Your first two points seem legit, but if you pay attention to the measurements they're taking it's pretty easy to notice that your periodontal pocket depths increase or decrease based on whether you've been flossing or not (mine do at least). And it's pretty obvious that deep pockets are a decay precursor.

Exactly. IMHO, dentistry has been a scam for 100 years. Every 80 year old I know doesn't have teeth. Anytime you ask for another opinion they act like the last dentist was an alien. I think flossing is important, but when they tried to do a study, nothing worked because all the dentists are lying scam artists -- so if you floss or not is irrelevant.

The lack of evidence for flossing astounds me.

I know that when I don’t floss, my gums will bleed sometimes during brushing and/or they’ll get inflamed. When I do floss regularly, absolutely no issue with bleeding or inflammation.

It’s so clear to me that I can’t imagine what the difference is between my anecdata and whatever actual data is coming from these studies.

>When I do floss regularly, absolutely no issue with bleeding or inflammation.

Do they bleed during flossing though? I used to get bleeding gums after brushing teeth, but switching to a softer toothbrush stopped it. Flossing, at the start, does cause my gums to bleed though.

For me, flossing causes bleeding during the first week. Afterwards, the bleeding stop and my sensitivity to temperature improves greatly. My halitosis goes away on most days, too.

My dental hygienist knows when I have been flossing and when I haven't.

Only during the first 2-4 times (and lessening each day) after having not flossed for a while.

After that, I never bleed during flossing. And I make sure to get it up between the gum and each tooth, so there’s a decent (but appropriate) amount of floss/gum friction.

Yeah, that went away pretty quickly when I started flossing regularly really for the first time, a year or two ago (my dentist having strongly advised that I need to). I do feel like it has made a positive difference, but I have also cut back very significantly on sugary drinks over roughly the same period, having improved my diet a lot, so maybe that made more of a difference...

Flossing or brushing only causes bleeding for me when my gums aren't healthy. For example after getting a proper cleaning my gums won't bleed for weeks or months.

If they start bleeding again it's a sign I've not been doing a good job staying on top of keeping them healthy.

In my observation, flossing does work . The toothbrush can't get to the crevices that a floss can. My gum bleeding only happens when I'm flossing too rough or when I'm starting to floss after a few days of skipping it.

One of the issues in the now infamous meta analysis was that many of the studies analyzed found some benefit, but they were low quality studies.

So this doesn't necessarily mean that flossing doesn't work. It may just mean that dentists are already making money hand over fist and don't care enough to do good studies and validate that.

BTW what was specifically looked at was whether unsupervised flossing works. So another possibility is that flossing properly works but a lot of people do it ineffectively.

All things you would want a conscientious, science-based ADA to care about

Also surprised, it seems to make such a big subjective difference. One tip I got from a busy dentist who did not want more business: smear a little toothpaste on the floss before using it, work through all the places where teeth contact. Gets flouride in places where it normally would not get to.

The high priests of dental religion er.. science is currently holding a trial over evolutionary dentistry

Dr Mike Mew, of 'Mewing', faces misconduct hearing - https://www.theguardian.com/society/2022/nov/14/orthodontist...

Once I went to a new dentist in a new area to do a teeth cleaning. He told me I had 4 cavities that needed filling. I was skeptical so I went to another one the next week. He said 2 cavities. I went to two more that month to see what else they'd say: one said no cavities, the other said 6. That was 8 years ago, I still don't have any cavities.

I know my dentist sees cavities that he just lets be because they are not an issue.

It seems a lot in dentistry of what does or does not need to be done is subjective.

> more popular to remove wisdom teeth

Even the pushy dentists have rarely recommended removal of wisdom teeth unless they are trouble. I mean if it's pushing inside the muscle area towards bones or screwing up things for other teeth you have to. If it's forming a cavity area (like in my case) you definitely should get rid of it.

Wisdom tooth removal is not rite of passage. It's need based and often the needs are real and very much "needed".

> Even FLOSSING was removed from the U.S. Department of Health's recommendations several years ago because there is a lack of evidence that it's effective

This is bizarre because I can feel the change in my mouth everyday with and without flossing. I am not sure there is a need for some kind of empirical evidence here. Especially if there are not gigantic mountain pass like gaps between your teeth.

Yeah the crown job recos are often con jobs. Whenever I have been advised a drastic dental job I visit a Govt or a charitable medical college dental hospital here (India) and get a consultation. I do not get "polite" or "sophisticated" service there :D but I get honest and expert to the point advice.

I'm not suggesting that no one should floss. The opportunity cost is low. You have nothing to lose by doing it, other than a couple bucks spent on floss. It's similar to multivitamins, the evidence on the benefits of those is also low quality, but the most you have to lose is a couple of bucks.

In theory if you think in an evidence-based way your positions on flossing and multivitamins should be about the same, which is interesting.

What's really important though is that the profession of dentistry has not felt the need to fully study and establish the benefits of one of their most foundational recommendations.

Every dentist tells you to floss yet they have not bothered to establish reliable evidentiary proof that it works. If they don't care about evidence when it comes to flossing, what other procedures are they pushing without solid evidence of benefits?

The hot take way of saying this (and I do kind of believe this) is that dentistry as a medical science is in its infancy, and as a result, dentistry as a profession/business is partially snake oil.

All that said I have had one crown including a root canal done in my life, the need was clear and it was done well and professionally and I'm happy with it. So I'm not saying that everyone should ignore dentists but this imho is an important place in your life to consider getting second opinions and steer towards professionals who are less profit-driven when you can.

> The opportunity cost is low. You have nothing to lose by doing it, other than a couple bucks spent on floss.

I have ADHD. I hate flossing, and I'd put off flossing to the point where I wrecked my sleep cycle and tended to end up just not brushing my teeth before bed.

Ever since I stopped flossing, I've basically always brushed my teeth and have kept my sleep cycle more successfully.

Yes, I know this is potentially very bad dentally, but frankly I'm sick of having a catastrophically unreliable sleep cycle due to my mental illness and I'm willing to accept half-assing it if it means it doesn't destroy my life.

That said, I have no particular opinion on the evidentiary base of flossing - my dentist has always recommended I floss, and I believe his recommendation. I would floss if I could.

My situation somewhat overlaps with yours. I ordered a "water flosser" from everyone's favourite ecommerce site, and use it daily in the shower.

It seems to be doing something, and can't possibly be worse than my previous flossing regime which was: "twice a year the day before a dentist visit".

I wasn't willing to shell out for the name-brand water flosser, other options do the same job at the same water pressure for 1/4 the cost.

It took about a month to move up through the power settings. Start on the lowest and click it up when that starts to feel a bit tame.

I've now been using this thing for 6 months, it's just about time to find out whether I get my bi-annual nagging about the importance of flossing. My personal opinion: Cochrane's probably right, flossing is most likely bunk, but I'm pleased to have found a way to do it that I can stand

Sorry, how does flossing impact?

Plenty of other professions have these kind of best-practise recommendations that are not based on quantative data, so it’s likely something more universally human rather than a function of the profession’s age.

Flossing definitely works against bad breath. If you feel that you get bad breath at the end of the work day it might be a good enough reason for that alone.

I do the whole shebang as a curtesy to others, and I hope they will return the favour.

>Even FLOSSING was removed from the U.S. Department of Health's recommendations several years ago because there is a lack of evidence that it's effective!

I think that whether flossing is useful or not is highly dependent on the space between your teeth. I have small gaps between my teeth, and I floss three times a day. I can see the food come off on the floss. My father never flosses (jus brushes0, and never has any problems with his teeth, but he has large gaps between his teeth. Presumably, the bits of food just fall out.

A lack of evidence of course is not the same as no evidence.