Raise your hand if you floss every day. (No one's looking, so be honest.)

Turns out, many people are keeping their hands down. In fact, just 41% of American adults floss their teeth daily. And 20% never floss, research shows.

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The American Dental Association says that flossing, also called interdental cleaning, cleans areas of teeth that are tough to reach by brushing only, decreasing your risk of gum disease and tooth decay. They recommend flossing once per day; the time of day you do it is up to you.

Your diet is a major factor in your dental health. The area where each tooth meets your gums is a "girdle of collagen and fibers that helps seal off that junction, keeping bacteria from the outside world out," explains Mark Burhenne, D.D.S., co-creator of Ask the Dentist. If you don't floss and you have a diet that contains processed carbs (birthday cake, crackers, chips), the oral microbiome will shift, favoring the growth of bacteria in the fold of your gums that triggers an immune response. Long-term, this can become chronic inflammation, says Burhenne.

Inflammation can also damage the blood vessels in your gums, says Burhenne. This can contribute to gum recession that's a hallmark of gum disease.

What flossing does is similar to brushing—it disrupts the formation of biofilm, a layer of bacteria that forms a "fuzzy feeling" on teeth; if not removed, it can harden into tartar, which can only be removed at the dentist. Flossing also massages gums to increase circulation, says Burhenne.

Flossing isn't just beneficial to your oral health. Research published over the past two decades shows a significant association between systemic diseases and poor oral health. Thus, flossing plays a role in lowering your risk of, or preventing, some major chronic health conditions. Here are six, according to Burhenne. (Check out his TikTok for more.)

Just as flossing helps lessen oral inflammation, it also helps with chronic inflammation in other parts of your body. In fact, research shows that periodontitis (gum inflammation) is associated with systemic inflammation. It seems that keeping your mouth healthy can help reduce inflammatory compounds like C-reactive protein that circulate throughout your body and stoke the flames of chronic inflammation. It's also this connection between oral health and chronic inflammation that often explains how your mouth influences the rest of your body. "You can't be healthy without a healthy mouth," says Burhenne.

Remember, acute inflammation is good for us (for example, that's the swelling that forms around a cut or sore to promote healing), but chronic inflammation is harmful—and, over time, hinders your immune system. For example, research shows that patients with inflammatory bowel disease often first experience changes in their oral health before gastrointestinal symptoms appear.

A large research study looking at data from more than 4,000 subjects in the National Health and Nutrition Examination Surveys—published in 2020 in the Journal of Alzheimer's Disease—showed that older adults with signs of gum disease and mouth infections at the start of the study were more likely to develop Alzheimer's during the course of the study. The authors suggest that periodontal bacteria may play a role in the course of cognitive decline.

Experts say the connection between flossing, brushing and overall oral health and heart disease isn't all that clear-cut. For instance, a large study published in 2018 found that adult smokers with a missing tooth were at a higher risk of coronary heart disease events. But when they analyzed outside variables that could be responsible for the results, they found that, for men only, smoking likely explained the relationship between poor oral health and heart disease. A later review in 2021 in Frontiers in Cardiovascular Medicine, however, says that data suggests that periodontal disease may indeed increase the risk for arteriosclerosis (where plaque builds up in arteries), as this oral bacteria may get into the bloodstream and/or cause inflammation that sets the stage for plaque formation, though more research is needed.

Research in the Journal of Oral Microbiology on 256 women found that those who had a specific type of oral bacteria associated with periodontal disease were nearly four times less likely to become pregnant compared to women who did not have this bacteria. Though more research is needed to more confidently suggest an association between oral health and female fertility, the study authors suggest that maintaining good oral health and attending routine dental visits may help maximize the chances of getting pregnant.

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It's important to go to the dentist if you're aiming to become pregnant or are pregnant, as these routine visits can catch gingivitis, a mild form of periodontal (gum) disease. Pregnant women with gingivitis who got treatment had a 56% lower risk of preterm birth and were more likely to give birth to higher-weight newborns compared to those who did not receive treatment, according to a meta-analysis of three clinical trials on over 1,000 women published in Oral Health and Preventive Dentistry. The researchers believe that it's the inflammation that results from periodontal disease that may trigger preterm delivery and/or affect the fetus and placenta.

Remember what Burhenne said—you can't be healthy without a healthy mouth. Research shows that you can remove up to 80% of interdental plaque by flossing—and that can lower your risk of developing cavities and prevent periodontal disease. So, get flossing, folks!