Should You Floss Before or After You Brush?

Should You Floss Before or After You Brush?
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How good is the evidence that flossing is effective, and what have randomized controlled trials shown is the optimal toothbrushing and flossing sequence?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Over the years, it has been generally accepted that [the use of] dental floss has a positive effect,”  removing up to 80% of plaque. How do we know? You can use what’s called a “splitmouth design,” where each person can act as their own control — for example, only flossing one quarter of their mouth. They asked study subjects to stop brushing their lower jaw so that plaque would build up, then they were randomized to floss half, and leave the other half as the non-flossed control. After three weeks, not only did the flossing cut plaque about 60%, more importantly, it cut signs of gingivitis in half — bleeding on probing, and another index of gum inflammation. Note, though, this is comparing flossing to nothing. They weren’t allowed to brush the jaw. So yeah, flossing is better than nothing, but is flossing plus brushing better than just brushing alone?

“The advocacy of floss…hinges, in large part, on common sense.” But common-sense doesn’t go very far as a form of evidence. You don’t really know until you put it to the test. What’s the efficacy of dental floss in addition to a toothbrush? Surprisingly, only three out of the 11 studies they looked at found a significant added benefit.

The anti-flossers were positively giddy, comparing dentists who continued to advocate flossing in the face of the data to flat-earthers. Dentistry was a profession “in denial.” Over 80% of people don’t floss regularly, and it’s just hard for the dental elite to accept that the “great unflossed masses” were right and us doctors were wrong. Flossing doesn’t work — get over it!

So, you’ve heard of the tooth fairy; is flossing just some tooth fairy tale? This review was published back in 2008. Since then, more studies were published, and while the evidence on additional plaque reduction is weak, at least there’s some evidence it helps with gingivitis — which is a primary reason you want to reduce plaque anyway. Why might they have not found stronger evidence? Well, the “[t]rials were of poor quality and [so the] conclusions must be viewed as unreliable.” So, basically, we don’t have good evidence either way, because good studies really haven’t been done.

Why not? Why wouldn’t Big Floss fund the studies? Because it appears that all floss works the same. If you compare unwaxed to woven to shred-resistant floss, they all have about the same plaque-removal efficacy, which it appears all such studies found. So why would a floss company fund a study to show flossing in general is good if they can’t show their product is better? Otherwise, you might just go buy their competitor’s floss.

Where do we stand today? “Although technically the evidence for flossing is weak, more importantly, the methodology…of the studies examining flossing effectiveness are also weak.” For example, they didn’t assess the quality of people’s flossing. This, for example, is not the way to floss (don’t ask—it’s a long story). Bottom line, the American Dental Association continues to recommend brushing and flossing every day.

But what’s the proper sequence? Should you floss before or after you brush? “Some dentists argue that flossing should come first, because you stir up the particles and plaque that the toothbrush can [then] brush” away, and then the fluoride from the toothpaste might get in there better. But others recommend brushing first, thinking that would “remove…the bulk of the particles” first, then the floss could like floss some of the fluoride from the residual toothpaste in there.

You don’t know until you put it to the test. “The effect of toothbrushing and flossing sequence on [between-tooth] plaque reduction and fluoride retention: A randomized controlled clinical trial” — and flossing first won, in terms of getting rid of significantly more plaque, and getting more of the fluoride in there. When we floss after brushing, much of the particles that are being pushed out by dental floss may stay in place on our teeth. The bottom line is flossing, followed by brushing, is preferred.

Please consider volunteering to help out on the site.

Image credit: Dr. Kami Hoss via flickr. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Over the years, it has been generally accepted that [the use of] dental floss has a positive effect,”  removing up to 80% of plaque. How do we know? You can use what’s called a “splitmouth design,” where each person can act as their own control — for example, only flossing one quarter of their mouth. They asked study subjects to stop brushing their lower jaw so that plaque would build up, then they were randomized to floss half, and leave the other half as the non-flossed control. After three weeks, not only did the flossing cut plaque about 60%, more importantly, it cut signs of gingivitis in half — bleeding on probing, and another index of gum inflammation. Note, though, this is comparing flossing to nothing. They weren’t allowed to brush the jaw. So yeah, flossing is better than nothing, but is flossing plus brushing better than just brushing alone?

“The advocacy of floss…hinges, in large part, on common sense.” But common-sense doesn’t go very far as a form of evidence. You don’t really know until you put it to the test. What’s the efficacy of dental floss in addition to a toothbrush? Surprisingly, only three out of the 11 studies they looked at found a significant added benefit.

The anti-flossers were positively giddy, comparing dentists who continued to advocate flossing in the face of the data to flat-earthers. Dentistry was a profession “in denial.” Over 80% of people don’t floss regularly, and it’s just hard for the dental elite to accept that the “great unflossed masses” were right and us doctors were wrong. Flossing doesn’t work — get over it!

So, you’ve heard of the tooth fairy; is flossing just some tooth fairy tale? This review was published back in 2008. Since then, more studies were published, and while the evidence on additional plaque reduction is weak, at least there’s some evidence it helps with gingivitis — which is a primary reason you want to reduce plaque anyway. Why might they have not found stronger evidence? Well, the “[t]rials were of poor quality and [so the] conclusions must be viewed as unreliable.” So, basically, we don’t have good evidence either way, because good studies really haven’t been done.

Why not? Why wouldn’t Big Floss fund the studies? Because it appears that all floss works the same. If you compare unwaxed to woven to shred-resistant floss, they all have about the same plaque-removal efficacy, which it appears all such studies found. So why would a floss company fund a study to show flossing in general is good if they can’t show their product is better? Otherwise, you might just go buy their competitor’s floss.

Where do we stand today? “Although technically the evidence for flossing is weak, more importantly, the methodology…of the studies examining flossing effectiveness are also weak.” For example, they didn’t assess the quality of people’s flossing. This, for example, is not the way to floss (don’t ask—it’s a long story). Bottom line, the American Dental Association continues to recommend brushing and flossing every day.

But what’s the proper sequence? Should you floss before or after you brush? “Some dentists argue that flossing should come first, because you stir up the particles and plaque that the toothbrush can [then] brush” away, and then the fluoride from the toothpaste might get in there better. But others recommend brushing first, thinking that would “remove…the bulk of the particles” first, then the floss could like floss some of the fluoride from the residual toothpaste in there.

You don’t know until you put it to the test. “The effect of toothbrushing and flossing sequence on [between-tooth] plaque reduction and fluoride retention: A randomized controlled clinical trial” — and flossing first won, in terms of getting rid of significantly more plaque, and getting more of the fluoride in there. When we floss after brushing, much of the particles that are being pushed out by dental floss may stay in place on our teeth. The bottom line is flossing, followed by brushing, is preferred.

Please consider volunteering to help out on the site.

Image credit: Dr. Kami Hoss via flickr. Image has been modified.

Motion graphics by Avocado Video

105 responses to “Should You Floss Before or After You Brush?

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    1. Yeah me too … but I bought a dental irrigator which does the same job as a Waterpik at a tiny fraction of the price. It’s ‘green’ too because it needs no electricity.

    1. Fumbles,

      Awwwww,, you have a little 4-year old. :-) May you live long enuf to watch him graduate from high school, at least.

      Do you raise him on the NAD? (No animals diet.)

      I never heard of the Floss dance before, but there was bound to be one. The chicken dance, etc. have had their day.

      https://thelunchtabletalks.com/floss-dance/

        1. YR, Chubby Checker looks really thin in that video! I guess he would have to change his name if he were popular today ;-)

    2. Laughing at the floss dance.

      My brother’s 8-year-old granddaughter loves the floss dance.

      Smaller world with technology where your 4-year-old and my brother’s 8-year-old and the children of my friend in Israel all would have watched the same floss dance.

  1. The biggest regret I have over the 48 years I ate pretty much SAD, is the damage done to my teeth by sugary drinks and fiberless foods. Reversed all that other stuff. My teeth yet show the ravages of sugar and processed foods.

    This is another reason I cringe inside every time I see a kid with a soda, or juice box.

    1. More like sugary/acidic drink and dehydrated foods especially if they are rich in carbs, not really fiberless foods because dried fruits are very sticky and are terrible for dental health worse than most candies that are not sticky.

    2. Had teeth problems all my life. Became vegan 19 years ago but ate a pretty crappy Americanized vegan diet and still had teeth problems. Switched to a WFPB diet 3 1/2 years ago and no more teeth problems. I asked my hygienist if I had any plaque: “No”. I asked her if there were any stains: “Very little”. Despite eating blueberries and cranberries every day. I stopped going to the hygienist over a year ago and my teeth are perfect. I also eat 1/4 each of a lemon and lime, and 1 orange every day. So it doesn’t seem that citrus is harming my teeth despite internet myths.

      1. Blair,

        I don’t think the citrus part is a myth.

        I didn’t have enamel problems until I started this diet and I do think it was things like citrus.

        Who knows, maybe I brushed too close to eating it?

        Not sure.

  2. ” I bought a dental irrigator which does the same job as a Waterpik ”
    Ok, what brand and where did you buy it?? I’m curious as it sounds neat. As for regular flossing my dentist recomended using a “proxibrush” which is a very tiny brush that fit’s between the teeth also. Works well and I still have to use floss where the proxibrush won’t fit or it’s too tight.
    mitch

  3. About 9 months ago I started flossing before brushing. I don’t think my dental hygienist noticed any difference at my dental cleaning , but I like my new routine.
    I also include the green tea rinse recommended in a nutritionfacts video. First, as I relax in my living room, I drink about 2/3 of a mug of green tea, swishing a bit to clean out loose food particles, then I floss, followed by rinsing with the rest of the tea to really clean out the spaces between my teeth. Later on before bed, I brush.

        1. Mine either. I’ve been drinking green tea for many years, and never developed stains. I also use it as a rinse after brushing. I have never whitened my teeth or used toothpastes that whiten, though. I notice that friends obsessed with extremely white teeth complain of stains from tea and coffee. I suspect that those treatments make the enamel more porous.

  4. My opinion is that flossing accomplishes minimal mechanical removal. Rather what you are doing is disrupting anaerobic micro-pockets of bacteria that metabolize sugars and form the plaque. By this disturbance and exposure of anaerobic bacteria to oxygen you “kill” the plaque forming bacteria. You are not mechanically removing plaque.

  5. It’s well worth noting that the public perceives the word ‘plaque’ to mean the calcified deposits that can be removed with edged instruments. The researchers blew it when they chose a word that rhymes with crack, to describe a gunky goo. I nominate ‘schmuzz’.

    1. When plaque calcifies it becomes calculus, also known as tartar, which then needs to be scraped off with sharp instruments. Before it becomes calcified, it can be removed with proper oral home care, ie, mechanical removal by toothbrush and floss.
      Btw, mouthwash does not help.

    1. Let’s see…to get nutrition, you must eat. To eat you must swallow. To swallow you must chew. To chew, you must have teeth. To have (healthy) teeth, you must brush and floss. Unless you get all your nutrition from smoothies and pureed soups, in which case this may or may not apply.

  6. I brush; swish with a water/sea salt mixture, waterpik with an added small capful of Essential Oxygen’s brushing rinse + sea salt , then swish with water/sea salt again. I’ve been doing this for several years with excellent check-ups at my biological dentists.
    IMO, flossing afterward can get remaining debri that brushing leaves behind. I think it’s gross to floss beforehand … just my opinion :-)

  7. As a former dental hygienist treating advanced deep infection, I must add that those with wider spaces won’t get clean much at all with floss and can use interdental brushes for best results.

    1. I agree. My dentist recommends interdental brushes too instead of floss. Best is to do both in my opinion. Floss to get rid of food particles stuck between very narrow spaces. Then brush with inderdental brushes. The hair of the brush cleans where floss can’t get. Then comes the toothbrush. Plus all the other recommendations dr Greger showed us in his video’s about dental care. Pfft…a lot of fuss with those teeth!

  8. Someone should do a good study examining floss technique. Take a single site such as the medial aspect of a single molar, and look at the scores of a population that answers yes to ‘Do you floss essentially every day?’
    It’s really rare to see good results, because so many don’t know how: for example, the clip art at the beginning of this video.

  9. I have been going to the same dental hygienist for 20 years. About 8 years ago I went 100% whole food plant based. I recently asked the hygienist if she noticed any difference in my teeth since going WFPB. She said the plaque was about the same, but that my gums were perfect. I only floss when I need to get celery out of my teeth.

    1. Yeah it wont do anything to enamel because this part of teeth does not have a blood supply, thats why a broken tooth wont repair itself unlike bones, i wish it could but nope…

      1. Well, new teeth can grow back as a side effect to PEMF as long as the root isn’t dead so that is something.

        Not quite as cool as a crocodile’s tooth.

        I watched a program where a vet was called to help a crocodile who had a sore tooth. Or was it an alligator? I think crocodile.

        Anyway, crocodiles grow lots of new teeth to replace their bad teeth, but this particular crocodile had one tooth, where the bad teeth didn’t get out of the way properly and he had to pull 4 teeth out of the same socket to get down to where the crocodile could grow the next one without problems.

  10. Another great and useful video, Dr. Greger and team!

    Now I will reverse my regimen to the advised. Hopeful to see if it will help my mild gingivitis.

    A healthy and grateful monthly supporter of Nutritionfacts.org.

  11. All that time wasted on flossing, irrigating, brushing… just toss ’em in a glass with water and a fizzy tablet… Done!

    1. I remember my great grandmother and my uncle had those.

      My grandmother kept her own teeth into her 90’s.

      She did have a few root canals and she did it without Novocaine because she was allergic.

      Gripped the arms of the dental chair.

      That experience might be why she kept such good care of her teeth.

  12. Journal of Exposure Science & Environmental Epidemiology recently published a study linking showing that some dental floss are treated with PFA’s, and can, of course, enter the body. Here is the link. https://www.nature.com/articles/s41370-018-0109-y

    According to a Buzzfeed news report about this study, “The researchers analyzed the chemical makeup of 18 types of dental floss. Six tested positive for fluorine, an element that they said indicates the presence of PFAS compounds. Those products were CVS Health EaseBetween SuperSlip Dental Floss Waxed, Oral-B Glide Pro-Health Mint and Glide Pro-Health Original, Crest Glide Deep Clean Cool Mint Floss, Safeway Signature Care Mint Waxed Comfort Floss, and Colgate Total Dental Floss Mint.”

    1. Whoa! Obviously written by an industry shill … I noticed there are no sources or references either. I believe Forbes Magazine caters to the more so-called “elite”, which would also include those that own/work for the big corporations like BIG food, pharma, ag, etc. Don’t believe this crap for a minute ….

    2. Boy, this was a great piece to read. Thank You! The author claims that “Glyphosate is less toxic than salt (technically it’s almost half as toxic*): you could eat it out of the box and have zero short term or long term problems.” Finally, we have an expert warn us all of the danger of “Big Organic funded fake news.”

      He goes on to state that “…people who eat organic are no healthier than those who do not. They still get cancer and Crohns and diabetes and food poisoning, and at the exact same rates. Eating organic doesn’t save them…Pesticides, organic or otherwise, are a nonissue in terms of human health.”

      Hurrah for the experts! At my next dinner party, I’m serving Roundup as an apéritif. Nothing more to worry about with GMOs or pesticides. Monsanto for President, 2020! If corporations are people per the Supreme Court, let’s elect one to office and take the whole “influence” step out of the political equation. We’ll get the same policies, while saving the money that would otherwise buy votes. Win-Win!!

  13. I brush first, then before rinsing I floss to try to get some of the fluoride in the tight space between where two teeth are touching. Then I rinse. Then I water pik and I’m always amazed that after brushing and flossing and rinsing that the water pik still flushes out food particles! Unbelievable! Since doing this before I go to bed I have no bad breath or morning breath because there’s no food for bacteria to eat at night. Also, I had a dental hygienist “massage” my gums one time after a cleaning! She just put her thumb and index finger (in a glove, of course) on each side of my gum (the inside and outside) and kind of rub around in small circles and move along the gum that way. It felt so good that ever since I have done that for myself and I think it has made for healthier gums because of the increased blood circulation it brings to the area.

    Also, it is recommended not to brush for at least an hour after eating because the enamel is softened for about an hour from acids in foods and your toothbrush will scratch the softened enamel. So instead I water pik immediately after eating to rinse out food particles. Before I had a water pik (or now if I’m not at home) I would always rinse out my mouth after eating. I’ve done this my whole life just because I get grossed out thinking about all the food particles in my mouth after eating.

  14. Neither one feels good to me…

    so, I usually interrupt my brushing to floss, then continue and complete brushing.

    best of both worlds, and makes more sense if you are OCD like me.

  15. What about over-brushing? Been told it can be harmful. Need to mention duration of brushing! Need to caution about how hard to push down on floss— till it touches the gum or perhaps cuts it creating an small open wound that lets bacteria enter. So many questions and so many opinions.

    A neighbor brushes and flosses before BF, after BF, after coffe and sweet roll, after lunch, after mid-day coffee, then at night before bed. Any thoughts about his routine! Good video. Thanks.

  16. Audio on your videos is still a bit ‘boomy’. Please consider improving your equipment and/or software.

    Thanks for all you do!

    1. Thomas, the following 7 vitamins and minerals are recognized as important for tooth (including bone and gum) health:
      Calcium, Phosphorous, Potassium, Vit A, C D and K. D, Vitamin C and Vitamin A. Of those Dr. Greger recommends the following supplements: (https://nutritionfacts.org/topics/supplements/) “2,500 mcg (μg) vitamin B12 (cyanocobalamin) at least once a week (or 250 mcg a day), and up to 1,000 mcg daily if over 65. I also recommend that people unable to get sufficient sun take one 2,000 IU Vitamin D3 supplement daily.” At this time those other important vitamins and minerals can be obtained through a varied whole food plant based diet. With the recommended supplements and a “WFPB diet you will be giving your teeth just what is needed to remain healthy.

  17. I’m considering trying the nasal/teeth flossing technique. Not only do you clean your teeth but you also unblock that nose!
    Winner.
    Imagine the number of tissues (paper, trees, etc) saved.

    Seriously though, I definitely think we should all receive a new set of teeth at say, 50 years of age. Perhaps for our future evolved selves?

  18. Seriously though, I definitely think we should all receive a new set of teeth at say, 50 years of age. Perhaps for our future evolved selves?
    —————————————————————————————————————————————————————————————
    Science has been promising the ability of seeding our gums and growing new complete teeth for a couple of decades at least. At one point they said it would be about a decade before that happened, and that was supposed to be doable a decade ago.

    Last I heard it was the enamel part that they were having trouble with. Eventually they will figure it out unless they abandon the process. I’ve been waiting for that for quite awhile now… but waiting it still is a better option than a foreign metal implant, IMO.

  19. I used to floss first, then brush, but I developed a pocket where some enamel repair had been done at the gum line. My gums were ok for my age according to my dentist and hygienist (late 50’s). I picked up a Waterpik on sale at Costco and started Waterpik first, brushing second. The pocket vanished and my gum health became perfect. My early bad health habits have left me with many fillings and a couple of crowns, but I’m now confident that I can keep what I have in good shape for the rest of my life.
    At first, I was using the Waterpik and flossing, but I dropped the flossing and it doesn’t seem to have been necessary. For my mouth, the Waterpik was the superior choice.

  20. The flossing video was very good, revealing, and informative. But I disagree with the conclusion.Whenever treating patients that were at high risk of decay I always taught patients to brush first with a fluoridated toothpaste. Then before rinsing, use the floss and or interproximal brush. The rational behind this sequence is to pull or push more fluoride to the inbetween tooth surfaces.

    For anyone who is seriously interested in prevention of tooth decay I will extend my comments. It is most important to understand that tooth decay is not caused by plaque. Tooth decay is caused by specific acid producing bacteria that may be found in the plaque and or free floating in the environment surrounding the teeth. Brushes and strings as proposed by the dental profession work well for removing plaque and “cleaning” the mouth, but are a waste of time and effort for removing bacteria that actually produce the acid which causes demineralization(decay) of the enamel.
    I assure you there is a plethora of peer reviewed scientific literature for all that I write next. There is no scientific study to refute anything I present here.
    The most important scientific discovery in the history of Dentistry came to us at the turn of this century when we discovered how to remineralize enamel. This enables us to reverse the early decay process and end up with re-hardened enamel which is actually more resistant to future decay than the original enamel crystals.

    Elimination of tooth decay is now possible by simply removing a few validated risk factors and reminerilizing early decay with TOPICAL FLUORIDE as is found in toothpaste. Not fluoridated water supply.

    Why isn’t this obvious information known by the public at large? The answer to that most important question is exactly the same as why doesn’t everyone know and practice a plant based whole food diet for health. The same medical industrial complex must sell you products and devices to survive, even if the products and services only make matters worse.

    Most of my dental career has been as a lecturer teaching dentists and hygienists conservative methods for eliminating tooth decay and periodontal diseases. My only remaining ambition is to volunteer to help Dr. Greger produce one of his greatest 10 minute videos on “The Way to Eliminate Tooth Decay for You and Your Children”.

    PS For anyone who doesn’t know:
    That first tiny filing placed in your or your child’s tooth is destined to a lifetime of breakdown and repair with ever larger fillings, eventual crowns, many root canal treatments and often eventual extraction and replacement. This averages about $3000 per tooth over a lifetime per each tooth. Inflation adjusted cost is about $10000 per tooth over a 75 year lifespan

    Larry Burnett DDS

  21. So don’t oil pull and do use fluoridated toothpaste?
    Got it.

    If one values health there is some really really bad info on this site,
    just as there is some very good evidence and advice.

    As always one must use discernment and a well calibrated __ meter.

    1. So don’t oil pull and do use fluoridated toothpaste?
      Got it.

      As always one must use discernment and a well calibrated __ meter.

      ===

      I suspect a /s is implied? If not, exactly. You’ve got it.

  22. At my dentist’s office there is a printed paper on the wall that reads “flossing is linked to reduced Alzheimer’s”. Not sure where she got that from, but maybe there is more to flossing then just removing plaque.

    1. Water pick type devices are more efficient than flossing and have the added advantage of using an anti-bacterial solution such as Listerine instead of water when necessary.

      1. using an anti-bacterial solution such as Listerine
        ————————————————————–
        Is this a good idea? Seems most of these have alcohol as an ingredient. I would think a good mouth swish with coconut oil (anti-bacterial) or even some oregano water which should also act as an anti-bacterial.

        1. If you don’t want alcohol in your mouthwash, use whichever evidence based germ killer you wish as long as it doesn’t clog your water pick device.

          1. Yeah, didn’t figure it necessary to deliver through a water irrigator… a good strong swish through the teeth should get to the germs.

            1. I’ve seen research showing that both brushing and rinsing are limited to 1 mm. Under the gum margin. I know it feels like more, but that’s what they said using dyes.

              1. I’ve seen research showing that both brushing and rinsing are limited to 1 mm. Under the gum margin. I know it feels like more, but that’s what they said using dyes.
                ——————————————————————————————
                Good to know.

        2. No its another really really bad idea, unless of course supporting Johnson and Johnson is of no concern.
          Get a moral compass, calibrate, and use repeatedly. It will pay huge dividends quickly.

          There are so many easy ways to eliminate dental bacteria and plaque, that using potentially toxic products
          from concerns like J & J scream clueless…

          1. Listerine also makes a non-alcoholic version of its ant-bacterial mouth wash for anyone concerned.

            If as you suggest, “there are so many easy ways to eliminate dental bacteria…” why do 90% of the population continue to suffer from the common oral bacterial infections called gingivitis, periodontitis and tooth decay.

            Could you kindly share with us some of your easy ways to eliminate these harmful bacteria that so many of us harbor. I’m sure many would be interested. Especially those if us that think these germs are very difficult to eliminate.

            1. Larry, are you on a WFPB diet? After going vegan and then WFPB (I still have oil in moderation and salt in moderation, etc.) I actually had a surface cavity heal itself and my guns drastically improved and I don’t even have that morning-breath feel anymore. My mouth stays so clean! A lot of the foods we eat on a WFPB diet (and drink) actually fight these bacteria as well as inflammation of the gums. For example, green tea and amla berry both fight cavity-causing bacteria in really interesting ways. And tomatoes due to the lycopene are shown to help with gum inflammation. There’s videos on each of those subjects on this site. I believe parsley helps clean the mouth and so many other herbs and plants we might regularly eat or drink kill harmful bacteria.

                1. gums… not guns, lol.
                  ————————————
                  Oh… was just about to ask you how much you could curl, but nevermind. ‘-)

              1. Hi S.
                Thank you for your thoughtful comments regarding decay prevention and dental flossing. I heartily ♥️ agree with most of your comments.

                Yes, I have been on a WFPB ever since my triple bypass cardiac surgery about 5 years ago. I attribute the WFPB diet to saving my life and providing me with a healthy old age free from chronic disease and disability. That’s why I’m here and posting comments.

                Prior to surgery, my diet was based on scientific opinion and “common sense”. I tried to stick with lean cuts of beef, trimmed all visable fat from my meat and removed the fatty skin from my supposedly lean chicken breast, didn’t use butter, etc. As I now know, “common sense didn’t always serve me well.

                The point is that “common sense” although useful should be practiced with an eye on modern scientific discoveries to be most useful.

                Like most dentists who were trained in the 20th Century, I understood decay to be a continuous process, once started would progress steadily until the tooth was lost. That’s why we searched carefully to find it in the earliest stages so we could drill out the decay and remove excess tooth structure for prevention. It was common sense to take xrays as often as the insurance company would pay for them in order to find signs of decay at the earliest stages. We were taught that dental x rays were insignificant with no more harm than typical background radiation. These procedures were all “common sense” to me until learning from Dr. Greger that all the background, dental X-rays and medical xrays were all cumulative over a lifetime and could result in cancer causing mutations.

                I was glad to read about your early surface decay that healed itself. I agree that your WFPB diet played a role in that reversal of decay that you experienced. I disagree however with the belief that certain foods killed or removed the bacteria causing the decay. The fact of the matter is that the decay causing bacteria must ingest REFINED carbohydrates in order to produce the acid that actually causes the decay. Sugar is an example of a refined carbohydrate. As you know REFINED carbohydrates are not included in your WFBP diet therefore the decay causing bacteria are less able to keep the acid flowing. This allows your surface cavity to be re-mineralized.(heal itself). Congratulations. If you had been seen by a 20th century dentist who saw that early surface decay, it would likely have been drilled and filled with a filling that would break down over a lifetime with the expense of ever larger fillings, crowns etc.

                The only point of disagreement I have is your belief that brushing and flossing without a fluoridated tooth paste will clean your mouth and prevent decay. In rebuttal to that assertion is my own common sense experience of treating couples from the same household where one partner with a super clean plaque free mouth continues to experience tooth decay, where the other partner with terrible lack of decent home care and a mouthful of plaque just doesn’t get cavities. The difference is in the individuals bacterial make up. Incidentally, the fluoride in toothpaste has been shown to be absorbed into the plaque and held close to the teeth for prevention (re-mineralization)

                Thanks again for your interesting post which allowed me to express my thoughts on this matter.
                Larry

                1. Larry, your candid explanations and personal history for going “plant based” are honest, no doubt did save your life, and has led you to conclusions that seem reasonable. Having a high level of educationmyself as well as 3 decades of clinical experience positions me to provide more insight

                  you said:  Prior to surgery, my diet was based on scientific opinion and “common sense”. I tried to stick with lean cuts of beef, trimmed all visable fat from my meat and removed the fatty skin from my supposedly lean chicken breast, didn’t use butter, etc. As I now know, “common sense didn’t always serve me well.

                  The point is that “common sense” although useful should be practiced with an eye on modern scientific discoveries to be most useful.

                  I would offer, though this was “common” it failed the “sense” part if sense was found by others who appreciated science but knew its severe limitations. You and countless others were lied to by people with credentials who had a dog in the race and also a cultural bias.  You said: Like most dentists who were trained in the 20th Century, I understood decay to be a continuous process, once started would progress steadily until the tooth was lost. That’s why we searched carefully to find it in the earliest stages so we could drill out the decay and remove excess tooth structure for prevention. It was common sense to take xrays as often as the insurance company would pay for them in order to find signs of decay at the earliest stages. We were taught that dental x rays were insignificant with no more harm than typical background radiation. These procedures were all “common sense” to me until learning from Dr. Greger that all the background, dental X-rays and medical xrays were all cumulative over a lifetime and could result in cancer causing mutations.

                  Dentists trained in the 20th Century were lied to and spoon fed nonsense not common sense. This allowed drill and fill dentistry to destroy healthy enamel undercutting teeth in order to install toxic amalgam fillings while doing little or nothingto educate people regarding health or the actual cause of dental caries. Over 30 years ago it was common knowledge that any amount of X-ray produced ionizing radiation the effects of which are cumulative. Oddly you were not taught this and somehow avoided knowing it for your entire career. Not taking away from Dr. G, but some of us did not need to learn this at the end of our careers.
                  Your opinion regarding fluoridation ought to be worth at least a thousand times more than that of any lay person based on your professional education and experience. Unfortunately this is also highly suspect. The dental profession has advocated for fluoridation of the public water supply all around the world. Not different from the memes used by Monsanto, now Bayer, with a toxic legacy, somehow a clueless public is supposed to believe their claims.  One could debate why this occurred but the reason is likely quite simple, just as preventing dental disease.
                  As Dr. G. has correctly pointed up dozens of times, science has been bought and paid for by corporate interests. It is most unfortunate that professionals are so tardy in admissions, usually only at the end of lucrative careers. If the first rational approach to evaluating the esteemed peer reviewed study must now be an attempt to understand financial interests by the investigators it should and ought to cast doubt on the entire process. Please don’t ask me for a better solution.I am aware of the stakes but refuse to pretend that much of what we read is untarnished.
                  If we really have no clue on how to prevent or best treat dental disease at this late date, it should be patently obvious that the dental profession has failed miserably and done untold harm. It is not different in the medical profession…
                  Fluoride is a toxic halogen and reactive species. It is associated with osteosarcoma in the long bones of adolescents. This has not dampened the fervor for adding it to the public water supply. Applying it topically on teeth likely kills bacteria and also likely makes the teeth stronger if more brittle thus more likely to fracture. In biology one never gets something for nothing.Therefore it is best avoided. Further whose interest is supported using it?  We were lied to by corporate interests with memes like “the science is settled” which equates to a green light for any or all corporate products.  PhD’s from the best universities happily lend their signatures, lie about their contributors, and later get caught lying. This sad scenario has repeated so many times it is sickening and not a rare occurrence.
                  Common sense is to avoid toxic substances including Fluoride and use time honored methods readily available.  That is a different discussion. Of more interest  is clarifying what has been mentioned already…
                  The idea that reading studies, linking them, and reporting is the best way to understand health is an idea, a poor one.It is not without merit, as educated people we ought to have references. Give me a good clinician anyday over lit. searching.
                  Robert O’Nara, DDS was delicensed for educating the public regarding the cause and prevention of dental disease over 40 years ago. Although the substance he advocated was  toxic, it was also effective. At that time discussing toxicity was mostly unknown. Fortunately we have learned a few things since then…

                2. Hi Larry, thanks for sharing your interesting insight! I 100% agree that common sense should always be paired with learning the scientific evidence. And I’m really glad to hear about what your WFPB diet has done for you!

                  “We were taught that dental x rays were insignificant with no more harm than typical background radiation.”

                  I would might actually argue that this wasn’t common sense but rather something you were taught in place of it. “Common sense” can be relative, to my mind it would be common sense to avoid x-rays as much as possible of any kind.

                  “I disagree however with the belief that certain foods killed or removed the bacteria causing the decay.”

                  I never said that the foods killed or removed the bacteria but certainly the foods that I ate and continue to eat and drink do kill bacteria, not sure about cavity causing bacteria, but some are known to kill cavity causing bacteria such as green tea and amla. So I do think that played some kind of a role, but the way I interpreted it was that it was many factors attributed to diet including the fact, like you said, that I stopped putting junk in my mouth like diet coke, highly refined and sugary foods, etc. Interestingly, though, I did eat a lot of sugar back then compared to now, I just got MORE whole plant food orientated desserts but they did still have sugar and I used to use a lot of maple syrup back then as a sweetener. But one of the main factors I truly believe played a big role was that eating a WFPB diet or a mostly WFPB diet (100% vegan) I was getting all of the minerals and other nutrients that my body needed to remineralize properly which I’m positive I was not getting before and basically overall I just made my body a better environment for healing to occur. That was my general takeaway. I also wondered if maybe the clay doesn’t help to remineralize.

                  ACTUALLY, funny story, I got lucky he didn’t drill. At the time, my insurance had run out so I couldn’t afford for him to drill and he was going to. He said to come back when I had insurance, but I went to a different dentist when this happened and I had assumed it would have gotten worse or still be there at least, but it was just gone and the new dentist actually explained that this can occur and he agreed that it’s better not to drill surface cavities. I’m very glad I ran out of insurance at the time! lol.

                  As far as fluoride, I’ve been brushing and flossing without fluoride for years and during those years I have not only never had a cavity, but the cavity of which I spoke actually healed itself. Since then, again, no issues and my gum health gets complimented every time I go for a clean up and I never have any issues with plaque or anything like that, no tooth sensitivity or anything. I do drink green tea on a daily basis so I don’t know, maybe the naturally occurring fluoride is helpful in that regard, I imagine it would be. I don’t swish with it thought for fear of staining. I’m happy to report this has been my experience.

    1. spring03, that is really helpful! And very cool information because as much as I think flossing is important, I hate all the waste that accumulates! I think I’m going to try a water flosser. Thanks for sharing this!!

  23. It doesn’t take a controlled study to know that leaving food between teeth is bad for oral health. Enamel erosion alone… supposed I ate a grapefruit and left all those stringy little highly acidic grapfriut fibers to just hangout in my teeth… And how could it not reduce plaque better than brushing alone when you can’t brush between teeth? Plus (and this is really important) it’s just GROSS not to floss. Maybe they should test the breath of flossers compared to non-flossers. Just gross.

      1. I respect your desire for s clean mouth. But in keeping with the goals of this website of revealing truth from what we think we know, I offer information on the other side of the flossing story.
        And please don’t think I’m suggesting anyone stop flossing if they like it. I just want to remove the myth that helps dentist “blame the victims” for the cavities the fill.
        https://www.google.com/amp/s/www.nydailynews.com/life-style/no-floss-u-s-health-department-article-1.2735915%3foutputType=amp

        1. Larry, I’m going with my common sense and Dr. G on this one. Common sense: obviously not leaving food in-between your teeth is better for oral health. Dr. G: not enough evidence to say how flossing compares to brushing. Personally, I see them both as necessary. Take the brushing action alone, dental experts have said that it’s the motion alone that gets teeth clean and paste isn’t known to necessarily be necessary. I tried this for about a week if not a couple days over and while there was no plaque build up, my teeth looked horrible from stains. As soon as I went back to bentonite clay brushing, they were nice and pearly again. For oral health it just seems that multiple steps are necessary for optimal oral health including a proper diet of or mostly consisting of whole plant foods.

          I don’t know if it’s a “blame the victims” because we are responsible for taking care of our teeth, but on the other hand, it’s the highly processed foods and sugary drinks and in other words, the standard westernized diet, that is the main culprit. It all kind of works well together doesn’t? Being on a SAD goes a long way in supporting so many other industries.

  24. I had once heard that flossing before brushing was preferred because the plaque that gathers on your teeth is the same plaque that clogs your arteries. If you brush then floss, you are more likely to just swallow the plaque that you lifted from your teeth, and some of it will end up in your arteries, while if you floss, then brush before swallowing, you’ll end up spitting the plaque out into the sink.

    Is there any truth to this. Is there a link between dental plaque and heart disease?

    1. That’s got to be totally made up, it makes no sense. The plaque that builds up in your arteries is from fat, cholesterol, calcium, etc. The plaque on your teeth is made of left over food particles–obviously plaque from eating a bunch of berries and not brushing isn’t going to be the stuff found in your arteries.

    2. Hello Rachel,

      There actually seems to be a link between oral health and cardiovascular disease; however, the plaque in your mouth is NOT the same as the plaque in your arteries. The link is not completely understood, but may have to do with the bacteria present in the mouths of those with poorer oral health or could be as simple as processed junk foods causing both oral plaque buildup and heart disease.

      I hope this clears up the confusion,
      Dr. Matt

      https://www.health.harvard.edu/press_releases/heart-disease-oral-health

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