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Oncology Supporting Your Practice

Myth or Truth: Is Flossing Safe During Cancer Therapy?


Drs. Debbie Saunders and Joel Epstein dispel the myth about the safety of flossing for patients undergoing cancer therapy.

Dr. Debbie Saunders is a Dentist and Medical Director of the Dental Oncology Program, Health Science North, in the North East Cancer Center. She is also Assistant Professor in the Norther Ontario School of Medicine. 

Dr. Joel Epstein is Professor and Medical Director Cancer dentistry at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Health System in Los Angeles and the Division of Otolaryngology and Head and Neck Surgery in City of Hope. 


Flossing is fundamental in reducing inflammation in the gingival tissues. It is important for patients to continue flossing during cancer therapy and to reduce or remove the risk of gingivitis. This also helps to prevent uncontrolled bleeding from the gums in patients with thrombocytopenia (low platelet counts).

Studies have shown that effective removal of bacterial plaque reduces inflammation and does not induce bacteremia in compromised patients. Generally speaking, patients that are able to floss in an atraumatic fashion should continue flossing. However, if bleeding occurs for longer than 2 minutes while flossing, patients should discontinue and be referred to dental oncology. Similarly, patients who have never flossed or are unable to floss in an atraumatic manner should not begin flossing at the time they are having cancer treatment. If patients have a platelet count of 20 or less, flossing is not recommended until the platelet levels rise.



Watch the video presentation




  1. Eric October 26, 2016

    Are the criteria similar for brushing

  2. Joe Paolasini October 27, 2016

    I cannot find the link in CCO for the guidlines to print for my hygiene team.

    1. JCDA Oasis October 27, 2016

      Hello Dr. Paolasini, Thank you for bringing this to our attention. Here is the link to the resource, I hope.
      Chiraz, CDA Oasis

  3. Linda Lee December 1, 2016

    As far as I know “dental oncology” is not a specialty in Canada. To recommend referral to a “dental oncologist” for gingival bleeding longer than 2 minutes is irresponsible. What can a dental oncologist do to stop bleeding that a dentist or oral surgeon cannot?
    Whether flossing is recommended for a patient undergoing chemotherapy depends on the type of chemotherapy, the general health of the periodontium, manual dexterity of the patient as well as other patient specific factors.
    Blanket, dogmatic statements regarding care for cancer patients underestimates the clinician’s ability to judge the situation to weigh the benefits/risks of invasive procedures.


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