London - Visits to the dentist are never pleasant. Not only do we have our pearly whites scraped, prodded and drilled, we then have to endure a telling-off for not having flossed.
Dentists insist it will keep our teeth sparkling and free from decay, as well as keeping our gums healthy. Regular flossing has even been said to protect us from heart disease. Yet, for most of us who try wrestling with the tape, it only results in a cricked neck and bleeding gums.
And now, according to a provocative new book, Kiss Your Dentist Goodbye, it seems that dedicated followers of flossing could actually be wasting their time.
The book is causing waves because it’s written by US-based Dr Ellie Phillips, who was among the first women dentists to train at Guy’s Hospital in London.
She says that flossing - and that goes for whichever gizmo, gadget or bit of tape you choose to use - will do nothing to reduce your risk of tooth decay.
The science, she says, is on her side. Only one study has shown a benefit, and that involved a group of schoolchildren who did not floss themselves, but instead had their teeth flossed by a hygienist five days a week for two years.
And a study published in the British Dental Journal in 2006 found no difference in the number of cavities suffered by adults who flossed and those who did not.
So is Dr Phillips right? Surprisingly, it seems she may be - but only up to a point.
“In all fairness, there is no evidence that flossing is effective in preventing tooth decay in the long run,” says Dr Graham Barnby, a dentist from Marlow, Bucks, who is also a member of the Simply Health Advisory Research Panel, which analyses the latest research and medical thinking.
“So in a sense, she does have a point. Yet although the benefits of flossing may be limited with tooth decay, flossing does have a role in the prevention of gum disease.”
Tooth decay occurs when acid in the mouth eats away at the teeth. This acid is found in foods, but is mainly produced when bacteria in the mouth “digest” sugar - hence the reason sweets rot our teeth.
Gum disease, on the other hand, is caused by plaque - a film of bacteria on the teeth which, if not removed with brushing, irritates the gums, causing them to bleed and recede.
If left, the plaque hardens into tartar, which irritates the underlying bone of the gums and, in severe cases, can lead to wobbly teeth.
Some studies have even linked gum disease to heart disease, as the same bacteria found in the mouth have also been found in the heart.
Christina Chatfield, an independent dental hygienist based in Brighton, who is nominated for hygienist of the year, says effective flossing should help reduce both tooth cavities and gum disease. She argues that the reason studies have shown it to have little effect is that too few people actually do it properly.
“The majority of those who do use floss (which I believe to be around five percent of the population), don’t use it effectively, so it is of minimal benefit to them,” she says.
“To remove plaque, you need to hook the floss like a C around the tooth, so it hooks out the plaque from between the contact points of the teeth.
“I liken bad flossing to trying to clean a bottle neck with a piece of string floating in the middle - which, in effect, is all most people achieve.”
Dr Nigel Carter, chief executive of the British Dental Health Foundation, says flossing is definitely not a waste of time - provided you’re doing it properly.
“We certainly shouldn’t be encouraging people not to do it,” he says. “If you don’t clean between the teeth, you’re cleaning only 60 percent of the tooth’s surface. The dental profession has been pushing it for 20 years, yet we’ve got only five percent of the population to do it - because it’s fiddly.
“Most dentists recommend interdental brushes - small brushes that can get right below the gum line. They are much easier to use, and get into the curves of teeth so it’s easier to clean each side of the tooth.”
However, Dr Ellie Phillips argues that rather than flossing or using brushes, all you need to do is use three different mouthwashes - one before brushing, and two after.
People often clean their teeth immediately after eating, yet this can lead to the teeth wearing away, she says, because food softens teeth.
Instead, she recommends using Ultradex mouthwash before brushing, which stops this happening. It contains chlorine dioxide, which studies show may help remove bacteria. After brushing teeth, she advocates Listerine, to enhance the cleaning process, and then a fluoride rinse such as Fluorigard to help strengthen and repair teeth.
In addition, she advocates using lozenges or chewing gum containing the sweetener xylitol, which has been found in tests to reduce tooth decay.
So does Dr Phillips’ method work?
“The bacteria around teeth that cause gum disease are extremely protective and hard to shift - they don’t even respond to antibiotics,” says Christina Chatfield.
“The idea that these bacteria could be shifted by mouthwash alone is ludicrous. The only option is to shift them physically, and even with the most thorough flossing some get left behind.”
But could xylitol still be the secret to a healthy mouth?
Xylitol, a naturally occurring sweetener found mainly in the bark of the silver birch tree but also in the fibres of many berries, fruits and mushrooms, works by suppressing production of harmful bacteria in the mouth.
“There are clearly dental health benefits with xylitol, therefore products that contain it can help fight tooth decay,” says Dr Carter.
Hundreds of studies show it is a proven force against tooth decay. A study of 80 adults who, for three weeks, were given xylitol gum to chew three times a day after meals revealed that the gum brought about a dramatic decline in bacteria numbers.
In Scandinavia - which is a major producer of xylitol thanks to its high numbers of birch trees - xylitol lozenges are popular.
In the UK, it’s more often used as an additive in sugar-free chewing gums and sweets, but these contain significantly less xylitol and may be diluted by other sweeteners.
“The lozenges have about 100 percent xylitol, but in the chewing gums you’ll get only about 30 percent,” says Dr Carter.
“Many dentists now recognise the benefits of xylitol and encourage their patients to use it.”
He adds that many European countries use xylitol in sweets instead of sugar. In Spain, for instance, around 70 percent of confectionary is sugar-free, whereas in the UK it is closer to 30 percent.
“The problem is that we have a very sweet tooth in the UK, and we are resistant to sugar-free confectionary. We like the real thing.”
The recommended dose is about 5g a day. Regular intake of xylitol can cause flatulence and diarrhoea, but Dr Carter says this effect will only be temporary.
Professor Stephen Porter, director of the Eastman Dental Institute in London, cautions that xylitol lozenges should be avoided by some groups.
“It’s certainly not suitable for children or the elderly, because it can have a laxative effect and cause tummy upsets.”
Rather than mouthwashes and sweets, most dental professionals say it is simple measures that will help protect dental health.
“That means avoiding sugary snacks between meals,” says Professor Porter, “as sugar leads to more acid which then attacks the teeth, and you want to limit the time that this happens.
“You also need to brush and floss thoroughly to clean plaque off, and use fluoride toothpaste to help strengthen the teeth.
“You don’t need fancy equipment - just dental tape and a toothbrush will do fine.
“Above all, people must remember that flossing will do them absolutely no harm whatsoever, and will actually most probably have an awful lot of benefits.” - Daily Mail