'Floss boss' or lose the floss?

Remember hearing that age-old adage, "Because I said so"? Didn't that just drive you crazy?

by JoAnn R. Gurenlian, RDH, PhD
jargphd@verizon.net

Remember hearing that age-old adage, “Because I said so”? Didn’t that just drive you crazy? If you were a teenager and your parents said that, you probably fumed because there was no good reason for the comment. Did you experience this same thing in hygiene school? How frustrating is that? I bet you vowed you would never be like that when you were in charge.

Well, if you’ve had that experience in your lifetime, just imagine how your patients feel when you continually recommend that they floss their teeth. No, your eyes did not misread that sentence.

I know, I know. There really are good reasons to floss the proximal surfaces of teeth. Of course, we want to encourage our patients to remove as much biofilm as possible. But is floss really the answer to interproximal cleansing?

How many times have your patients flat out told you they don’t floss, don’t like to floss, and will not floss? Yet we continually recommend they floss, even though they tell us they are not willing to. Do we like banging our heads against the proverbial wall, or are we missing the point of our patient education moments?

Where did we get the idea that we should recommend flossing to all our patients? Does it come from that cute little sign in the reception area that says, “Only floss the teeth you want to keep”? Where is the evidence that supports this recommendation? Would you be surprised to learn that flossing for all patients exists in the minds of dental hygienists and dentists, but not necessarily in science?

I recently attended the SISIO dental hygiene research conference in Pisa, Italy. Dagmar Else Slot, MSc, researcher in the Department of Periodontology of the Academic Centre for Dentistry in Amsterdam, presented results of a systematic review of flossing. Based on her research, there does not appear to be much evidence to support flossing over other regimens such as tooth brushing and using an antiseptic mouth rinse.

Remember when the makers of Listerine had the audacity to suggest that fact based on scientific research, and had advertisements that promoted brushing and mouth rinsing as effective as brushing and flossing? There was research to demonstrate that finding, yet they were sued by Johnson & Johnson and later purchased by that company.

Irony aside, we really do need to take a look at what we know and what we don’t know about interproximal biofilm removal. We do know that most patients do not floss. We know that flossing is most suited for a healthy mouth, not a mouth with deep periodontal pockets. We know that there are other interdental aids available and that one recommendation does not fit all. Further, there is substantial research that demonstrates that other regimens are at least as effective as flossing.

So, back to my question about why we continue to recommend flossing to our patients. For me, flossing is as natural as brushing and rinsing, maybe even as natural as breathing. After all, I’m a dental hygienist and really am not sure I could live without my floss. Because I NEED my floss, I tend to think that everyone else NEEDS it.

Maybe that’s where we go astray in our patient education. Our patients simply do not share the joy of flossing with those of us in the dental profession. It is possible that we impose our values on our patients rather than letting our patients inform us of their perceptions and needs. Perhaps we get so caught up in our excitement about floss that we don’t pay attention to what other resources are of interest to our patients. Or, it might be that we are stuck in our routine. I doubt very much that we intentionally quit thinking about the needs of our patients.

I’m reminded of a patient who had a relatively healthy mouth save for a bit of deposit in the proximal molar regions. When jumping into my floss

mode, he told me to stop being the “floss boss,” and asked if there was something else he could use. He said that he hated coming in for his hygiene appointments because he knew that we were going to “yell” at him about flossing. My heavens! I never raise my voice to patients. Yelling?! I don’t yell. I recommend. However, I was stopped in my tracks for a brief moment and had to get hold of myself. I opened a cabinet drawer and showed this patient all the choices available for interdental cleansing. He was overcome by the options and asked me why no one had ever showed him “this stuff before.”

The more I thought about this patient, the more I realized I did not have a good answer for him. Hence, I am writing this column. What I do know is that my patient left the office happy to try something new, and with the promise that we could try other interdental aids if the one he chose was not effective. And, I left the practice that day feeling very fortunate to have left the “floss boss” behind.

JoAnn R. Gurenlian, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and interim dental hygiene graduate program director at Idaho State University, adjunct faculty at Burlington County College and Montgomery County College, and president-elect of the International Federation of Dental Hygienists.

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