Plaque removal efficacy of a water flosser compared to string floss: What is the best?
Posted on 3rd April 2017 at 18:40
WaterPik, is an oral irrigator or dental water jet, is a device that aims a stream of water at the teeth to remove food particles. The dental floss is a flexible strand of nylon or plastic filaments that mechanically removes food trapped between teeth and the film of bacteria that forms before it has a chance to harden into plaque. Which one is better for our patients health?.
Dental floss is an inexpensive way to help keeping your teeth and gums healthy but for most people it is very hard to use it, some says it can be irritating, specially when using too much strength, and even can cause bleeding of the gums. Also dental floss can't be used by people who wear braces. In the other hand, an oral irrigator is perfect for people who wear braces.
The word “WaterPik” is a registered trademark invented in 1962 by Water Pik, Inc., according to the company's website, but Waterpik has become a generic term for any device that shoots water into the teeth to clean them, it was invented looking for a product that could clean areas of the oral cavity that are not readily assessable by traditional methods such as toothbrushing and dental flossing.
Which one is better ?
Water Pik, Inc published a study in The Journal of Clinical Dentistry in 2005 made by Barnes, conducted at the University of Nebraska Medical Center, College of Dentistry, Lincoln, Nebraska. USA. The purpose of the study was to evaluate the ability of a Waterpik® Water Flosser paired with either a power or manual toothbrush, and a manual toothbrush and floss, to reduce gingivitis, bleeding and supragingival plaque biofilm. During four weeks they evaluated one hundred and five subjects. One group used a Waterpik® Water Flosser with a manual toothbrush and a second used the Waterpik® Water Flosser with a power toothbrush. The control group used a manual toothbrush and floss. Subjects brushed twice daily and used either the Water Flosser or dental floss once daily. Plaque biofilm, bleeding, and gingivitis were evaluated at two and four weeks. According to their results at 4 weeks, the addition of a Water Flosser resulted in significantly better oral health, regardless of toothbrush type used over manual brushing and flossing. Adding the Waterpik® Water Flosser was up to 93% better in reducing bleeding and up to 52% better at reducing gingivitis than traditional dental floss.
By 2013 a new study was published in the same journal. This time it was conducted by Goyal CR, Lyle DM, Qaqish JG and Schuller R from BioSci Research Canada Ltd., Mississauga, Ontario, Canada. Their objective was very similar to the first study, to compare the plaque removal efficacy of a water flosser to string floss combined with a manual toothbrush after a single use. In their study participated seventy adults. Even though there were less subjects, their study had a randomized, single use, single blind clinical study. Subjects were assigned to one of two groups; Waterpik Water Flosser plus a manual toothbrush (WF) or waxed string floss plus a manual toothbrush (SF). Each participant brushed for two minutes using the Bass technique. The WF group added 500 ml of warm water to the reservoir and followed the manufacturer's instructions, and the SF group used waxed string floss between each tooth, cleaning the mesial and distal surfaces as instructed. The group that used the oral irrigator had a 74% reduction in whole mouth plaque and 81,6% for approximal plaque compared to 57,7% and 63,4% for the group that used string floss, respectively.
In conclusion, the oral irrigator can be expensive to purchase, and will need space for storage. It requires access to electricity and water, making it difficult to use outside of the home. But it has an extensive body of evidence that demonstrates its safety and efficacy with multiple patients and different oral care needs, although some authors recommend it. Dental professionals need to evaluate the evidence for each specific product, as studies are not transferable between technologies and manufacturers and all studies have been done using the Waterpik Water Flosser.
Barnes CM, et al. J Clin Dent, 2005; 16(3): 71-77.
Deborah M. Lyle. What constitutes new technology? Water flossing revisited. Industry News. 2013.
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.
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