Evaluation of the Addition of a Water Flosser to Manual Brushing on Gingival Health.

OBJECTIVES: The purpose of this clinical trial was to compare the use of a manual toothbrush plus water flosser to a manual toothbrush alone on clinical signs of inflammation. METHODS: Seventy-two subjects were randomized into two groups and completed this four-week, single-blind, parallel, clinical trial. Group 1 used a Waterpik®Water Flosser (WF) once daily and brushed with a manual toothbrush twice a day. Group 2 brushed twice a day with a manual toothbrush only (MT). Subjects in group 1 were provided written and verbal instructions for the water flosser and all participants used the toothpaste and manual brush provided, brushing as they normally do. Data were evaluated at baseline (BSL), two weeks (W2), and four weeks (W4) for bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification of the Navy Plaque Index (RMNPI). RESULTS: Both groups showed a significant reduction from BSL for BOP, MGI, and RMNPI at W2 and W4, except for MT W2 facial proximal MGI (p = 0.153) and marginal RMNPI (p = 0.324). The WF was significantly more effective than the MT for reducing BOP, MGI, and RMNPI at W2 and W4 for all areas measured. The WF was 3.13 times as effective for reducing BOP, 2.69 times for MGI, and 2.44 times for RMNPI at W4 (p < 0.001) for whole mouth scores. CONCLUSIONS: The addition of the Waterpik®Water Flosser to manual tooth brushing is significantly more effective for improving gingival health than manual tooth brushing alone.

Comparison of Water Flosser and Interdental Brush on Reduction of Gingival Bleeding and Plaque: A Randomized Controlled Pilot Study.

OBJECTIVES: The purpose of this randomized, two-week, single blind, two-group parallel pilot study was to compare the reduction in gingival bleeding and plaque in subjects using a water flosser or interdental brush, each combined with a manual toothbrush. METHODS: Twenty-eight subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik® Water Flosser (WF) plus manual toothbrush or interdental brushes (IDBs) plus a manual toothbrush. Bleeding on probing (BOP) was measured at six sites and reported for whole mouth, lingual, facial, and interproximal areas. Plaque data were measured using the Rustogi Modification of the Navy Plaque Index (RMNPI) and were reported for whole mouth, approximal, marginal, facial, and lingual areas. Subjects received verbal and written instructions on the use of their interdental product and demonstrated proficiency prior to starting the study. RESULTS: There were no differences between the groups for BOP or RMNPI at baseline. Both groups demonstrated a significant reduction in BOP and RMNPI for all regions and areas measured from baseline to two weeks. The WF was more effective than the IDBs for BOP whole mouth (56%), facial (44%), approximal whole mouth (53%), and approximal facial (41%). Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between groups for lingual and marginal assessments for BOP or any area for RMNPI. CONCLUSIONS: The Waterpik Water Flosser is more effective than IDBs for reducing gingival bleeding over two weeks.

Comparison of Water Flosser and Interdental Brush on Plaque Removal: A Single-Use Pilot Study.

OBJECTIVES: The purpose of this randomized, single-use, single-blind, two-group, parallel pilot study was to compare the plaque removal ability of a water flosser and interdental brush when used in combination with a manual toothbrush. METHODS: Twenty-eight (28) subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik®Water Flosser (WF) plus manual tooth brushing or interdental brushes (IDB) plus manual tooth brushing. Pre-cleaning plaque scores were obtained using the Rustogi Modification of the Navy Plaque Index (RMNPI). Subjects were instructed on the use of their interdental product. Post-cleaning scores were obtained after a supervised brushing and use of the interdental device. Scores were recorded for whole mouth, marginal, approximal, facial, and lingual regions for each subject. RESULTS: There were no differences between the groups for pre-cleaning plaque scores for whole mouth, marginal, approximal, facial, or lingual regions. Both groups showed significant reductions in plaque from baseline for all areas measured (p < 0.001). The WF group was significantly more effective than the IDB group for removing plaque from all areas measured. Specifically, the WF was 18% more effective for whole mouth and marginal areas, 20% for approximal areas, 11% for facial areas, and 29% for lingual areas. CONCLUSIONS: The Waterpik Water Flosser and manual toothbrush removes significantly more plaque from tooth surfaces (whole mouth, marginal, approximal, facial, and lingual) than interdental brushes and a manual toothbrush after a single use.

Efficacy of Two Interdental Cleaning Devices on Clinical Signs of Inflammation: A Four-Week Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare the reduction of the clinical signs of inflammation by two power interdental cleaning devices combined with a manual toothbrush. METHODS: Sixty-nine subjects completed this randomized, four-week, single-blind, two-group, parallel clinical study. Subjects were randomly assigned to one of two treatment groups: Waterpik Water Flosser (WF) plus a manual toothbrush; or Sonicare Air Floss Pro (AFP) plus a manual toothbrush. All subjects received both written and verbal instructions and demonstrated proficiency prior to starting the study. Instructions were reviewed at the two-week visit (W2). Data were evaluated for whole mouth, lingual, and facial areas for bleeding on probing (BOP) and Modified Gingival Index (MGI). Plaque data were recorded for whole mouth, lingual, facial, approximal, and marginal areas of the tooth using the Rustogi Modification of the Navy Plaque Index (RMNPI). BOP, MGI, and RMNPI were scored at baseline (BSL), two weeks, and four weeks (W4). RESULTS: Both groups showed significant reductions in BOP and MGI from baseline for all regions and time points measured (p < 0.001). Both groups showed significant reductions from baseline for all areas at W4 for RMNPI (p < 0.001). The WF group was significantly more effective than the AFP group at reducing bleeding and gingivitis for all areas measured at all time points. At W4, the WF group was 54% more effective for bleeding and 32% for gingivitis (p < 0.001). Plaque accumulation was significantly less at W4 for the WF group compared to the AFP group (28%, p 0.017). CONCLUSIONS: The Waterpik Water Flosser is significantly more effective than the Sonicare Air Floss Pro for reducing clinical signs of inflammation.

Dental hygiene and research: irrevocably connected.

UNLABELLED: Although remarkable growth has occurred in the dental hygiene research arena, an increased emphasis on research development will facilitate the designation of dental hygiene as a true discipline. BACKGROUND: Dental hygienists have participated in research for nearly 100 years. Support for research development has increased due to contributions of the American Dental Hygienists' Association and other grant monies that have funded seminal educational endeavors to elevate the research skills of dental hygienists. Dental hygiene initiated research endeavors, the advent of doctoral degree programs in dental hygiene, expansion of the dental hygiene body of knowledge, and efforts toward interprofessional collaboration continue to elevate the profession of dental hygiene while addressing the oral health needs of the public. METHODS: The research focus in dental hygiene is reviewed. Landmark events that have supported research endeavors are described and examples of historically important global contributions made by dental hygienists are chronicled. CONCLUSIONS: Further development of a body of dental hygiene research will help position the profession alongside other academically recognized health care disciplines. A small, dedicated group of dental hygienists have worked toward advancing the profession in this way, but additional growth is essential if dental hygiene is to be considered a true discipline. One such initiative on the near horizon is the doctoral degree in dental hygiene.

Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use.

OBJECTIVE: To compare the plaque removal efficacy of a water flosser to string floss combined with a manual toothbrush after a single use. METHODS: Seventy adult subjects participated in this randomized, single-use, single-blind, parallel 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. Subjects were observed to ensure they covered all areas and followed instructions. Scores were recorded for whole mouth, marginal, approximal, facial, and lingual regions for each subject using the Rustogi Modification of the Navy Plaque Index. RESULTS: The WF group had a 74.4% reduction in whole mouth plaque and 81.6% for approximal plaque compared to 57.7% and 63.4% for the SF group, respectively (p < 0.001). The differences between the groups showed the water flosser was 29% more effective than string floss for overall plaque removal and approximal surfaces specifically (p < 0.001). The WF group was more effective in removing plaque from the marginal, lingual, and facial regions; 33%, 39%, and 24%, respectively (p < 0.001). CONCLUSION: The Waterpik Water Flosser and manual toothbrush is significantly more effective than a manual brush and string floss in removing plaque from tooth surfaces.

Effectiveness of subgingival irrigation and powered toothbrush as home care maintenance protocol in type 2 diabetic patients with active periodontal disease: A 4-month randomized controlled trial.

Background: There is a bidirectional link between diabetes and periodontal disease. Control of active periodontal infection is an essential requisite to maintain optimal oral and systemic health in diabetic patients. The purpose of this study was to evaluate the efficacy of subgingival irrigation and powered toothbrush as home care maintenance protocol in type 2 diabetic patients with active periodontal disease compared to routine oral hygiene. Materials and Methods: Forty (n = 40) diabetic (HbA1c >7%) patients were enrolled in this parallel, examiner-blind, interventional clinical trial. Patients were randomized into two groups: Group A (sonic toothbrush and irrigation with water twice daily) or Group B (manual toothbrush and mouth rinsing with 0.12% Chlorhexidine gluconate (CHX) twice daily)). All patients received Phase I therapybefore the start of the study. Clinical parameters (plaque index [PI], gingival index [GI], oral hygiene index [OHI], pocket depth [PD], clinical attachment level [CAL], and bleeding index [BI]) were assessed at baseline, 1, 2, and 4 months. Levels of C-reactive protein (CRP), HbA1c, and interleukin (IL)-1 ß were assessed at baseline and 4 months only. Verbal and written instructions were provided to each subject specific to their intervention allocation. Descriptive, parametric, and nonparametric analyses were used where appropriate. Results: Sixteen (n = 16) patients in Group A and fifteen (n = 15) patients in Group B completed the 4-month study. Both groups showed a significant difference in BI, PD, CAL, and HbA1c from baseline to 4 months. There were no differences within groups for OHI, GI, or PI and CRP, IL-1 ß. The results are based on an underpowered study due to the drop out of 9 patients reducing the number below the needed 19 patients per group based on the power analysis. Conclusion: Results from this study provide information for future studies on self-care regimens for individuals living with Type 2 diabetes.

Relevance of the water flosser: 50 years of data.

A review of the literature answers many questions related to the use of water flossers, the first of which was introduced in 1962. Numerous studies suggest that water flossers remove biofilm from tooth surfaces and bacteria from periodontal pockets better than string flossing and manual toothbrushing-together or alone. Clinicians should review these findings and consider recommending water flossers for appropriate patients to improve their oral health. As different irrigation or water-flossing devices now on the market offer different features, designs, and combinations of pulsation and pressure, clinicians must consider the needs of individual patients and supporting research in selecting a model that the patient will like and use, and that will provide improved oral health.

Comparison of two power interdental cleaning devices on plaque removal.

OBJECTIVE: The objective of this randomized, single-use, single-blind, two-group, parallel clinical trial was to evaluate the supragingival plaque removal efficacy of two power interdental devices combined with a manual toothbrush. METHODS: Eighty-two (82) subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik Water Flosser (WF) plus manual tooth brushing or Sonicare Air Floss (AF) plus manual tooth brushing. Pre-brushing and interdental cleaning scores were obtained using the Rustogi Modified Navy Plaque Index (RMNPI). Subjects were instructed on the use of the manual toothbrush and assigned an interdental product. Post-brushing and interdental cleaning scores were obtained after a supervised two-minute brushing and use of the interdental device. Scores were recorded for whole mouth, marginal, approximal, facial, and lingual regions for each subject. RESULTS: There were no differences in the pre-cleaning plaque scores for whole mouth, marginal, approximal, facial, or lingual regions. Both groups showed significant reductions in plaque from baseline for all regions. The WF group demonstrated significantly higher reductions as measured by the RMNPI compared to the AF for whole mouth (74.9% vs. 57.5%), marginal (58.6% vs. 36.7%), approximal (92.1% vs. 77.4%), facial (83.6% vs. 69.1%), and lingual (65.7% vs. 45.4%). CONCLUSION: The use of the Waterpik Water Flosser removes significantly more plaque from tooth surfaces (whole mouth, marginal, approximal, facial, and lingual) than the Sonicare Air Floss when used with a manual toothbrush.

Comparison of two power interdental cleaning devices on the reduction of gingivitis.

OBJECTIVE: The objective of this study was to compare the reduction of gingivitis by two power interdental devices combined with a manual toothbrush. METHODS: Eighty-two subjects completed this randomized, four-week, single-blind, two-group parallel clinical study. Subjects were randomly assigned to one of two groups: Waterpik Water Flosser (WF) plus manual tooth brushing or Sonicare Air Floss (AF) plus manual tooth brushing. Subjects were provided written and verbal instructions for all products at the baseline visit and instructions were reviewed at the two-week (W2) visit. Data were evaluated for whole mouth, lingual, and facial areas for gingivitis and bleeding on probing. Plaque data were evaluated for whole mouth, lingual, facial, approximal, and marginal areas of the tooth. Gingivitis, bleeding on probing, and plaque were scored at baseline (BSL), two weeks, and four weeks (W4). RESULTS: Both groups showed significant reductions in gingivitis, bleeding on probing, and plaque from baseline for all regions and time points measured (p < 0.001). The WF group was significantly more effective than the AF group at reducing plaque and gingivitis at W2 and W4 for all areas measured (p <0.001). At W4, the WF group was 80% more effective than AF for whole mouth gingivitis reduction, and twice as effective for the lingual region. In terms of plaque removal at W4, the WF group was 70% more effective for whole mouth (50.9% vs. 30%), 60% for approximal area (76.7% vs. 48%), and 47% for facial (52.8% vs. 35.9%) surfaces. The WF was twice as effective for lingual areas and more than three times as effective for marginal areas vs. the AF group (p <0.001). Results for bleeding on probing showed the WF group was numerically better than the AF group for all areas and time points, with these improvements being statistically significance for whole mouth (p = 0.02) and facial area (p = 0.004) at W2, and for the facial area (p = 0.02) at W4. CONCLUSION: The Waterpik Water Flosser is significantly more effective than Sonicare Air Floss for reducing gingivitis and plaque.

The addition of a water flosser to power tooth brushing: effect on bleeding, gingivitis, and plaque.

OBJECTIVE: The primary objective of this study was to compare the effectiveness of a water flosser plus sonic toothbrush to a sonic toothbrush alone on the reduction of bleeding, gingivitis, and plaque. The secondary objective was to compare the effectiveness of different sonic toothbrushes on bleeding, gingivitis, and plaque. METHODS: One-hundred and thirty-nine subjects completed this randomized, four-week, single-masked, parallel clinical study. Subjects were assigned to one of four groups: Waterpik Complete Care, which is a combination of a water flosser plus power toothbrush (WFS); Sensonic Professional Plus Toothbrush (SPP); Sonicare FlexCare toothbrush (SF); or an Oral-B Indicator manual toothbrush (MT). Subjects were provided written and verbal instructions for all power products at baseline, and instructions were reviewed at the two-week visit. Data were evaluated for whole mouth, facial, and lingual surfaces for bleeding on probing (BOP) and gingivitis (MGI). Plaque data were evaluated for whole mouth, lingual, facial, approximal, and marginal areas of the tooth using the Rustogi Modification of the Navy Plaque Index (RMNPI). Data were recorded at baseline (BL), two weeks (W2), and four weeks (W4). RESULTS: All groups showed a significant reduction from BL in BOP, MGI, and RMNPI for all areas measured at the W2 and W4 visits (p < 0.001). The reduction of BOP was significantly higher for the WFS group than the other three groups at W2 and W4 for all areas measured (p < 0.001 for all, except p = 0.007 at W2 and p = 0.008 for W4 lingual comparison to SPP). The WFS group was 34% more effective than the SPP group, 70% more effective than the SF group, and 1.59 times more effective than the MT group for whole mouth bleeding scores (p < 0.001) at W4. The reduction of MGI was significantly higher for the WFS group; 23% more effective than SPP, 48% more effective than SF, and 1.35 times more effective than MT for whole mouth (p <0.001) at W4. The reduction of MGI was significantly higher for WFS than the SF and MT for facial and lingual surfaces, and more effective than the SPP for facial surfaces (p < 0.001) at W4. The WFS group showed significantly better reductions for plaque than the SF and MT groups for whole mouth, facial, lingual, approximal, and marginal areas at W4 (p < 0.001; SF facial p = 0.025). For plaque reduction, the WFS was significantly better than the SPP for whole mouth (p = 0.003) and comparable for all other areas and surfaces at W4. The WFS was 52% more effective for whole mouth, 31% for facial, 77% for lingual, 1.22 times for approximal, and 1.67 times for marginal areas compared to the SF for reducing plaque scores at W4 (p < 0.001; SF facial p = 0.025). The SPP had significantly higher reductions than the SF for whole mouth and lingual BOP and MGI scores, and whole mouth, approximal, marginal, and lingual areas for plaque at W4. CONCLUSION: The Waterpik Complete Care is significantly more effective than the Sonicare FlexCare toothbrush for reducing gingival bleeding, gingivitis, and plaque. The Sensonic Professional Plus Toothbrush is significantly more effective than the Sonicare Flex-Care for reducing gingival bleeding, gingivitis, and plaque.

The effect of different interdental cleaning devices on gingival bleeding.

OBJECTIVE: To compare the effectiveness of an oral irrigator (OI) with a prototype jet tip or a standard jet tip to floss as adjunct to daily toothbrushing on gingival bleeding. METHODS: In this single masked, 3-group parallel, 4-week home use experiment, 108 subjects were randomly assigned to one of three groups: 1) 01 with a prototype jet tip; 2) OI with a standard jet tip; 3) waxed dental floss. All groups used their assigned product once a day as adjunct to twice daily toothbrushing for two minutes with a standard ADA reference toothbrush. Professional instructions were given by a dental hygienist in 01 use or floss use according to written instructions. All subjects also received a toothbrush instruction leaflet (Bass technique). Subjects were assessed for both bleeding and plaque at baseline and after two weeks and four weeks and were instructed to brush their teeth approximately 2 to 3 hours prior to their assessment. RESULTS: With respect to mean bleeding scores the ANCOVA analysis with baseline as covariate and week 4 as dependent variable showed a significant difference between groups in favor of both the oral irrigator groups. For plaque, however, no significant difference among groups was observed. CONCLUSION: When combined with manual toothbrushing the daily use of an oral irrigator, either with prototype or standard jet tip, is significantly more effective in reducing gingival bleeding scores than is the use of dental floss, as determined within the limits of this 4-week study design.

Use of a water flosser for interdental cleaning.

Interdental cleaning is an important part of a patient's personal oral care regimen. Water flossers, also known as oral irrigators or dental water jets, can play a vital, effective role in interdental hygiene. Evidence has shown a significant reduction in plaque biofilm from tooth surfaces and the reduction of subgingival pathogenic bacteria from pockets as deep as 6 mm with the use of water flossing. In addition, water flossers have been shown to reduce gingivitis, bleeding, probing pocket depth, host inflammatory mediators, and calculus. Educating patients on the use of a water flosser as part of their oral hygiene routine can be a valuable tool in maintaining oral health.

Efficacy of the Use of a Water Flosser in Addition to an Electric Toothbrush on Clinical Signs of Inflammation: 4-Week Randomized Controlled Trial.

This study compared the use of an oscillating-rotating powered toothbrush and a water flosser to the use of an oscillating-rotating powered toothbrush on the reduction of clinical signs of inflammation and plaque. METHODS: Seventy adult participants (N = 70) completed this examiner-blind, two-group, parallel clinical trial. The participants were randomized into either the water flosser + oscillating-rotating powered toothbrush (WF) group or the oscillating-rotating powered toothbrush only group (OR). Inflammation was measured by bleeding on probing (BOP) and modified gingival index (MGI) at baseline, 2 weeks, and 4 weeks. Plaque was scored using Rustogi Modification of the Navy Plaque Index (RMNPI) at the same timepoints. Data was reported for whole mouth, areas (marginal and proximal), and surfaces (facial and lingual). A post-study Likert scale questionnaire was completed at the 4-week visit. RESULTS: Both groups demonstrated significant reductions in BOP, MGI, and RMNPI from baseline to 4 weeks for whole mouth (P < .001). The WF group was 37% more effective at reducing BOP, 36% for MGI, and 33% for RMNPI than the OR group at 4 weeks for whole mouth (P < .001; except RMNPI P = .003). Additionally, the WF group was significantly more effective at reducing proximal BOP (37%, P < .001), MGI (46%, P < .001), and RMNPI (52%, P = .004) compared to OR at 4 weeks. The questionnaire revealed subjects in both groups felt the device was easy to use, the instructions were clear, and their mouth felt fresh and clean. There were no adverse events reported during the study. CONCLUSION: An oral hygiene regimen consisting of the use of a water flosser in addition to an oscillating-rotating powered toothbrush significantly improved gingival health. The products used in both groups were effective and well-tolerated by the study population.

Evaluation of the efficacy of subgingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries.

BACKGROUND: In certain medically and physically compromised; and terminally ill patients, periodontal surgery may not be feasible. They need special attention and assistance for their daily plaque control regimens for the management and maintenance of periodontal conditions. Subgingival irrigation home care devices with antiplaque agents may serve as useful tools in such specific patient populations. AIMS: The aim of this study was to evaluate of the efficacy of sub-gingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries. SETTINGS AND DESIGN: Randomized comparative parallel group interventional clinical trial. MATERIALS AND METHODS: Forty adults with moderate-to-severe periodontitis, divided inot Group A and B, were subjected to the use of subgingival home irrigations using 0.06% chlorhexidine (CHX) and mouth-rinsing with 15 ml of 0.12% CHX twice daily, respectively after Phase I therapy. Clinical parameters, i.e., gingival index, oral hygiene index simplified, and bleeding on probing scores were assessed at baseline, 2 weeks, 4 weeks, and 12 weeks' postphase I therapy, whereas clinical attachment level (CAL), probing depth (PD), and stain assessment at baseline and 12 weeks following Phase I therapy. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA version 15.0 for Windows). RESULTS: A statistically significant difference was seen with the use of 0.06% CHX irrigations in PD (P = 0.004) and CAL (P = 0.002) as compared to the use of mouth rinsing with 0.12% CHX. Similar differences were observed in both intensity (P = 0.014) and area (P = 0.034) of lingual surface staining with greater staining with CHX mouth rinsing. CONCLUSION: The adjunctive use of subgingival home irrigations using 0.06% CHX has a promising potential to maintain the oral health and results in lesser staining compared to CHX mouth rinsing. The regimen may further obviate the need of periodontal surgery in medically compromised subjects.

Biofilm removal with a dental water jet.

OBJECTIVE: The objective of this study was to evaluate the effect of a dental water jet on plaque biofilm removal using scanning electron microscopy (SEM). METHODOLOGY: Eight teeth with advanced aggressive periodontal disease were extracted. Ten thin slices were cut from four teeth. Two slices were used as the control. Eight were inoculated with saliva and incubated for 4 days. Four slices were treated using a standard jet tip, and four slices were treated using an orthodontic jet tip. The remaining four teeth were treated with the orthodontic jet tip but were not inoculated with saliva to grow new plaque biofilm. All experimental teeth were treated using a dental water jet for 3 seconds on medium pressure. RESULTS: The standard jet tip removed 99.99% of the salivary (ex vivo) biofilm, and the orthodontic jet tip removed 99.84% of the salivary biofilm. Observation of the remaining four teeth by the naked eye indicated that the orthodontic jet tip removed significant amounts of calcified (in vivo) plaque biofilm. This was confirmed by SEM evaluations. CONCLUSION: The Waterpik dental water jet (Water Pik, Inc, Fort Collins, CO) can remove both ex vivo and in vivo plaque biofilm significantly.

Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances.

INTRODUCTION: Effective self-care is difficult for people with orthodontic appliances because of the inherent design of brackets and archwires. It is not uncommon to have increases in plaque and gingivitis after placement of fixed appliances. The purpose of this study was to evaluate the effect of using a dental water jet (DWJ) with a specialized tip (orthodontic) on plaque and bleeding in adolescent orthodontic patients with fixed appliances. METHODS: One hundred six subjects were enrolled in this single blind, parallel clinical study. They were randomly assigned to 1 of 3 treatment groups: group 1, once daily irrigation with a DWJ and orthodontic jet tip plus a manual toothbrush; group 2, once daily flossing (FL) plus a manual toothbrush; group 3, manual toothbrush (MT) only. Plaque index (PI) and bleeding index (BI) scores were recorded at baseline, and at 2 and 4 weeks. RESULTS: All groups showed statistically significant reductions in PI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). In group 1, the DWJ was statistically more effective at reducing whole-mouth and interproximal plaque than the methods in the other groups (P >.001) at both 2 and 4 weeks, whereas the FL protocol in group 2 was significantly more effective than the MT protocol in group 3 at 4 weeks (P =.025) for whole-mouth plaque and at 2 and 4 weeks (P = .011 and P = .028, respectively) for interproximal plaque. All groups showed statistically significant reductions in BI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). The DWJ in group 1 was statistically more effective at reducing whole-mouth bleeding than the protocols of the other groups at 2 and 4 weeks (P <.001), and the FL was statistically more effective than the MT at both times (P <.001). Both the DWJ and the FL were significantly more effective than the MT at 2 weeks (P <.001 and P <.016, respectively) for interproximal bleeding, but there were no differences between the groups at 4 weeks. CONCLUSIONS: A DWJ with a specialized orthodontic jet tip is effective for adolescents in fixed orthodontic appliances; it demonstrated beneficial results for the reduction of plaque and bleeding.

Evaluation of the plaque removal efficacy of three power toothbrushes.

INTRODUCTION: The objective of this randomized, single use, single blind, single center, 4-group parallel clinical study was to evaluate the plaque removal efficacy of three power toothbrushes and a manual toothbrush. METHODS: One hundred forty-four (144) subjects completed the study. Subjects were randomly assigned to one of four toothbrush groups: Sonicare Elite, Oral-B Sonic Complete, Waterpik Sensonic or Oral-B Indicator (manual). Subjects abstained from brushing 23-25 hours prior to the pre-brushing data collection. Pre-brushing scores were obtained using the Rustogi modified navy plaque index (RMNPI). Post-brushing RMNPI scores were obtained after a supervised uninstructed two-minute brushing with the assigned toothbrush. Scores were recorded for whole mouth, marginal region, and approximal region for each subject. RESULTS: Pre-brush comparability of whole mouth, marginal and approximal regions indicated no statistical differences among the four groups for any of the three measurement regions. All four toothbrushes showed statistically significant change from pre-brush to post-brush scores for whole mouth, marginal region, and approximal region. The Waterpik Sensonic provided significantly greater reduction in plaque as measured by the RMNPI compared to the other three brushes for whole mouth (89%), marginal area (81%) and approximal area (97%). The only exception was for adjusted p-values for the approximal area compared to the Oral-B Sonic Complete (p = 0.12). CONCLUSION: All groups demonstrated a significant reduction in plaque. The single use plaque removal efficacy of the Waterpik Sensonic toothbrush compared favorably to the other two power toothbrushes, the Sonicare Elite and the Oral-B Sonic Complete, and compared favorably to the manual toothbrush, the Oral-B Indicator.

Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque.

OBJECTIVE: The purpose of this twenty-eight day, randomized, single-blind clinical trial was to assess the efficacy of the addition of daily oral irrigation to both power and manual tooth brushing, compared to a traditional regimen of manual tooth brushing and flossing, to determine which regimen had the greatest effect on the reduction of gingival bleeding, gingivitis, and supragingival plaque. METHODOLOGY: The study was designed for a total of 105 subjects to participate in a twenty-eight day trial, with 35 subjects randomly assigned to one of three groups: Group 1-manual toothbrush and floss; Group 2-manual toothbrush and dental water jet; and Group 3-sonic toothbrush and dental water jet. All subjects received written and verbal instructions for using their regimens. Subjects were asked to brush for a timed two minutes, twice per day, with the brush and the dentifrice provided, and to refrain from using any additional oral hygiene aids. Subjects using the dental water jet were instructed to use the water jet on a medium setting, irrigating once per day with 500 ml of luke warm water. Subjects using the dental floss were instructed to use the floss once daily. Subjects were examined by two calibrated examiners, and data were collected at baseline (BSL), 14 days (D14), and 28 days (D28). Subjects were asked to abstain from any oral hygiene for 12 hours prior to each study visit. Subjects were scored using the Carter and Barnes Bleeding Index, Löe and Silness Gingival Index, and the Proximal/Marginal Plaque Index. Mean scores on the three indices for the three groups were used for statistical analysis at each time point. Additionally, the means were used for comparisons as change from baseline and percent change from baseline at D14 and D28. The significance of percentage change in each index from baseline to D14 and D28 was evaluated using a one-tailed t-test. Significant differences are reported at alpha < or = 0.05 for these planned group comparisons. RESULTS: Thirty-one subjects in Group 1, 32 subjects in Group 2, and 32 subjects in Group 3 completed the study. Bleeding Index: Groups 2 and 3, the irrigation groups, were statistically significantly more effective than Group 1 in reducing the bleeding index at D14 and D28, whether measured by mean reduction or percentage reduction. Gingival Index: At D14, both irrigation groups demonstrated a statistically significantly greater reduction in the gingival index compared to brushing and flossing for the facial surfaces. There was no significant difference between groups for the lingual surface at D14. At D28 there was a significant difference between Groups 1 and 2 for both the facial and lingual surfaces. Plaque Index: There was one significant difference between groups for the plaque index measured on the lingual surfaces. The manual toothbrush and floss were less effective than the sonic toothbrush and irrigation. Group 3 was also significantly better than Group 1 in reducing the plaque index on the facial surfaces at both D14 and D28. On plaque percentage reduction on the facial surface, Group 2 was significantly better than Group 1 at D14. There was no statistical difference between Group 1 and Group 2 at D28. CONCLUSION: The results of this clinical trial indicate that when combined with manual or sonic tooth brushing, oral irrigation is an effective alternative to manual tooth brushing and dental floss for reducing bleeding, gingival inflammation, and plaque removal.

Safety of a water flosser: a literature review.

Since their introduction more than 50 years ago, water flossers (also known as oral irrigators) have been subject to numerous studies on their safety, efficacy, and delivery of antimicrobial agents, particularly in relation to their ability to impact clinical parameters such as plaque, bleeding, gingivitis, pocket depth, and calculus. Evidence based on such studies and decades of use by the public continues to support their safety and efficacy and disproves suggestions of possible detrimental effects on the attachment, junctional epithelium, or pocket depth.