The Hidden Costs of Not Flossing
There’s a connection between oral health and more serious diseases.
Have you ever felt a pang of guilt when you go in for a regular check-up and your dentist asks whether or not you’ve been flossing regularly? We’ve all fibbed about it — or at least thought about telling a little white lie, though it’s safe to say you’re probably not fooling anyone (at least, not someone with a trained eye).
The reality is avoiding this crucial step in your dental routine could have some pretty major impacts on your body as a whole. “The mouth is an extension of your whole body — it can affect your overall health and make you feel better and arguably live longer,” says Sasha Ross, DMD, MS., a periodontist at the Cleveland Clinic.
It’s true: Flossing is considered so crucial to our health that it’s included in the Living to 100 life expectancy calculator, a tool that uses parameters like diet, exercise, and health habits to determine an approximate age of death. While it’s difficult to quantify those habits in terms of how many years of life they add, doctors and dentists alike assert that flossing is essential for good dental health, which has also long been tied to overall physical health.
But trying to convince Americans to floss is a different story. We aren’t exactly enthusiastic about this chore: Studies show that only about 32 percent of us floss at least once a day.
Still not convinced that you need to make time for flossing? Here’s a breakdown of what the experts have to say — and why you probably don’t want to skip this step of your morning (and nightly) routine.
Can little to no flossing have a larger impact on your health?
The short answer is yes. Getting food stuck in your teeth isn’t just an embarrassing faux pas — if left behind for too long, the buildup could lead to potentially serious gum diseases like gingivitis or periodontitis, which causes swollen gums and even tooth loss. Unfortunately, these conditions can’t be cured — only treated with professional cleaning, and some advanced cases might even require surgery.
But what makes gum disease particularly dangerous is the bacteria that causes it in the first place. Fusobacterium nucleatum (or F. nucleatum) is associated with other serious oral conditions, such as mouth cancer. Mouth germs can also have potentially life-threatening implications on other parts of the body, including the heart. Though this condition is relatively rare, F. nucleatum can enter the bloodstream and settle into the heart’s inner lining or valve, causing what’s known as infective endocarditis (IE), according to The American Heart Association.
“Endocarditis due to poor oral health isn’t unheard of, and it can be very serious,” Martha Gulati, MD tells us.
There’s also a connection between gum disease and heart disease, which is the leading cause of death in the U.S. Experts say even seemingly harmless irritation in your gums can spark an inflammatory response throughout your whole body, potentially accelerating heart disease.
“When you get bacteria in your mouth, it can cause inflammation not only in your gums but also ultimately in your blood vessels, which lead to the heart,” explains Dr. Gulati.
What are some of the other implications of not flossing?
While it might seem odd that bacteria in our mouths can have such far-reaching effects, a 2022 study published in Frontiers in Aging Neuroscience found that oral germs can travel as far as the brain. This, in turn, causes surrounding tissue to deteriorate, as seen with brain disorders like Alzheimer’s disease and dementia. Like the heart, the brain is particularly sensitive to infections in various parts of the body because of the impacts of inflammation. That could explain why periodontitis can lead to strokes by causing clots in the heart valve that then travel through the bloodstream to the brain, according to Mitch Elkind, MD, MS.
“There’s interest in general in the relationship of infections to cardiovascular disease, including heart attacks as well as strokes and potentially to longer-term brain complications like cognitive decline in dementia,” says Elkind, who’s a professor of neurology and epidemiology at Columbia University Irving Medical Center. “Periodontal disease and bacterial infections of the mouth in general is one really important source of infection — it’s almost like having a festering wound in the mouth for an extended period of time.”
The good news: Catching gum disease in the early stages of Alzheimer’s could potentially slow the progression of this debilitating brain disorder, and the study’s researchers say understanding the interplay between these two conditions could make a major difference. A CDC analysis found that an estimated 6.5 million Americans over the age of 30 have some form of gum disease, whether mild, moderate, or severe. By comparison, as many as 6.5 million Americans age 65 and older are now living with Alzheimer’s, according to the nonprofit Alzheimer’s Association.
How often should you floss?
For decades, dentists and the U.S. government have been recommending flossing daily to prevent cavities, tooth loss, and gum disease. But the federal government turned this advice on its head in 2016, when the Departments of Agriculture and Health and Human Services quietly dropped any mention of flossing from U.S. dietary guidelines without notice. As it turned out, officials never actually researched the effectiveness of the popular recommendation to floss daily, as required before issuing their recommendation.
It’s worth noting that there have been some attempts to back up this advice. For instance, in 2011, there was a systematic evaluation of 12 trials published in The Cochrane Database of Systematic Reviews that found only “very unreliable” evidence that “flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.”
Recent rollbacks don’t mean you should ditch your dental floss, though. Even without the rigorous research to back up the recommendation, major dental associations and most dentists, including Dr. Ross, recommend manually cleaning the space between your teeth at least twice a day. After all, a toothbrush alone can’t cut it when it comes to cleaning between teeth and under the gums.
“We shouldn’t think it’s not necessary to floss just because we don’t have these studies out to prove it,” she says. “All of the main dental associations — including the American Dental Hygiene Association — and even my own personal practice have seen enormous benefit with patients flossing.”
Not only can flossing help keep your teeth white by preventing plaque build-up which results in yellowing, but it can also reduce your risk of cavities and gum diseases like gingivitis. That’s not all: Paying attention to your oral health can prevent more serious damage to your teeth. For example, Dr. Ross says if a tooth turns pink, that could be a sign of dental resorption, which is an autoimmune process where the tooth starts eating itself away. While the cause isn’t exactly well understood, it could be caused by a physical injury to a tooth or swelling caused by an untreated cavity.
What else can you do to better take care of your oral health?
For starters, you can make sure to go to your regular dental check-ups. (Dr. Ross says the average person should go in every six months.) Aside from scheduling those visits, you should brush your teeth twice a day with fluoride toothpaste for “at least two whole minutes.” You also want to make sure you floss daily, ideally before you brush to help remove as much food and plaque as possible. And if flossing and brushing still aren’t keeping your bad breath at bay, then you might find tongue scraping a useful addition to your routine.
As for how to floss? “I usually say take a piece of floss about a shoulder width length and you wrap it around your middle finger and use your thumb and first finger to grip about a couple inches apart so you’re really able to hold it well,” Dr. Ross tells us.
But be careful: There is such a thing as flossing too much. “If you’re flossing too many times a day incorrectly, you can create cuts in your gums,” she says.
So while it may feel a little annoying to have to spend a couple of extra minutes in front of the mirror every morning and night, it’s so worth it in the long run — trust us (and your dentist).
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