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No longer tied down by string floss: Good oral health in teenage boy prompts hygienist to check out water flossers

July 21, 2016
Good oral health in teenage boy prompts hygienist to check out water flossers

Good oral health in teenage boy prompts hygienist to check out water flossers

I graduated from dental hygiene school on June 4, 2004. Armed with shiny new instruments and buzzing with clinical information, I was ready to take on gingivitis and periodontal disease. Like every new dental hygienist, I felt ready to lead the charge in oral disease prevention. I was an oral health educator, a gingivitis superhero! All of my patients would floss! Oh, the powers this seemingly innocuous string seemed to carry-it could remove plaque biofilm and prevent gingivitis and tooth decay.

What I seemed to have overlooked in all of my excitement was how quickly this minty little spool of string would unravel my best efforts at oral hygiene instruction. I could recommend a wide variety of interdental aids- picks, sticks, tips, and brushes-but just mentioning the word "floss" would elicit unpleasant reactions from my patients. I saw denial, anger, sadness, regret, and excuses-especially excuses. Each of us might have a few
"unicorn patients" whose oral care habits rival those of any hygienist, but sadly, this is not the norm. The statistics agree.

Survey data indicates that three of four Canadians1 and two of three Americans2,3 visit a dental professional on an annual basis. These surveys also found that the majority of Canadians and Americans brush their teeth at least twice a day.1,2,3 Yet, in both countries, the rate of flossing was abysmally
low.1,2,3 Are patients not being taught the importance of complete plaque removal, including what can't be reached by brushing alone? I don't think that's the case at all. I'm guessing most of you are like me-committed to motivating patients to take charge of their oral health.

For most of the 12 years that I have practiced dental hygiene, I tried (desperately) to make patients compliant with using the almighty string floss. It was frustrating, and I often sensed that my efforts were completely futile. I was stuck inside the box the floss came in.


An alternative method of plaque control I dismissed early in my career now has me completely abandoning string floss-the water flosser. Initially, I thought the water flosser was just a fancy tool for mouth rinsing with no proven clinical effectiveness. It took a teenage boy to completely change my mind.

One of the things that I regularly do in my clinical practice is ask patients, "What do you use at home to keep your mouth clean?" This question
gives me a way to open up the oral health discussion without even mentioning the F-word, and I'm often surprised by what I hear.

The case that changed my perspective involved a teenage boy in mid-orthodontic treatment who had been scheduled for preventive maintenance every three months due to his history of plaque and gingivitis. When I asked the question, he informed me that his orthodontist "told [his] mom to get [him] this 'water thingy,' so [he was] using that every day." Truth be told, before I even looked in his mouth, I had already formed an opinion about what I would see, based on his history and my preconceived notions about the efficacy of water flossing. Imagine how shocked I was when he-a teenage boy in full orthodontics-opened his mouth and revealed virtually plaque-free teeth with healthy pink gingiva throughout. Obviously, I needed to take a closer look at the research on water flossing.

Continuing to learn and grow as a professional is very important to me, so I took my task quite seriously. One of the first studies I found was very surprising. It found that the pulsation and pressure produced by the water flosser created sheer hydraulic forces that removed 99.9% of plaque biofilm from treated areas.4

Another study found the water flosser was 29% more effective than string floss for plaque removal.5 Not only did I see how effective it was with my patient, but the amount of research backing up the evidence was hard to ignore. I now recommend water flossing over string flossing for all of my patients, and the response has been overwhelming. I am continually seeing healthier mouths in my practice.

As a hygienist, I never thought I would be able to detangle myself from the almighty string floss. But untying myself and my patients has improved my patients' oral health and the dynamics of their hygiene visits. There are no more excuses! The water flosser provides more than just interdental cleaning-it leads to overall healthier mouths. I'm happy to leave that string behind! RDH

Kryssi McKiel, RDH, BS, is a practicing dental hygienist from Langley, British Columbia. She is also an independent professional educator on behalf of Water Pik, Inc. She can be contacted at [email protected].


1. Health Canada. Canadian Health Measures Survey (CHMS). 2010. http://www.hc-sc.gc.ca /hl-vs/pubs/oral-bucco/fact-fiche-oral-bucco-stat-eng.php. Updated April 16, 2010.
2. American Dental Association. Survey finds shortcomings in oral health habits. ADA News. http://www.ada.org/en/publications/ada-news/2014-archive/october/survey-finds-shortcomings-in-oral-health-habits. Published October 20, 2014.
3. Delta Dental. 2014 Oral Health and Well-Being Survey. https://www.deltadental.com/DDPAOralHealthWellBeingSurveyBrochure2014.pdf. Published 2014.
4. Gorur A, Lyle DM, Schaudinn C, Costerton JW. Biofilm removal with a dental water jet. Compend Contin Educ Dent. 2009;30(Spec No 1):1-6.
5. Goyal CR, Lyle DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J Clin Dent 2013;24(2):37-42.