Research data has evolved supporting the use of H2O for flossing
by Carol Jahn, RDH, MS
It's been nearly 14 years since I started working for the company that makes the Waterpik Water Flosser. Back then, the company was Teledyne Waterpik and the product was the Waterpik Oral Irrigator. I knew the product worked because I had seen results firsthand with my patients. What I didn't know, and was embarrassed to find out, was just how much research had been done on the product. You see, back in the dark ages (the 1980s), most of us were not told much about the device in school.
Today, many dental professionals recommend the water flosser with confidence, yet truthfully, there is still room for growth. I'm still amazed when someone approaches me after a CE course or at a tradeshow and tells me they don't know much about our product. Yet I'm proud of them, and grateful they had courage to ask, and of course I'm happy to help them.
So how much do you know about the Waterpik Water Flosser?
1. It does not remove plaque. False
The evidence: A study conducted at the University of Southern California School of Dentistry, with renowned biofilm expert Dr. Bill Costerton, evaluated the removal of plaque biofilm with a Water Flosser using a scanning electron microscope. Periodontally involved teeth with existing plaque were extracted, and then processed to accelerate biofilm growth. The teeth were then subjected to a three-second treatment with the Water Flosser. Viewing the teeth under a highly sensitive microscope, the researchers were able to see far more than with traditional measures, such as staining and viewing with the naked eye. The microscope revealed that 99.9% of the plaque biofilm was removed by Water Flosser treatment.1
2. It can drive bacteria in the pocket and damage the tissue. False
The evidence: A study conducted at the University of Missouri Kansas City examined 32 extracted teeth, each with pocket depths of 6 mm and no prior instrumentation for at least six months. Half the teeth were treated with the Water Flosser at 60 psi for eight seconds using only water prior to the extraction. The specimens were treated and examined for bacteria levels by scanning electron microscopy and transmission electron microscopy for evidence of tissue damage and/or ulcerations. The investigators found that the Water Flosser reduced the number of microorganisms up to 6 mm. In comparison, the untreated areas had thick mattes of microbes. There were no observable differences between the control and test specimens in regard to the integrity of the pocket soft tissue wall, nor was there any evidence of bacterial penetration.2
3. It needs to be used with an antimicrobial to be effective. False
The evidence: The majority of studies conducted on the Waterpik Water Flosser have been done with plain tap water. A study at Baylor University in Texas found that patients who added the Water Flosser with water to regular oral hygiene for only two weeks had better reductions in plaque biofilm, bleeding, gingivitis, and probing depth than those who used traditional measures. The study also evaluated the level of inflammatory cytokines associated with attachment and bone loss. The Water Flosser reduced the production of these agents within two weeks. The measures were taken eight hours post irrigation to avoid any dilution effects. The investigators concluded that using the Water Flosser with water for only 14 days provided clinical benefits for patients with chronic periodontal disease, including a down modulation of proinflammatory cytokines.3
4. It's only for people with ortho. False
The evidence: The Water Flosser is safe and effective on patients of almost any age, from 10 to 100. Most studies have been conducted on people with gingivitis or in periodontal maintenance, but it can be used on patients who have a variety of unique oral health needs. The Water Flosser is excellent for people with crown and bridge.4 It has been tested on patients with implants and found to reduce bleeding 87% better than rinsing with 0.12% chlorhexidine.5 People with type 1 or 2 diabetes used the product post scaling and root planing and had a 44% better reduction in bleeding and 41% better reduction in gingivitis than those who used traditional self-care.6 The new orthodontic tip makes it an ideal choice for people with orthodontic appliances. Adolescents who used this tip with plain water removed three times as much plaque as those who flossed with a floss threader. Those who used the Water Flosser had a 26% better reduction in bleeding.7
5. It is an easier and more effective alternative to string floss. True
The evidence: A 2005 University of Nebraska study demonstrated that the addition of the Water Flosser once daily with water and used with either a manual or power brush, was an effective alternative to string floss for reducing bleeding, gingivitis, and plaque biofilm. It provided superior results in reducing inflammation, with the Water Flosser up to 93% better at reducing bleeding, and up to 52% better at reducing gingival inflammation over string floss. Significant improvements in oral health occurred regardless of toothbrush type, so it was deemed likely that many patients currently using a power toothbrush might improve their oral health with the addition of a Water Flosser.8
A study was conducted at the University of Amsterdam Center for Dentistry in 2010. In this four-week trial, manual toothbrushing combined with the Water Flosser with the Classic Jet Tip, or a new tip called the Plaque Seeker Tip, was compared to manual toothbrushing combined with string floss. After two weeks, subjects using the Water Flosser had twice the reduction in bleeding versus those using string floss. After four weeks, the results between the tips and string floss were even more dramatic. There was no difference in plaque biofilm removal between the tips and dental floss at any point.9
If some of this information was surprising to you, that's OK. Since its introduction in 1962, information about the Water Flosser has evolved a great deal. Many practitioners confidently recommend it to patients and are getting great results. Whether patients are trying to keep their periodontal disease in remission, have implants, have ortho, suffer from diabetes, or just plain do not like to floss, the Water Flosser can help them improve their oral health.
Carol Jahn, RDH, MS, is the senior professional relations manager for Water Pik, Inc.
1. Gorur A, et al. Biofilm removal with a dental water jet. Compend Contin Educ Dent 2009; 30 (Suppl 1):1-6.
2. Cobb CM, et al. Ultrastructural examination of human periodontal pockets following the use of an oral irrigation device in vivo. J Periodontol 1988; 59:155-163.
3. Cutler CW, et al. Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol 2000; 27:134-143.
4. Krajewski J, et al. Evaluation of a water pressure cleaning device as an adjunct to periodontal treatment. J Amer Soc Periodont 1964; 2:76-78.
5. Felo A, et al. Effects of subgingival chlorhexidine irrigation on peri-implant maintenance. Am J Dent 1997; 10:107-110.
6. Al-Mubarak S, et al. Comparative evaluation of adjunctive oral irrigation in diabetes. J Clin Periodontol 2002; 29:295-300.
7. Sharma NC, et al. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2008; 133:565-571.
8. Barnes CM, et al. Comparison of irrigation to floss as an adjunct to toothbrushing: Effect on bleeding, gingivitis, and supra-gingival plaque. J Clin Dent 2005; 16:71-77.
9. Rosema NAM et al. The effect of different interdental cleaning devices on clinical paramenters. Presented at IADR, Barcelona, Spain, July 17, 2010. Abstract #3797.
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