Why is it so tough to remember to floss? I rarely run into a patient who can't remember to brush their teeth twice a day, but even the most conscientious among us come to their hygiene appointment anxious and awaiting the hygienist's lecture about flossing.
Flossing can be icky and awkward -- no one likes feeling like they're shoving their entire fist into their mouth. But the reason why we don't make flossing a habit is a bit more complicated and has its roots in psychology.
During the early 1900s, right around World War I, dental hygiene was so bad, it was said to be a national security risk. Why? People weren't brushing their teeth, of course, and the 1900s marks the period when Americans first began to consume sugary, ready to eat processed foods in the form of crackers, breads, and potato chips.
America's brushing habits were forever changed at this point by a toothpaste campaign that told people, "Just run your tongue across your teeth. You'll feel a film -- that's what makes your teeth look 'off colour' and invites decay. Why would you keep a dingy film on your teeth? Our toothpaste removes the film!"
As Charles Duhigg explains in his book, The Power of Habit, the success of this campaign was in its ability to create a craving in people, which is at the heart of all habits.
In order to make a habit, Duhigg asserts, you need the following:
When people ran their tongue across their teeth like the campaign instructed, that became a simple and obvious cue for them to brush their teeth. The reward? Removing the "dingy film" on their teeth. The ad people had created a craving. If people forgot to brush, they missed that "tingling clean feeling."
Now, back to flossing. The problem with flossing is there is no instant gratification, no clearly defined reward. People don't think it's working.
Unfortunately, our brains are not wired to develop habits that will do good things for our health 10 or 20 years later.
Flossing is going to prevent decay, keep your teeth and smile looking young as you age, prevent your teeth from falling out, prevent gum recession, expensive dental bills, and pain -- so trick your brain into making it an effortless routine that you perform on autopilot.
Start with giving yourself a simple and obvious cue -- you might decide to floss every night before bed, for example -- and a clearly defined reward, like a favorite flavor of floss. For children, a sticker for every day on a flossing calendar in the bathroom is a great way to cement the habit.
Create a cue. I tell my patients to take a blank post-it and stick it on your mirror. That's a cue. Don't write things like "floss" on it -- that sounds too authoritarian and disciplinary. Every time you see that post-it, you'll know deep down, that means to floss. I did this to get into the habit myself.
Make it easy. Keep floss stashed everywhere. The samples of floss you get from the dentist are great for this -- keep one in your desk drawer at work, your gym bag, in the car, in your laptop bag, and your travel toiletry case. We might not think of flossing late at night before bed because we're tired, but the thought (or craving) could hit you during the day.
Invest in a flossing stick, which is basically like the handle of a toothbrush, but with floss on the top. These are fantastic, I use one myself. They turn flossing into a one-handed operation and are awesome for multi-taskers -- you can flip through your phone with one hand while flossing with the other.
Take the pressure off. Don't do what the hygienist tells you, which is, floss every day. This can be too much of a jump and too much to expect right of the bat. It's easy to get frustrated when trying to get in the habit of flossing, especially since so much coordination is involved with it.
What I tell my patients is, floss once a week. What ends up happening is they floss once, and a few days later, begin to crave the feeling again. When you floss once, you get sensation of the separation of the teeth, stimulation of the gums -- it's a distinct feeling, almost like a massage. Which is why you'll crave it again. This can be a much better way to break into the habit of flossing daily.
You can think of flossing like kicking over an anthill each day. You can kick the anthill to destroy it, but each day, the ants come back and build a new one. Flossing one week before your appointment with the hygienist isn't going to prevent gum disease, tooth decay, and gum recession -- but keeping up with that "anthill" and flossing daily, will.
Mark Burhenne, DDS
You can purchase Charles Duhigg's brilliant book, The Power of Habit, here.
<a href="http://www.ajog.org/article/S0002-9378(11)00917-3/abstract" target="_hplink">A new study</a> published in the American Journal of Obstetrics & Gynecology found an association between the use of a non-alcohol antimicrobial mouth rinse in pregnant women and a decreased rate of delivering babies prematurely. Analyzing 226 women with periodontal disease, the researchers found that study participants who rinsed twice-daily with the mouthwash were about three fourths as likely to deliver early, <a href="http://today.msnbc.msn.com/id/43931581/ns/today-today_health/t/mouthwashing-moms-less-likely-have-preemie/" target="_hplink">reports Reuters</a>. While the study didn't look to find the reason for the difference, lead author Marjorie Jeffcoat of the University of Pennsylvania School of Dental Medicine <a href="http://today.msnbc.msn.com/id/43931581/ns/today-today_health/t/mouthwashing-moms-less-likely-have-preemie/" target="_hplink">told Reuters</a> that one theory is that gum-disease-induced inflammation could trigger early birth. (The publication also points out that the researchers used a Crest mouthwash, with staffing and funding from the brand's parent company, Proctor and Gamble.)
In other pregnancy news, research presented earlier this month at the European Society of Human Reproduction and Embryology found that <a href="http://www.eshre.eu/membership/page.aspx/1355" target="_hplink">gum disease could up the time</a> it takes for a woman to become pregnant. In the study, <a href="http://www.huffingtonpost.com/2011/07/07/gum-disease-pregnancy-chances_n_890529.html" target="_hplink">women with gum disease</a> took an average of seven months to conceive, compared to five months among their peers without gum disease, The Huffington Post reported when the findings were released. Like the previous study, one hypothesis for the cause is the inflammation resulting from gum disease. And, of course, the best way to prevent gum disease in the first place is through brushing and flossing.
Some research has connected <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002051/" target="_hplink">periodontal disease</a> (or inflammation and infection in the tissue around the teeth) to heart problems. <a href="http://www.perio.org/consumer/mbc.heart.htm" target="_hplink">According to the American Academy of Periodontology</a>, "Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease." "If you have gum disease or cuts in your gums from dental work, oral bacteria can enter your bloodstream and cause infection in your heart or lungs," HuffPost blogger<a href="http://www.huffingtonpost.com/deepak-chopra/reasons-to-floss_b_871049.html" target="_hplink"> Deepak Chopra wrote last month</a>. "Poor oral health probably won't give you heart disease or other diseases. But if you already have risk factors for certain diseases, it can increase your chances of getting them."
A study published in October 2007's <em>Journal of the American Dental Association</em> found a relationship between <a href="http://jada.ada.org/content/138/10/1314.full.pdf" target="_hplink">people who lost more teeth</a> before the age of 35 and an increased risk of dementia. "Our findings suggest that a low number of teeth has an association with dementia late in life," the researchers wrote in their conclusion section of the study, pointing out, of course, that while they had found a correlation, they don't know at this point if tooth loss actually <em>causes</em> dementia.
In a preliminary 2007 study among rats, researchers found a possible link between periodontal disease and a progression toward diabetes among rats who were already prediabetic. While the results, published online in the<em><a href="http://www.joponline.org/doi/abs/10.1902/jop.2007.060358" target="_hplink"> Journal of Periodontology</a></em>, are still early, they suggest one more possible reason to keep up with a brushing and flossing routine.
<a href="http://www.perio.org/consumer/healthy-lungs.htm" target="_hplink">Another study published in the Journal of Periodontology</a> uncovered a suspected link between periodontal disease and pulmonary disease, such as pneumonia and acute bronchitis. "By working with your dentist or periodontist, you may actually be able to prevent or diminish the progression of harmful diseases such as pneumonia or COPD," Donald S. Clem, DDS, president of the American Academy of Periodontology, said in an organization press release. "This study provides yet another example of how periodontal health plays a role in keeping other systems of the body healthy."
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