2 0 1 1 ▁C och rane ▁Database ▁system atic ▁review ▁identified ▁" some ▁evidence ▁from ▁ 1 2 ▁studies ▁that ▁fl oss ing ▁in ▁addition ▁to ▁to oth ▁br ushing ▁reduces ▁ging iv itis ▁compared ▁to ▁to oth ▁br ushing ▁alone ", ▁and ▁" weak , ▁very ▁un re li able ▁evidence ▁from ▁ 1 0 ▁studies ▁that ▁fl oss ing ▁plus ▁to oth ▁br ushing ▁may ▁be ▁associated ▁with ▁a ▁small ▁reduction ▁in ▁pla que ▁at ▁ 1 ▁and ▁ 3 ▁months ." ▁ ▁More ▁recently , ▁a ▁ 2 0 1 9 ▁C och rane ▁Database ▁system atic ▁review ▁compared ▁to oth br ushing ▁alone ▁to ▁inter d ental ▁clean ing ▁devices , ▁and ▁also ▁compared ▁fl oss ing ▁to ▁other ▁inter d ental ▁clean ing ▁methods . ▁In ▁all , ▁ 3 5 ▁Random ized ▁Control ▁Tri als ▁met ▁the ▁criteria ▁for ▁inclusion , ▁with ▁all ▁but ▁ 2 ▁studies ▁at ▁high ▁risk ▁for ▁performance ▁bias . ▁The ▁authors ▁concluded ▁that ▁“ over all , ▁the ▁evidence ▁was ▁low ▁to ▁very ▁low ▁certain ty , ▁and ▁the ▁effect ▁sizes ▁observed ▁may ▁not ▁be ▁clin ically ▁important .” ▁ ▁As ▁many ▁authors ▁note , ▁the ▁effic acy ▁of ▁fl oss ing ▁may ▁be ▁highly ▁variable ▁based ▁on ▁individual ▁preference , ▁technique , ▁and ▁motiv ation . ▁Moreover , ▁fl oss ing ▁may ▁be ▁a ▁relatively ▁more ▁difficult ▁and ▁ted ious ▁method ▁of ▁inter d ental ▁clean ing ▁compared ▁to ▁an ▁inter d ental ▁br ush . ▁▁ ▁In ▁response ▁to