Is Water Flossing Better Than String Flossing?

The future of healthy gums?

waterpik water flosser
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Let me paint a situation for you. You have your dentist check-up tomorrow and you’re madly flossing because you’re worried about your bleeding gums. The main worry you have is that you promised your dentist at your last appointment (which was longer ago than you’d like to admit) that you would floss this time around.

As a dentist for a long time, I saw patients that simply didn’t floss. I heard every excuse in the book.

Naturally, I wondered if there was a better way to floss. Bleeding gums and periodontal disease is a common and serious problem. Even though flossing, in my opinion, was helping my patients, I felt that the larger picture was that we were losing the battle.

Is there a magic solution to this situation? Many of my patients ask if there’s an alternative to flossing. Well, until recently, my answer was no. However, water flossers have provided an interesting alternative to our traditional string and finger method.

Water Flossing: Solution to an Age Old Dentist's Problem

Since dental floss was introduced nearly 200 years ago, oral health-care providers have consistently promoted or even pushed floss use, but flossing compliance has been an ongoing challenge. Regularly flossing is just a hard thing to achieve for patients. That anxiety before dental appointments would often be alleviated if the need to floss would just go away.

The basic premise of a water flosser is to use a water stream to remove biofilm. Besides dislodging plaque and food debris, a water flosser also helps to prevent gum disease and inflammation by flushing away bacteria responsible for gingivitis and other oral infections.

Some data shows that the water flosser and standard floss were equivalent in plaque biofilm removal.

The water flosser, though, may add an extra dimension to plaque removal. The oral microbiome is more complicated than simply the ‘amount of plaque’ present.

Bleeding gums and gum disease begin via an increase of pathogenic bacteria. These occur in pockets hidden away in the mouth. As bleeding gums progresses to gum disease, there is an increase in fluid to the crevice. These may carry factors that help the growth of harmful bacteria.

Water flossers may provide an extra edge in fighting this process.

Do You Need to Floss in the First Place?

Before we even get into the different methods of flossing, let’s attack the problem at a head. If you don’t feel that flossing is important, there’s no fancy gadget that’s going to convince you to do it.

The areas between your teeth account for 35 percent of plaque build-up, and these areas are prone to gingivitis which will lead to gum disease if left untreated. Flossing is designed to clean the plaque in your mouth that builds up in these areas.

Gingivitis or bleeding gums is a very common condition. It’s a signal of inflammation in your mouth and body. Oral hygiene is designed to prevent the build-up of harmful bacteria on your teeth and gums. Between the teeth, particularly, are areas where bacterial imbalances can first begin to happen.

Flossing is designed to prevent bacterial changes that lead to gum disease. Gum disease has been linked to heart conditions, diabetes, and lung infections.

Normal Flossing May Not Be What It's Cracked Up to Be  

Remember, we’re trying to find a solution to something that may not have been a huge problem in the first place. In 2015, the FDA declared that the evidence behind flossing wasn’t justified to specifically recommend it. They stated the following:

"The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year. Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy.”

Now before you throw the floss away, there are limitations to the referenced studies. For one, it’s very difficult to blind the studies, making accurate results even more difficult. In other words, you can’t have individuals who don’t know whether or not they are actually flossing without committing major ethical violations in your research. Plus, people lie to the dentist about how much they floss all the time (I can attest to this).

As a dentist, I’ve seen people’s gums benefit from flossing. This is anecdotal evidence that many dentists agree with. So, the story isn’t clear cut, but we can certainly conclude that conventional floss may not be the answer for everyone.

What Does Research Say About Water Flossing?   

So what do the studies say? The water flosser has been evaluated more than 50 times since its introduction in 1962. Clinical findings for reducing bleeding and gingivitis are supported by positive outcomes from more than 20 clinical trials.

One study in 2013 showed that a water floss in combination with brushing to be significantly more effective than a manual brush and string floss in removing plaque from tooth surfaces.

Other studies have shown significant reduction in plaque over interdental brushes, such as air floss.

Advantages of a Water Flosser

Here are some advantages of a water floss:

  • It is safe and gentle around dental restorations and implants. Maintenance of implants is critical to their long-term survival. A three-month study that compared water flossing with 0.06 percent CHX (chlorhexidine, an active ingredient in mouthwash) delivered with the Pik Pocket™ Tip to rinsing with 0.12 percent CHX found that those who used the water flosser had superior reductions in plaque (29 percent vs. 9 percent), bleeding (62 percent vs. 33 percent), and gingivitis (45 percent vs. 10 percent) over rinsing.
  • Cleaning around orthodontic appliances. Keeping orthodontic appliances (especially for teenagers) clean can be tedious and challenging. Water flossing makes it easier. Adolescents ages 11 through 17 who used a water flosser with the orthodontic tip every day for 4 weeks had three times the reduction in plaque vs. those who used a manual brush and floss, and five times the reduction than those who only brushed. The water flosser group reduced bleeding by 84.5 percent from baseline, which was 26 percent better than brushing and flossing and 53 percent better than toothbrushing alone.
  • It is easy to use. Using a water flosser is easier than string flossing because it requires less manual dexterity. It takes about a minute to cleanse the entire mouth. Beyond the initial investment, all you need is water, although the water flosser can also accommodate most mouth rinses. It is appropriate for people of almost any age; even children as young as 6 with supervision.

Despite these benefits, here is some negative feedback I’ve heard from patients who didn’t like the water flosser when compared to normal floss:

  • It’s bulky and difficult to carry. 
  • It requires, batteries, refilling and maintenance.
  • It's more expensive than regular floss.

Personal Choice Is Key

If there’s anything I’ve learned as a dentist, it’s that people are different. It’s important to know your own preferences. But if there’s one thing we can agree on, it's that your teeth and oral health are important! If regular flossing isn't getting the results you're looking for, a water flosser might be the best option for you.

Sources:

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.

Lyle DM​, Relevance of the water flosser: 50 years of data. Compend Contin Educ Dent. 2012 Apr;33(4):278-80, 282.

Sharma NC, Lyle DM, Qaqish JG, Schuller R. Comparison of two power interdental cleaning devices on plaque removal. J Clin Dent. 2012;23(1):17-21.

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