention may depend on working smarter, not just scraping harder. For more information, visit oracareproducts.com.
References
Sambunjak, D., Nickerson, J. W., Poklepovic, T., et alia (2011). Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews, (12), CD008829. https://doi.org/10.1002/14651858.CD008829.pub2
Centers for Disease Control and Prevention. (2023). Oral health conditions.https://www.cdc.gov/oralhealth/conditions/index.html
American Academy of Periodontology. (2022). Gum disease statistics. https://www.perio.org/for-patients/gum-disease-information/
