Topology, Biofilm, and Flossing


Recently, the Associated Press (AP) pushed a hot button for the dental profession by independently assessing the scientific basis for flossing of teeth. The AP’s review found little scientific support for the practice.

Any discipline that claims to have a scientific basis must be open to constant review and testing of its “established” facts.

In considering the AP’s assessment, professionals should focus on dental topology and the nature of intraoral biofilm. Dr. Sam Low ( has been a strong voice for science-based methods in dentistry, and for re-evaluation of past practices in dental hygiene and periodontal care (if you haven’t attended one of his CE courses, I’d highly recommend it). In his lectures, Dr. Low makes the point that teeth are not spheres (i.e. completely convex). Teeth and tooth roots have many concavities that are inaccessible to toothbrush bristles and cannot be cleaned simply by passing a string over them.

Consider the following thought experiment: Imagine a stalk of celery. Cut off a piece about 10 inches long. Spread some peanut butter in the concavity of the stalk. Hold the stalk up in one hand, and ask a friend to remove the peanut butter using a piece of string stretched between their hands. Or have them try to rinse out the sticky peanut butter by holding the stalk under tap water. Neither of these approaches (representing flossing and low pressure rinsing) is going to have much impact in removing a sticky substance (representing oral biofilm) from a concavity.

It’s clear that, in addition to flossing, we need to be able to safely and conveniently disrupt sticky biofilm in tooth concavities. In response, Philips ( has created the AirFloss device. Having personally used a unit now for a year, my impression is that AirFloss is very good at removing food debris and biofilm in areas that are inaccessible to tooth brush, floss, or toothpick. Initial research on the device appears to agree with me.

I hope dental professionals will consider adding the AirFloss unit to their recommendations for oral health home care, especially for patients with periodontal disease and those without the dexterity to handle dental floss. Think of AirFloss as a small scale pressure washer, which would have easily cleaned the celery stalk in our thought experiment!

(Original post on November 17, 2016)


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