What are the three main habits for keeping the mouth healthy? Why, brushing, flossing, and tongue scraping, of course. Wait – tongue scraping? Tongue scraping‼?? Got your attention? Read on.
In round numbers, everyone in 21st Century America knows that brushing is the essential self-care practice for oral health. In truth, we’re not as a nation all that reliable about brushing, though. As a matter of fact, about 30% of Americans fail to brush twice a day. Twice a day is what the American Dental Association recommends. What’s more, a study found that 23% of us had gone without brushing at all for two or more days during the previous year. That, without a doubt, is outright neglect. Perhaps surprisingly, the same study found that a little over 30% of Americans require their partners to brush before kissing. Hmm. That may not have to do with preventing tooth decay.
Then, there’s flossing. Most people are familiar with the idea that flossing is important for oral health. The ADA recommends cleaning between the teeth daily. Well, only about half of us do that. Around 20% of Americans don’t floss at all. No data is available at the present time on how many of us make partners floss before kissing.
TONGUE SCRAPING? REALLY?
Then, there’s the matter of tongue scraping. The ADA leans toward the position that “…there is no evidence that brushing or scraping your tongue will prevent bad breath or improve halitosis (chronic bad breath). “ We Americans are, in contrast with brushing and flossing, on board with the ADA in this one. In fact, the subject of tongue cleaning in general, and tongue scraping in particular, is largely unstudied. There aren’t, surprisingly, any reliable numbers.
This is a big change from earlier in American history. Tongue scrapers used to be fairly common in American households. In colonial times, local “urgent care” centers, that is, apothecaries, recommended and performed it for a number of ailments. In the 19th Century they were “must have” items in well-to-do families. In much of the rest of the world, outside the Western societies, it’s been practiced since ancient times.
The case in favor of tongue cleaning for oral health is pretty simple. If teeth and gums need to be kept free of the bacteria that cause tooth decay, gum disease, and bad breath – why not the tongue? After all, the tongue is right in there, too. It comes into contact with the exact same food and beverages as do the teeth and gums. Furthermore, if the niches between the teeth are such great hideouts for bacteria, what about the tiny nooks and crannies all over the tongue? Shouldn’t we be as worried about our tongues as we are about our teeth and gums?
THE UNSUNG TONGUE
On the face of it, the bacteria-control concept makes sense. We know that certain strains of bacteria that live in the mouth produce VSCS – volatile sulfur compounds. You don’t need a diploma to detect VSCS. They stink. The anerobic bacteria strains that produce VSCS are culprits in causing gum disease and tooth decay. Therefore, the argument goes, keeping the tongue as free as possible of these bacteria ought to improve oral health. Or, at least, solve the bad breath problem. So why the ADA’s skepticism? Why the apparent lack of enthusiasm for tongue scraping in the general public?
DOES IT WORK?
The first question ought to be whether tongue scraping does, in fact, remove unfriendly bacteria. There’s some scientific evidence that it does, indeed. From the tongue, at any rate. This study found that a tongue cleaning device effectively removed plaque and bacteria from the tongue. However, no effect was seen on dental plaque or bacteria. This hints that dental plaque isn’t resupplied by “migrants” from the tongue. It’s a bit of a stretch, but if this is true, tongue scraping may not help with tooth decay. Moreover, it’s worth noting that this study didn’t look at the subjects’ gums. It doesn’t address the possible connection between tongue scraping and preventing gum disease.
The results of controlling bacteria on the tongue were seen in another study which focused on those volatile sulfur compunds. These researchs reported that brushing the tongue and scraping both reduced VSCS levels by as much as 75%. Signficantly, they found scraping considerably more effective than brushing.
SOME ARE SKEPTICAL
As has been noted, the American Dental Association finds it can’t recommend tongue cleaning as a measure against bad breath. The ADA, of course, is conservative and evidence-based in its public policies. It certainly should be. They correctly point out that the rates at which tongue bacteria populations grow back might be as fast as the rate cleaning removes them. We simply don’t know yet.
Speaking of skepticism and the ADA, consider this. The US Department of Health and Human Services in 2016 removed flossing from it’s published list of recommended practices. The Department explained that the law requires it to publish only “evidence-based” recommendations. The Department’s review, in essence, found that the scientific evidence for the health benefits of flossing is “…”weak, very unreliable,” of “very low quality” and carries “a moderate to large potential for bias…”.
Well, there’s a surprise. Don’t toss out your floss just yet, though. More on this later.
There’s more than one way, in fact, to judge the value of any practice or habit. Science is a method, with a set of rules for investigating the world. Contrary to what most people think, science never proves anything true. In fact, by its own rules, science can’t prove anything true. It can only prove a thing to be false. The strongest positive statement science can make about anything is ” ...so far, we haven’t been able to show that X isn’t true.” But the work is never done, although, at some point, science does move on.
The ADA’s statement on tongue scraping is very much in this spirit. They don’t say “tongue scraping doesn’t work”. Rather, they say “the evidence doesn’t show that it works”. That’s not the same thing.
In any case, the science of subjects like tongue scraping and flossing is scattered and technical. Too much, at any rate, for a regular person with a life to lead. New work is reported intermittently. Thankfully, there, are dedicated professionals who pay attention to this subject. They work to put all the pieces together and report.
THE ART AND SCIENCE OF DENTISTRY
Moreover, scientific knowledge isn’t the only kind of valuable knowledge. First-hand, practical experience has served humanity since the beginning of time. Since long before science as we know it was invented.
That’s why your Lake Worth dentist’s office is such a valuable resource. These dentists have a deep grounding in science and keep up-to-date. Additionally, they have years of real-life experience with real individual patients. This combination can’t be replaced by broad, general policies of the ADA or the US Department of Health and Human Services. General, evidence-based public policies are a good and valuable thing, to be sure. But they’re often much too broad to provide as much value to an individual as can a professional familiar with him or with her.
BRUSH? FLOSS? TONGUE SCRAPING?
Yes, rather than no. There are, of course, some risks in too much of a good thing. It’s true, though relatively rare, that some people brush too much. Their enamel suffers. With this in mind, the best thing an individual can do is consult with the dentist. Dr. Google is interesting and fun, but he’s not your dentist. He doesn’t know you. And unless you’re properly trained, you’re not in a position to judge what you read. That includes this article, by the way, except for the last sentence:
Ask your Lake Worth dentist about the best brushing, flossing, and tongue scraping habits for you.