Last Thursday, there was a rally on Broadway for an unusual cause: flossing. People holding signs outside the dental office of Dr. Thomas Cingel were handing out floss and floss literature to passersby. Cingel, who organized the event, invited people to chow down on potato chips and cookies, then handed out sugarless gum so they could remove the sugar buildup. His waiting room was turned into an art gallery: on display were the blown-up pages from Cingel’s book, Avid Flosser: How to Keep Your Teeth Forever. The dentist, who wore an arty T-shirt showing drawings of teeth, had hung a banner reading “FLOSS: Makes Your Mouth Great Again” on the side of the building, so that passing motorists would get the message.
The rally was precipitated by a recent report in the media that flossing your teeth is not proven to prevent cavities or gum disease. “The latest dietary guidelines for Americans, issued by the departments of Agriculture and Health and Human Services, quietly dropped any mention of flossing without notice,” reported The New York Times last month. “This week, The Associated Press reported that officials had never researched the effectiveness of regular flossing, as required, before cajoling Americans to do it.”
Cingel is passionate about the subject, claiming that for most of the population, flossing is absolutely essential to prevent tooth decay. “Since the beginning of my career, I saw a stark difference between dental problems and the longevity of teeth from people who reported they didn’t floss,” said the dentist. “While we as dentists have no long-term research from well-controlled studies that proves flossing is beneficial, over 200 articles show the benefits.”
The Brooklyn native, who attended dental school at SUNY Buffalo and began his practice in a sleek, Modernist wood building in Midtown nine years ago, takes a pro-active approach in preventative care. His pocket-sized book, which was published in January and is available from Amazon and www.avidflosser.com (the website also includes a “tooth death clock” quiz, to determine if you’ll have your teeth in 20 years), provides valuable tips amid a layout of striking photos and graphics that mix humor and wit. A co-founder of the O+ Festival, Cingel is also an art collector, displaying many local artists’ works on the walls of his office.
The Kingston Times recently interviewed Cingel, who lives in Kingston with his wife, Jessica, a midwife, and two young children, by phone:
Kingston Times: Have you always been a proponent of flossing?
Thomas Cingel: Initially in my career, I wasn’t truly sold on flossing. I knew I needed to do it, but nothing out there made flossing easier. Once I saw the Reach Flosser, now known as the Listerine Flosser, the, problem was solved. Every single one of my patients gets a flosser. I instruct them to keep it next to their toothbrush, so they remember to floss. It makes money for them by keeping my drill off their teeth.
KT: How did the anti-flossing story get started?
TC: Jeff Donn is an Associated Press writer who took his son to the orthodontist and the orthodontist said ‘I got a story for you. You know there’s no evidence on the benefits of flossing.’ Dunn took that information and went to the U.S. dietary guidelines. He said, ‘Where’s the scientific evidence?’ They were unable to provide it. When the new dietary guidelines came out, they dropped the flossing guidelines. Other government entities, such as the U.S. Surgeon General and the Centers for Disease Control and Prevention, said you still have to floss. We sort of do our own studies in the office, although they are anecdotal. Ask someone 50 or 60 years old if he or she flosses, and if they say no, they have less teeth and more problems.
KT: When should people start flossing? How often?
TC: People in their 20s and 30s who do not floss and have a carbs diet can slowly develop cavities, and once a tooth is filled, it’ll need dental work in the future. I see people making a difference and stopping the destruction by flossing. It’s a habit you do need to follow every single day. There was a study reported in the same “anti-flossing” article in The New York Times in which a dentist flossed children’s teeth on school days over the course of two years and found there was a 40 percent reduction in decay in those kids after they started flossing every day.
Because people don’t feel the buildup between their teeth, there’s a cognitive dissonance about this. They brush, but don’t floss. They’re tired. I wanted to reaffirm the message for the community that they still have to do it. I view a person’s teeth as their own little community, a community that needs love from a simple daily act called flossing.
KT: Are some people just lucky in having better teeth?
TC: Five percent of the population genetically have something in their saliva that’s protecting their teeth. They don’t floss and they don’t have periodontal issues, because their body doesn’t provide the inflammatory response for bone loss. However, these people also have good brushing techniques, don’t have a sweet tooth, don’t snack, and never wait too long in between cleanings.
KT: What do you tell your patients so they can take better care of their teeth?
TC: I do a quick behavior interview, find out what foods they’re eating, whether they’re flossing, and get right into an intervention. It’s part of why I enjoy practicing dentistry, I get to see positive change in patients and they are happy to get good news at their cleaning appointments. I would get little job satisfaction if I kept seeing these patients get more cavities on my watch.
KC: What led you to write Avid Flosser?
TC: I ask my patients questions I know will open up a door to their problems, such as how often do you brush and floss, what kind of foods do you eat, and do you like to snack. I started seeing a pattern. The book is an aggregate of all the information people gave me on how teeth get destroyed. I’ve had people cry in my chair when they get the news about the state of their teeth and how much money it’s going to cost them to fix them. Or that they’re about to lose a tooth, which is a body part. Seeing these people in this state is heartbreaking. So I wrote a book on how to not get into those situations.
KT: How important is a good diet in protecting your teeth? What foods are best for your teeth?
TC: A lot of people have a high sugar diet in our country. People say “my family has soft teeth” but in fact they’ve inherited their family’s eating and drinking habits.
If you eat just fat and protein, you’ll never get a cavity. If you eat sugar in between meals by snacking on crackers and potato chips, you will get cavities. If I had brownies before my dinner, the risk of decay goes down because I flushed that sugar down with my food. After you snack, the best way to save your teeth is to chew sugarless gum. Or it could be just a ball of wax — something that removes the build up, like a carrot. Even better is brushing and flossing afterwards.
KT: Your book notes that people on meds tend to get more cavities. Why?
TC: The meds cause dry mouth. Your saliva rebalances the oral environment and prevents cavities and bacteria buildup. Dry mouth is also caused by the natural aging process, so I’m seeing older people on meds with a lot of cavities. A low dose of Ritalin also cuts down on the salivary glands. Kids with ADHD on medication tend to get a bunch of cavities. If they were eating healthy foods, maybe they wouldn’t have to be on meds? That is a question many naturopaths raise.
KT: What do you give your kids for snacks? Do you snack?
TC: My son loves bunny crackers, but after he got one cavity, I decided to rein in his sugar intake. When I have the opportunity, my kids eat avocados, sardines and walnuts for snacks, and they’re stuffed. We know that plant-based fats especially are good for you, so I snack on peanut butter and walnuts. If I’m feeling adventurous I put in chocolate chips.
KT: What are some foods to avoid?
TC: If it’s in a package, then you know it’s cavity causing, unless it’s unsalted peanuts. Granola bars, energy bars, they’re all cavity causing. Dry fruit is more cavity-causing than fresh fruit because the sugar is more concentrated.
KT: What about juices?
TC: Apple cider, to cite one example, consists of concentrated sugar, with the pulp removed. You should rinse out your mouth with water afterwards, as you should after drinking soda. Or better yet, use a straw.
It’s more hygienic to eat an apple, which is fibrous. Fiber helps clean off the teeth. I’ll end my meal with a salad, which gets rid of food stuck to the teeth. And if you love dessert, why not have it before dinner to reduce the risk of decay. Or better yet, no dessert. A percentage of the population won’t change, and you can only ask so much.
KT: What about coffee and alcohol?
TC: Coffee has acidity, but it’s fine; however, if you drink it with sugar, you’re toast. Alcohol will ruin you in other ways, but beer, especially hoppy beer, causes no cavities. Wine is very acidic and also does not produce cavities. After eating sugar, a bacterial waste product called lactic acid is deposited on your teeth, which does the damage. If your mouth has a pH below 5.5 you’ll get cavities.
KT: When I was growing up in the 1960s, we ate mostly processed food. Are kids eating healthier today, with so much more healthy food available?
TC: They’re in school all day drinking sugary drinks and eating chips. There’s more junk food available today than in the past. Even if there’s a good food culture at home, there’s the risk of a bad culture at school. I play basketball at the YMCA and see grown individuals drinking Gatorade, because they think they’ll perform better.
But really, they are just getting cavities. I know, I am no fun.
KT: What made you decide to be a dentist?
TC: I grew up in Greenpoint, Brooklyn. My dad, who had immigrated from Slovakia and was a laborer, kept telling me, “You’re going to be a doctor,” so I chose pre-med as an undergraduate. But I didn’t want to be a doctor. I wanted to do something constructive so I decided to switch to engineering, but I would have had to do an extra two years of college, so I went to the primitive Internet — I used an Alta Vista browser — and looked up professions. When I got to “Dentist,” I knew it was for me. I like my job. I like seeing people who are in a good mood at the dentist’s office, which means providing them with the information that puts them in state where there’s less bad news.
KT: How did you end up in Kingston?
TC: My parents moved out of the city in 1989. I lived in Pine Hill, then Glenford. While I was in dental school I traveled around the country. It was the people who brought me back to the valley. I am used to dealing with people from New York. They are predictable. I couldn’t practice anywhere else. I had a hygienist from Georgia, and she told me in Georgia you can’t talk to patients there like I do here in New York. Here in New York, I can tell people they are part of their problem and they are not offended. But I make sure I offer them reasonable solutions. As long as I do it in a caring environment, I’m telling them, “You’re part of the problem and also part of the solution.”
KT: You opened your office in Midtown at a time where many people were avoiding the area. Why?
TC: It was my best friend’s uncle’s practice, and after he got cancer, he had to sell the practice. Also, I knew in my lifetime Midtown would be changed for this simple reason: it is too unsustainable to have a large population living in the suburbs. The area just needs time and a facelift. I put forth a big effort into making the outside of the building as presentable as possible. I enjoy improving things, whether it’s a mouth or a structure.
KT: What was your role in starting the O+ Festival?
TC: I was at the Truck America concert in Big Indian that was also attended by co-founder and organizer Joe Concra. We met up at a party a few weeks later and we both had similar aspirations of having a similar festival in Kingston. He also heard that I contacted one of the bands, Monogold, from the festival and discussed bartering dental care for playing in Kingston. When Concra told me he was serious about the festival, I told him as a bonus for drawing good acts, I would provide dental care for nothing. That’s when O+ was hitched. I have since kept my word and been providing dental care for O+ artists ever since.
KT: Is there anywhere in town where one can buy your book?
TC: It’s available at the Kingston Candy Store, in my office and at avidflosser.com. You can also borrow it for free and return it at a later date. The designer, Carla Rozman, did a fantastic job in visually laying out the message. She made the book an artistic adventure and made sure every other page was an entire image.