By Roy Benaroch, M.D., Emory University
For generations, we have been advised to complement our tooth cleaning routine with flossing. It was so forcefully emphasized that failing to floss our teeth made us feel guilty of not taking care of our teeth properly. But, the scene suddenly changed with a news headline in August 2016. This headline came as a shock, discrediting the health professionals’ advice as well as parents and grandparents around the globe, who had always been pushing their children to floss.
Why Flossing has no Benefits?
The headline appeared in the New York Daily News, reading: Flossing Has No Proven Benefits, so US Health Department Stops Recommending the Practice. Other media outlets and newspapers followed suit, each questioning the usefulness of flossing due to a lack of substantial evidence. Some of them, like the New York Post, went as far as saying, Flossing is a Complete Waste of Time.
So, what was behind this sudden change? What happened that was stronger than years of mainstream health professional recommendations a majority of people had accepted?
In 1979, a US government recommendation on dental floss was published in Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. The surgeon general was the top government health authority in the US and recommended that a careful combination of brushing and flossing helped slow down the process of cavity formation.
Media Influence on Health Guidelines
The Dietary Guidelines for Americans has since recommended flossing for maintaining dental health. According to federal law, the US Departments of Agriculture, Health and Human Services is required to update and publish the guidelines in cooperation with the Dietary Guidelines for Americans. These overlapping departments are required by federal law to present their recommendations based on strong scientific evidence.
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Based on this law, in 2015, the Associated Press asked the US government to provide scientific proof for this recommendation. The US government was required by the Freedom of Information Act to comply and share this information with any interested party. The response that the government provided the AP stated that although flossing is recommended, no research has supported its necessity. They published this story, and hundreds of news agencies reprinted it. The story went: although flossing has been strongly recommended by government agencies and floss manufacturers, there is no solid proof to support that.
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The next year, the Dietary Guidelines for Americans removed the flossing guidelines that they had promoted for 30 years. It is not officially acknowledged that the AP inquiry directly led to the removal of the recommendation. However, no other explanations have been provided, and the timing suggests that the removal was the result of the AP inquiry.
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The AP is one of the most influential news sources with more than 200 news bureaus operating in 100 countries around the globe. So, when they report on something, other news outlets often reprint it.
The AP stated that the studies conducted on the efficacy of flossing were not reliable and rigorous. They did not show that a combination of flossing and brushing was useful, and had a ‘moderate to large potential for bias’. The studies were indeed weak and unreliable. But what about rigorous and well-designed studies? Shouldn’t we wait for those studies to present their findings? Should we drop the recommendations based on the results of poorly conducted investigations?
Another reason that the AP report gives is a financial one. According to the report, the flossing products have a 2-billion-dollar market. The dental floss producers are allowed to promote their products as ADA-approved. The American Dental Association charges each manufacturer $14,500 for an initial evaluation and $3,500 an annual charge. According to the story, ADA has been promoting dental floss since 1908. Each manufacturer pays $3,500 for over 100 years. Doing simple math, the numbers we get are significant.
But maybe these numbers might not be that straightforward. Firstly, the number of floss manufacturers is not clear. Also, the fee cannot have been 3,500 dollars all these 100 years. Besides, a major floss manufacturer like Procter and Gamble reported annual sales of 83 billion dollars in 2014. The ADA has a yearly income of $5.4 million. 3,500 dollars is not a significant figure for either of them. This simple math does not support AP’s theory that the flossing seal of approval is a scam for making money, strengthened by the fact that they do not provide any figures to prove their theory.
The importance of what AP did is highlighted in the fact that government guidelines have to be transparent and back their guidelines with scientific evidence. It might seem superficial to think of transparency in an everyday issue like flossing. But transparency is vital in such matters as baby formula ingredients or drinking water safety. So, the role of free media empowered by law to question everything is pivotal in protecting public health.
However, in this flossing story, the AP might have overreacted and turned their simple investigative activism into the hype that may not have been that helpful.
Common Questions about Media Hype: How a Generally Accepted health Routine was Debunked as a Myth.
Flossing every day is recommended by the FDA. However, improper flossing might be harmful.
Incorrect flossing might damage your teeth. However, the AP article that said improper flossing can be harmful did not say what harms it might have.
Yes, ADA recommends flossing. But in 2016, after a news story hit the headlines, some government organizations removed their recommendations for flossing.
The media influence is so powerful that they can even change professional opinions about health issues.
