There are many established, regularly parodied cultural differences between France and the US: style, portion sizes, attitudes towards picking up after your dog.
But there’s another – possibly bloodier – contrast: flossing.
Sarah Diligenti, the director of the Alliance Française in Washington DC, had never heard of flossing before she moved to the US in 1995. Growing up in the south-western French city of Toulouse, she was not ignorant of dental care – her cousin was a dental surgeon, she had briefly endured a pair of wire retainers as a teen and she never had any cavities. But flossing? Mais non.
“Being French, we didn’t know what flossing was,” recalls Diligenti. “Absolutely nobody mentioned it – certainly not my cousin.” Some were mysteriously familiar with the practice; once, in the 80s, she saw a French friend rubbing a string between his teeth. But she thought, “What the heck is he doing?”
In 1996, she and her then husband – a Mancunian with “really bad teeth” – went to their first American dental checkup.
“The dentist looked at us like we were freak shows,” she said. Every time the couple went back for a cleaning, the dentist would tell them they had to floss. “Finally, we said, ‘What do you mean?’”
“Preventative care has not traditionally been a priority in France,” says Dr Adriana Agachi, a pediatric dentist in Paris. She suspects this is because dental care in France is largely covered by social security, so there is less concern about the financial cost of dental emergencies.
Agachi says that when she worked in Switzerland, where dental care tends to be more expensive than in France, patients were diligent about scheduling checkups and cleanings every six months. When Agachi asked them why, they told her that because of the high costs, “they prefer to avoid major issues through regular prevention”.
Dentistry in the US is “very focused” on preventative care, says Dr Sally J Cram, a periodontist and spokesperson and consumer adviser for the American Dental Association (ADA).
“[US] dentists and researchers are putting dentists out of business in some respects,” says Cram. “When you help people take care of their teeth at home, they have fewer cavities and less gum disease.”
Flossing cleans the areas between the teeth that can’t be reached with a toothbrush, Cram says. Both brushing and flossing remove plaque – a sticky buildup of bacteria and food debris that starts forming on the teeth as soon as 10 minutes after we eat.
A healthy person who removes all the plaque from the surface of their teeth and under the gumline every 24 hours is unlikely to have many dental problems, says Cram. When plaque sits on the teeth for more than 24 hours, however, the bacteria in plaque begin to inflame the gums. “That’s what makes your gums bleed and feel sore,” Cram explains.
Left longer than one to two days, plaque hardens and becomes impossible to remove with at-home brushing and flossing – only a professional dental cleaning can get it off. Left for months or years, the bacteria from plaque can make its way down to the jawbone and begin to erode it, leading to periodontal disease.
In fairness to the French, there is actually very little data to support the benefits of flossing.
In 2015, the US Departments of Agriculture and Health and Human Services caused a media hubbub when they removed any mention of flossing from official dietary guidelines. The government later told the Associated Press that “the effectiveness of flossing had never been researched”. Indeed, one 2015 review found that “the majority of studies fail to demonstrate that flossing is generally effective in plaque removal”.
Cram acknowledges that there have been limited long-term studies on flossing. But she attributes this to the complexity and expense of carrying out effective long-term studies of anything.
“The bottom line is, flossing is a low-risk, low-cost way to clean parts of your teeth where your toothbrush can’t reach,” says Cram. “So what is the harm in doing it?”
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The French dental landscape does seem to be slowly changing in regards to flossing.
“It depends where you are and what the age group of the dentist is,” says Julien Suaudeau, a lecturer in French and Francophone studies and program director of film studies at Bryn Mawr College. “In big cities, it is something that has become more common practice.”
Suaudeau says that he was first introduced to interdental cleaning in his early 20s, when he still lived in France. His dentist at the time had traveled to the US, and did not recommend using floss, but small interdental brushes.
When he came to the US, the dental hygienist Suaudeau saw told him to ditch the interdental brushes and use floss instead. He wonders now if his use of the brush was “not satisfactory”.
Suaudeau became a regular flosser for the reason so many people do: because “it’s unpleasant to have someone scolding you when you are an adult”.
Still, he says that when he travels home to Paris, some of his friends are confused by his dental accoutrements.
“I get questions every now and then, like, ‘What the hell is this stuff?’” Suaudeau says. There isn’t even a word for flossing in French, he adds. Or if there is, he doesn’t know it. “I should because I’m a teacher.”
I asked my French colleague, Jessica Reed, who also couldn’t think of a word for flossing. (She also said she regularly lies to her US dentist about flossing, seeing it as “another American imposition on her relaxed French lifestyle”.) Google Translate suggested “passer la soie dentaire”, which roughly translates to “passing dental silk between your teeth”.
Diligenti says she does floss – sorry, pass the dental silk between her teeth – now. Well, most of the time. “Sometimes I go to bed without flossing because I come back late from work,” she admits. “But otherwise I do it.”
Très bien.
