Water flossing is a way to clean between and around teeth using a handheld device called the water flosser that sprays streams of water in steady pulses. A water flosser is a device also known as an oral irrigator or dental water jet. The water spray, like traditional floss, removes accumulated food particles and the bacterial plaque formed between teeth. This becomes even more critical in people who have had dental work done, such as crowns, bridges, fillings, braces etc —that makes traditional flossing difficult.

Why do people need additional cleaning in the interproximal spaces between the teeth ?

The interdental areas, especially the posterior, are the least accessible to toothbrushes, which leads to accumulation of soft and/ or hard deposits in the space between teeth in almost all patients. For the same reason, periodontal and gingival lesions are predominantly observed at these sites. Since interproximal areas are also frequently affected by caries, interproximal cleaning represents a critical component of oral self-care.

Hence, patients should devote additional time and go beyond regular toothbrushing, and clean the interdental areas.

Does flossing, as prescribed by the dentists, really help?

Problems with flossing:

Although flossing has received the most attention, the difficulty associated with flossing makes this technique less than universal in its application.

1. Studies that have compared flossing with toothbrushing have found that their combined use produces no clear benefit.
2. Self-flossing has no effect on reducing caries risk.
3. Self-performed dental flossing may not be effective in reducing bacterial plaque and gingival inflammation.
4. Also, the improper use of dental floss may result in lacerations of the interdental papilla.
5. An inability to floss correctly may further reduce motivation.
6. Historically, compliance with regular flossing has been far less than ideal. The probability of consistent use of dental floss has been shown to be dramatically low.
7. Research has shown a range of daily use among adults ranging from 10% to as high as 30% due to lack of patient ability and lack of motivation.

Water-flossers: Many patients find it easier to use water flossers compared to mechanical interdental aids.

1. Compared to toothbrushes and mouth rinses, water-flossers can remove nonadherent bacteria and debris from the oral cavity more effectively.
2. Water-flossers are most effective in debriding the inaccessible areas around orthodontic appliances and fixed prostheses.
3. Water-flossers, when used as adjuncts to toothbrushing, can exert a beneficial effect on the periodontal health by reducing the microbial plaque biofilm accumulation as well as calculus build up.
4. Clinically, supragingival irrigation with water flossers reduces gingival inflammation and pocket depth.
5. Water-flossing is not a monotherapy but an adjunct designed to supplement or enhance other mechanical plaque removal home care methods, such as brushing and flossing.

Special use case:

Daily supragingival irrigation with dilute chlorhexidine for 6 months reduced gingival inflammation and bleeding much more significantly compared to plain water irrigation and chlorhexidine rinse.

Indications

Water-flosser can be recommended as an adjunct to regular toothbrushing for

1. Patients who lack motivation
2. Patients who lack manual dexterity
3. Patients wearing orthodontic braces
4. Individuals who present with closed type 1 embrasures
5. People who have implants Plakoff Water Flosser 3
6. People who have overdentures

American Academy of Periodontology (2001)

“Among individuals who do not perform excellent oral hygiene, supragingival irrigation with or without medicaments is capable of reducing gingival inflammation beyond that nor‐ mally achieved by toothbrushing alone. This effect is likely due to the flushing out of subgingival bacteria”.

Plakoff Water flosser: