It’s one of the most universal recommendations in all of public health: Floss daily to prevent gum disease and cavities.

Except there’s little proof that flossing works.

Still, the US government, dental organisations and manufacturers of floss have pushed the practise for decades.

Dentists provide samples to their patients; the American Dental Association insists on its website that, “Flossing is an essential part of taking care of your teeth and gums”.

The US government has recommended flossing since 1979, first in a surgeon general’s report and later in the Dietary Guidelines for Americans issued every five years. The guidelines must be based on scientific evidence, under the law.

Last year, the Associated Press asked the departments of Health and Human Services and Agriculture for their evidence, and followed up with written requests under the Freedom of Information Act.

When the federal government issued its latest dietary guidelines this year, the flossing recommendation had been removed, without notice.

In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required.

The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is “weak, very unreliable”, of “very low” quality, and carries “a moderate to large potential for bias”.

“The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year.

Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy”.

One study review in 2011 did credit floss with a slight reduction in gum inflammation – which can sometimes develop over time into full-fledged gum disease.

However, the reviewers ranked the evidence as “very unreliable”.

A commentary in a dental magazine stated that any benefit would be so minute it might not be noticed by users.

The two leading professional groups – the American Dental Association and the American Academy of Periodontology, for specialists in gum disease and implants – cited other studies as proof of their claims that flossing prevents buildup of gunk known as plaque, early gum inflammation called gingivitis, and tooth decay.

However, most of these studies used outdated methods or tested few people.

When the ADA was asked for proof of its claim that flossing helps prevent early gum disease and cavities, the group cited the 2011 review and a 2008 two-week study that measured bacteria and did not even consider gum disease.

In a later statement to the AP, the ADA said flossing “removes plaque” and “is proven to help remove” debris from between teeth.

Even companies with a big market share of the flossing business – by next year, the global market is predicted to reach almost $US2 billion ($A2.65 billion), with half in the US, according to publisher MarketSizeInfo.com – struggled to provide convincing evidence of their claims that floss reduces plaque or gingivitis. Yet the industry has paid for most studies and sometimes designed and conducted the research.

Procter & Gamble, which claims that its floss fights plaque and gingivitis, pointed to a two-week study, which was discounted as irrelevant in the 2011 research review.

Johnson & Johnson spokesman Marc Boston said floss helps remove plaque. When the AP sent him a list of contradicting studies, he declined comment.

Floss can occasionally cause harm. Careless flossing can damage gums, teeth and dental work. Though frequency is unclear, floss can dislodge bad bacteria that invade the bloodstream and cause dangerous infections, especially in people with weak immunity, according to the medical literature.

National Institutes of Health dentist Tim Iafolla acknowledged that if the highest standards of science were applied in keeping with the flossing reviews of the past decade, “then it would be appropriate to drop the floss guidelines”.

Regardless, he added, people should still floss.

“It’s low risk, low cost,” he said. “We know there’s a possibility that it works, so we feel comfortable telling people to go ahead and do it.”