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A History and Update of Fluoride Dentifrices

A String around Your Finger: Do We Really Need to Floss?


Gentiane Valiquette, DMD, MSc, FRCDC, ABP Diplomate; Maria L. Geisinger, DDS, MS

Credit Hours:

1 Hour(s)

Controversies about the utility of flossing were thrust into the spotlight in 2016 in a controversy known amongst dental professionals as “Flossgate. As a part of the update to the 2015-2020 Dietary Guidelines for Americans, the federal gov...

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Controversies about the utility of flossing were thrust into the spotlight in 2016 in a controversy known amongst dental professionals as “Flossgate. As a part of the update to the 2015-2020 Dietary Guidelines for Americans, the federal government omitted a recommendation for flossing previously included in the guidelines in 2000, 2005, and 2015.1 Citing the reasons for the omission, the Dietary Guideline Advisory Committee (DGAC) stated they focused on food and nutrient intake (e.g., added sugar) and cited the 2011 Cochrane systematic review,2 which concluded there is currently a lack of strong evidence to support the use of floss as a preventative measure for caries and periodontal diseases, although the systematic review does acknowledge evidence that flossing results in a reduction in gingival inflammation and interdental plaque. The Surgeon General, Centers for Disease Control (CDC), the Department of Health and Human Services, and other federal and state health agencies continue to publish materials that support the importance of flossing and interdental cleaning, and that advice is available to the public through the National Institute of Dental and Craniofacial Health (NIDCR),3 CDC’s Division of Oral Health,4 and Healthy People 2020.5

The appropriateness of floss as an interdental cleaning aid for all individuals was further questioned with the release of the European Federation of Periodontology’s (EFP) statement regarding flossing efficacy in individuals with periodontal diseases. Iain Chapple, PhD, BDS, an EFP spokesperson, stated that the use of floss demonstrates utility in healthy patients without diastema may prevent the development of periodontal diseases and gingival inflammation, but that in patients with gingivitis or periodontitis, evidence suggests that floss is not useful in reversing disease and interdental brushes are advocated for use in those patients.6,7 Dr. Chapple suggested that dental healthcare providers need to consider changing our behavior and recommendations based upon the current evidence.6,7

Despite the support of governmental agencies and numerous nonprofit groups, this messaging has created confusion in the lay media and the public with regards to the role of patient-administered oral hygiene for the prevention of oral diseases. Interdental cleaning continues to be an essential part of oral hygiene to maintain a healthy oral environment.8 There are 700+ identified species of bacteria and up to 1,500 putative pathologic microorganisms found in dental biofilm.9-11 Many of these organisms as well as other factors including bacterial nutrients, food debris, molecules that facilitate bacterial adhesion and invasion, and other extrinsic factors in the environment and the body’s own immune response contribute to diseases of the teeth and gingival tissues.12,13 Current recommendations from the American Dental Association (ADA) include brushing for two minutes twice daily and cleaning between teeth to maintain a healthy mouth and smile, but these may be tailored to individuals based upon risk factors and their current oral health!14

  • Intended Audience:

    Dentists, Dental Hygienists, Dental Assistants, Dental Students, Dental Hygiene Students, Dental Assistant Students

  • Date Course Online:

    Apr 2, 2018

  • Last Revision Date:

    Nov 9, 2021

  • Course Expiration Date:

    Nov 8, 2024

  • Cost:


  • Method:


  • AGD Subject Code(s):


Learning Objectives

Upon completion of this course, the dental professional should be able to:

  • Address questions generated by patients related to media coverage of the omission of flossing recommendations from the 2015-2020 U.S. Dietary Guidelines and other statements in the press about the utility of flossing.
  • Apply the current scientific literature about the benefits, if any, of flossing and other interdental cleaning aids in addition to tooth brushing in their practice for patient benefit.
  • Discuss with patients the optimal strategies and rationale for oral hygiene, including interdental cleaning.
  • Develop home care recommendations that focus on evidence-based strategies for oral health and emphasize individualized patient care recommendations based upon patient needs.
  • Discuss the importance of preventive strategies for oral diseases including maintaining good oral hygiene in order to promote oral and overall well-being with a wide range of interdisciplinary colleagues and patients.


  • P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
  • Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.  Only sound evidence-based dentistry should be used in patient therapy.

Note:  Registration is required to take test.


Conflict of Interest Disclosure Statement

  • Dr. Geisinger has been or is currently a co-investigator and/or principal investigator on research funded entirely or in part by The Procter & Gamble Company. All funds were used for research endeavors and not for personal gain.
  • Dr. Valiquette reports no conflicts of interest associated with this course. She has no relevant financial relationships to disclose.
Dentalcare author

Gentiane Valiquette

DMD, MSc, FRCDC, ABP Diplomate

Dr. Gentiane Valiquette obtained her doctorate in dental medicine from the University of Montreal in 2014. She continued her training in the United States by completing a General Practice Residency at the Bronx Lebanon Hospital in New York. ...

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Maria L. Geisinger

Maria L. Geisinger


Submission Information

Academy of General Dentistry (AGD) Submission For credit transfers to appear in your AGD account in real time, make sure to add your AGD membership number in the field provided on the “Share Your Test Score” page.

CE Broker For all states that use CE Broker for licensure, “proof of completions” are electronically reported the first of every month. If a course was taken in November, the “proof of completion” will be submitted the beginning of December.


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Approved PACE Program Provider


Nationally Approved PACE Program Provider for FAGD/MAGD credit.

Approval does not imply acceptance by any regulatory authority or AGD endorsement.

8/1/2021 to 7/31/2027

Provider ID# 211886