Efficacy of Water Flossing on Clinical Parameters of Inflammation and Plaque: A Four-Week Randomised Controlled Trial
Lyle DM, Qaqish JH, Goyal CR, Schuller R. Int J Dent Hyg 2023; 21:659–668.
Objective
To compare the efficacy of a pulsating water flosser with a pulsating water flosser infused with air microbubbles on clinical signs of inflammation and plaque. Manual brushing and flossing were included as a positive control.
Methodology
One hundred and five subjects were randomised into three groups in this four-week, single-blind, parallel clinical trial.
-
Group 1: Waterpik™ ION Water Flosser
-
Group 2: Oral-B® Advanced Water Flosser
-
Group 3: Waxed dental floss
All groups used a manual toothbrush twice daily for two minutes with fluoride toothpaste. Participants were not permitted to use additional interdental products or mouth rinses. All received written and verbal instructions.
Bleeding, gingivitis, and plaque were measured at baseline, two weeks, and four weeks using the following indices: Bleeding on Probing (BOP), Modified Gingival Index (MGI), and the Rustogi Modification of the Navy Plaque Index (RMNPI).
Results
From baseline to four weeks, the Waterpik Water Flosser was more effective at removing plaque and reducing inflammation than either the Oral-B Advanced Water Flosser or string floss.
Compared with the Oral-B Advanced, the Waterpik Water Flosser was:
-
26% more effective at reducing bleeding
-
26% more effective at reducing gingivitis
-
22% more effective at removing plaque (whole-mouth scores)
When compared with traditional floss, it was up to 2X as effective at reducing whole-mouth bleeding and removing plaque, and 85% more effective at reducing gingivitis.
In proximal areas, it was up to 7X as effective as string floss at removing plaque, up to 2X as effective at reducing bleeding, and 90% more effective at reducing gingivitis.
Conclusion
This study demonstrated that a manual toothbrush and water flosser, with or without air microbubbles is more effective than string floss for improving gingival health over a 4-week period. The study also indicates that the Oral B® device infused with air microbubbles did not provide an advantage in improving oral health over the Waterpik ION water flosser.