Can flossing reduce your risk of a stroke?

04/15/25 • 27 min

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Can a simple habit like flossing really reduce your risk of stroke? In this episode, Dr. Bobby unpacks the headlines sparked by a recent presentation at the American Stroke Association’s International Conference that claimed regular flossing could reduce stroke risk by 20–50%.

Dr. Bobby begins with a refresher on the importance of stroke prevention. From there, he explores the biological plausibility of a connection between oral health and cardiovascular events. While Americans are fairly diligent about brushing (with 90% brushing once daily and 60% brushing twice a day per YouGov data), flossing habits lag significantly (NIH Oral Health Study—highlighting a clear opportunity if the flossing-stroke link is real.

Dr. Bobby dives into the study behind the headlines, a new analysis from the long-running Atherosclerosis Risk in Communities (ARIC) study, which tracked over 6,000 individuals for 25 years. The preliminary finding: regular flossers had significantly lower risk of ischemic and cardioembolic strokes (Study Abstract). Surprisingly, brushing and dental visits showed no significant benefit in this analysis.

So why isn’t this flossing-stroke connection headline a "five-alarm fire" in medicine? Dr. Bobby explains the limitations: the results were shared via a conference abstract, not a peer-reviewed journal article. Without full access to the data or understanding how many other hypotheses were tested from this large dataset (which has already generated over 2,300 publications), we risk falling into the trap of correlation being mistaken for causation.

To further evaluate the credibility of this association, Dr. Bobby introduces the Bradford Hill criteria—nine principles to assess causality in observational studies. While the biological plausibility is strong and the effect size notable, the study fails on criteria like replication, dose-response, and publication rigor (Bradford Hill Overview).

In closing, Dr. Bobby affirms the benefits of flossing—not necessarily for stroke prevention, but for better oral health, which is valuable in its own right. He shares his personal oral care routine, including flossing nightly and using a water jet, while reminding listeners to stay evidence-informed in their health decisions.

Takeaways
Flossing likely improves oral health, but its role in stroke prevention remains unproven.
Be cautious with headlines drawn from unpublished conference abstracts—they’re a starting point for inquiry, not a reason to change behavior just yet.

"How to Live Long and Well" at DrBobbyLiveLongAndWell.com.

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#34 Resilience: The More You Have, The More You Have to Lose

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Resilience is crucial as we age, especially when it comes to maintaining muscle, joint, and bone health. In this episode, Dr. Bobby DuBois discusses how building physical reserves early on can help withstand inevitable changes and setbacks as we get older. Just like investing in an IRA, the earlier you start building your physical resilience, the better prepared you’ll be for the challenges of aging.

Dr. Bobby shares insights from his interview with Karen, who experienced a rapid decline in strength after a period of inactivity. Despite previous success with weight loss and fitness, Karen found herself struggling to lift groceries after weeks of illness and time away from the gym. Her story highlights the importance of maintaining muscle mass and staying active, even after setbacks.

Key Points:

The Impact of Inactivity: As we age, muscle loss accelerates. We can lose 1–2% of muscle mass per year after age 30, and inactivity can drastically speed up this decline. Strength exercises, even when started later in life, can still yield significant gains (study).
Muscle Memory and Recovery: Muscle memory helps regain lost strength more rapidly than building it from scratch, but the recovery time lengthens with age. Karen’s experience reinforces the importance of staying consistent, even when life gets in the way.
Protecting Joints: Joint cartilage thins with age, increasing the risk of osteoarthritis. Contrary to popular belief, regular running does not inherently damage joints. However, previous injuries significantly raise the risk of osteoarthritis (study).
Bone Health Maintenance: Bone density peaks around age 25 and gradually declines, especially after age 50. Engaging in weight-bearing and high-impact exercises can help preserve bone density. Heavy resistance training is especially beneficial for maintaining bone strength (study).
Supplementing won't solve the problem: Calcium/Vitamin D supplements don't seem to solve the problem.
Practical Tips for Resilience:
- Keep your protein intake between 0.5 to 0.75 grams per pound of body weight to support muscle maintenance.
- Incorporate cross-training activities during periods of injury or illness to maintain fitness.
- Focus on exercises that build both muscle and bone density, such as resistance training and weight-bearing movements.

Takeaways:

Aging is inevitable, but weakness isn’t. Building resilience through consistent exercise and strength training is crucial to maintaining independence and quality of life.
Don’t give up after setbacks—muscle memory and consistent effort can help you regain lost strength.
Prioritize activities that strengthen both muscles and bones to minimize the impact of inactivity and age-related decline.

Live long and well by staying resilient and proactive. Remember to keep moving, invest in your muscle and bone health, and stay committed to your fitness journey. If you found this episode helpful, please share it with others and rate the show!