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.
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