In Defense of Flossing: Part II-Can We Agree It's Premature to Claim Flossing Is Ineffective to Help Prevent Periodontal Diseases?

Periodontal diseases are complex, multifactorial disorders. Effective daily plaque control promotes gingival/periodontal health. Recent meta-analyses and other reviews have found inconclusive evidence to support that tooth flossing promotes gingival/periodontal health. Ideally, the claim should have been that, "at present, we do not have high-quality evidence from well-designed randomized clinical trials to determine whether flossing lowers the risk for periodontal diseases." Rather than "not proven to be effective," the lay public may now think that flossing is "almost entirely unhelpful and/or unnecessary." How does the dental community communicate the nuances of this topic? Herein, we examine the key structural issues underlying this area of research. We assert that effective flossing between specific teeth can promote gingival/periodontal health. Furthermore, we explore the nuances for whom this may be true and untrue, why our evidence is lacking, and what can be done to clarify the effectiveness of flossing on clinical outcomes.