When a patient comes in for their dental hygiene appointment—whether with a healthy mouth or advanced periodontal disease—the dental professional will typically review the patient’s daily home-care regimen. During the review process, the dental professional hopes the patient will mention how they clean their teeth interproximally and care for their gums, usually with dental floss.
Flossing teeth is recommended because we know that toothbrush bristles cannot effectively reach all the line angles of a tooth, and bacterial colonies will collect there. It has been proven that one can improve their overall health by caring for their gingival tissues with routine dental floss.1 A patient’s overall health is linked to many things, and studies have now indicated that dental care products can be manufactured from man-made chemicals that play a role in our general health.
Deconstructing dental floss
Dental floss is the stringlike material dental professionals recommend to keep gingival tissues healthy and clean interproximal surface areas on opposing dentition.1 Dental floss comes in a variety of types so that the patient and clinician can work together to decide one would clean most effectively based on the tightness of contact areas, the gingival tissue’s contouring, existing dental restoration margins, and the patient’s dexterity abilities.1
PFAS in dental floss: Bad for our health?
Dental floss is manufactured as a synthetic material with mono- or multifilaments.1 A synthetic monofilament floss can be coated so it can move smoothly between the dentition and gingival tissues and not get stuck on tight contacts or rough existing dental margins.1 On the contrary, dental floss that is made up of synthetic multifilament material will be slightly thicker because the multiple pieces of material are braided or woven together.1 This larger surface area claims to pull more bacteria and biofilm off larger dental embrasure spaces.1 Monofilament dental floss is typically coated with PTFE, Pebax, and PFAS, man-made chemicals designed to make products nonstick, waterproof, and stain-resistant.2-4
What are PFAS, and why do they matter?
Perfluoroalkyl and polyfluoroalkyl substances are man-made chemicals that have been around since the 1950s and are more commonly known as PFAS.2-8 While PFAS have been chemically altered and adapted since that time, they are still found in low amounts in lots of places, including drinking water (both tap and bottled), cosmetics, cookware, flame-retardant and water-resistant clothing and gear, food wrappers and containers, and food.5,8 Research shows that the soil and water near factories that produce PFAS may also become contaminated with these chemicals.5
More than 9,000 PFAS chemicals have been created since the 1950s; the chemicals have a family of similar compounds, so PTFE, PFAS, PFOA, PFOS, and GenX are all related.8 The concern with these chemicals is that they are deemed “forever chemicals,” because the human body takes so long to get rid of them. The chemicals have been found in umbilical cords, indicating they can be passed along in utero, and they can accrue in the human body in microscopic amounts over time.2,5,8
The bigger concern about PFAS, PTFE, PFOA, PFOS, and GenX is that they are all endocrine disrupters, which can affect how the human body grows and develops.2,8 Research has shown that all PFAS affect the growth, learning, and development of babies and children, possibly induce cancer and cause infertility, increase one’s chances of heart disease, and interfere with natural human hormones and the immune system.2-8
As part of their education to become licensed experts, dental professionals undergo training in dental materials to gain the necessary knowledge and expertise in this area. Depending on when one graduates will determine what materials are taught.
Businesses constantly change what they use to make products based on availability, costs, and demand. Manufacturers of any product are usually hoping to impress their buyer by having updated products that are tailored to their lifestyle.
More recently, dental patients—especially young adults—are not just asking what is in their dental products; they are starting to increasingly demand natural products.9 More than half of the total population surveyed said they were more mindful—that it was very important to them to purchase health and beauty products that were considered natural or clean.9 Unfortunately, some dental product companies fail to list all the ingredients on the packaging to inform patients of what their dental floss is made of.2 There is also little research showing how much of the man-made chemicals are ingested or built up over time in the human body from daily dental flossing.6
While studies have shown that these man-made products can be found in dental floss, the best advice is not to consume yourself with worry.6,7 Man-made chemicals are everywhere, and consumers can be exposed to them from numerous things other than dental floss.2-4,6,7 The main point is to decide if it is important to know what dental floss is made of and what alternatives are available so that patients can still floss but with a different oral hygiene aid.
At one time, the American Dental Association was concerned that dental patients would stop flossing altogether if they discovered that various types of floss contained different chemicals.4 Until proven otherwise, it is still recommended that the public clean between their teeth daily, as long as they are given the knowledge and choice to decide what product they are using interproximally.1-4,6,7 Choosing not to floss daily puts patients at a far greater health risk than flossing daily with coated monofilament dental floss.1-4,6,7
Alternatives to PFAS
Anyone wanting to reduce their exposure to monofilament-coated dental floss and PFAS chemicals do have options for interproximal dental cleaning. Consumers and dental professionals are suggested to use a water flosser to clean between their teeth, rather than string dental floss. If water flossing is not an option, products that don’t contain man-made chemicals include dental floss made from silk or cotton, unflavored and unscented floss, and floss with natural coatings such as beeswax and various plant waxes.2,3,6 For those who are concerned about PFAS in dental floss, reading product ingredient lists can help determine if the floss is something they would like to use.
Since natural health-care products are starting to become more widely available to consumers, we may see more research on them in the future. Dental professionals looking for research ideas could further studies on which dental product companies have more chemicals than others in their products.
Further research could also investigate what natural oral care products could replace the ones with man-made chemicals. Finally, scientists could examine how different types of dental floss break down in the human body and in landfills, since these two processes have not been well researched.
Even if dental professionals are not able to conduct a thorough investigation on potential chemicals in dental floss, they can help guide their patients who are considering natural product alternatives. Dental professionals should always aim to make their patients feel supported and happy with their oral care regimen and product choices. It is essential to reinforce the fact that bacteria and biofilm collected in the gingival tissues need to be removed after eating, so it is best that patients continue flossing while they shop for an alternative dental floss that fits their needs.
Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.
References
- Pieren JA, Gadbury-Amyot C. Darby and Walsh Dental Hygiene Theory and Practice.6th ed. Elsevier; 2024.
- Cook S. How to choose dental floss without PFAS or other harmful chemicals. Consumer Reports. April 10, 2024. Updated May 15, 2024. https://www.consumerreports.org/toxic-chemicals-substances/dental-floss-without-pfas-and-other-harmful-chemicals-a9722832754
- Segedie L. Concerning amounts of toxic PFAS “forever chemicals” in tooth floss and dental floss – report. Mamavation. September 7, 2022. https://www.mamavation.com/beauty/toxic-pfas-dental-floss-tooth-floss.html
- MacMillan A. Should you use PFAS-free dental floss? Health. May 31, 2022. https://www.health.com/condition/oral-health/pfas-floss
- Our current understanding of the human health and environmental risks of PFAS. United States Environmental Protection Agency. Updated May 16, 2024. https://www.epa.gov/pfas/our-current-understanding-human-health-and-environmental-risks-pfas
- Burhenne M. Is your floss toxic? How to find and use safe dental floss. Ask the Dentist. January 22, 2019. Updated August 3, 2023. https://askthedentist.com/safe-dental-floss/
- Boronow KE, Brody JG, Schaider LA, Peaslee GF, Havas L, Cohn BA. Serum concentrations of PFASs and exposure-related behaviors in African American and non-Hispanic white women. J Expo Sci Environ Epidemiol.2019;29(2):206-217. doi:10.1038/s41370-018-0109-y
- Spanne A. What are PFAS? Environmental Health News. February 15, 2022. https://www.ehn.org/what-are-pfas-2656619391/whats-the-difference-between-pfas-pfos-pfoa-ptfe-and-genx
- Masory A. Naturally beautiful: millennials and preference in beauty and personal care products. AlixPartners. May 30, 2019. https://www.alixpartners.com/insights/102j5oz/naturally-beautiful-millennials-and-preferences-in-beauty-and-personal-care-prod/
