ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
View the CAT printer-friendly / share this CAT
spacer
Title Dental water jets have not been demonstrated to be more effective than floss at removing interproximal plaque.
Clinical Question Are dental water jets more effective than floss in the removal of interproximal plaque?
Clinical Bottom Line There is insufficient evidence at this time to indicate that either the dental water jet or dental floss are more effective at removing interproximal plaque.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25581718Salzer/20156 systematic reviews/3534 patientsMeta-Analysis
Key resultsOf the two systematic reviews regarding the use of dental floss, one found no statistically significant benefit of flossing in addition to the use of a manual toothbrush, while the other found a statistically significant benefit with questionable clinical significance. Only one systematic review regarding oral irrigators met inclusion criteria. The findings of this review indicated that the use of oral irrigators may reduce bleeding scores and improve gingivitis when used as an adjunct to brushing, but that no improvement was noted in the removal of visible plaque. The benefits of flossing and the use of an oral irrigator were not directly compared to each other, but the overall level of evidence to support the use of either as an adjunct to brushing was considered weak.
#2) 16305005Barnes/200595 adult patientsRandomized Controlled Trial
Key resultsAs an adjunct to a manual toothbrush, the use of a water jet was found to produce a greater reduction in plaque on facial surfaces of teeth than the use of floss after two weeks. At four weeks, there was no statistical difference in plaque percentage reduction between either floss or the water jet in combination with the manual toothbrush. However, the use of an oral irrigator did result in less bleeding and healthier gingiva at both the two week and four week time interval than the flossing group.
#3) 24282867Goyal/201370 adult patientsRandomized Controlled Trial
Key resultsFollowing a single use of either flossing or a water jet as an adjunct to manual brushing, a significantly greater amount of plaque was removed from teeth in the group using the water jet. For the whole mouth, as well as specific tooth areas (marginal, approximal, facial, and lingual), the use of the water jet resulted in plaque score reductions that were 24-39% better than the flossing group.
Evidence Search ((("plaque, amyloid"[MeSH Terms] OR ("plaque"[All Fields] AND "amyloid"[All Fields]) OR "amyloid plaque"[All Fields] OR "plaque"[All Fields] OR "dental plaque"[MeSH Terms] OR ("dental"[All Fields] AND "plaque"[All Fields]) OR "dental plaque"[All Fields]) OR ("dental plaque"[MeSH Terms] OR ("dental"[All Fields] AND "plaque"[All Fields]) OR "dental plaque"[All Fields]) OR (supragingival[All Fields] AND ("plaque, amyloid"[MeSH Terms] OR ("plaque"[All Fields] AND "amyloid"[All Fields]) OR "amyloid plaque"[All Fields] OR "plaque"[All Fields] OR "dental plaque"[MeSH Terms] OR ("dental"[All Fields] AND "plaque"[All Fields]) OR "dental plaque"[All Fields]))) AND ((("water"[MeSH Terms] OR "water"[All Fields] OR "drinking water"[MeSH Terms] OR ("drinking"[All Fields] AND "water"[All Fields]) OR "drinking water"[All Fields]) AND flosser[All Fields]) OR waterpik[All Fields] OR (("mouth"[MeSH Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND irrigator[All Fields]) OR (microdroplet[All Fields] AND flosser[All Fields]) OR (microdroplet[All Fields] AND ("equipment and supplies"[MeSH Terms] OR ("equipment"[All Fields] AND "supplies"[All Fields]) OR "equipment and supplies"[All Fields] OR "device"[All Fields])) OR (("water"[MeSH Terms] OR "water"[All Fields] OR "drinking water"[MeSH Terms] OR ("drinking"[All Fields] AND "water"[All Fields]) OR "drinking water"[All Fields]) AND ("J Evol Technol"[Journal] OR "jet"[All Fields])))) AND (floss[All Fields] OR ("dental devices, home care"[MeSH Terms] OR ("dental"[All Fields] AND "devices"[All Fields] AND "home"[All Fields] AND "care"[All Fields]) OR "home care dental devices"[All Fields] OR ("dental"[All Fields] AND "floss"[All Fields]) OR "dental floss"[All Fields]) OR (interdental[All Fields] AND floss[All Fields]))
Comments on
The Evidence
Validity: Although the meta-review contained six studies, only three pertained to either floss or the water jet. Although a low to moderate risk of bias was assessed for these articles, the magnitude of the effect of both treatment modalities was considered unclear, and the level of evidence weak. Additionally, the systematic reviews presented did not directly compare the use of floss to the water jet. For both randomized clinical trials, the examiners were blinded to whether floss or a water jet was used as the treatment modality when assessing results of treatment, giving more credibility to the results. Perspective: Based on the meta-analysis, there is insufficient evidence at this time to recommend the use of either floss or the water jet as better than the other for plaque removal as an adjunct to a manual toothbrush. However, the randomized clinical trials did indicate some benefit of the use of a water jet over floss for a reduction in bleeding gums. Further randomized clinical trials directly comparing the two treatment adjuncts are necessary to improve the body of evidence.
Applicability Tooth brushing alone is insufficient for the complete removal of plaque, specifically for proximal surfaces. A number of treatment adjuncts are available, including dental floss and water jets. that have limited evidence of their benefits in plaque removal and the improvement of gingival health. The dental practitioner needs to be familiar with the strengths and limitations of both modalities in order to best guide their patients in choosing the adjunct that will be most beneficial for their individual circumstances.
Specialty/Discipline (General Dentistry) (Orthodontics) (Periodontics) (Prosthodontics)
Keywords dental floss, water jet, oral irrigator, plaque
ID# 3279
Date of submission: 10/31/2017spacer
E-mail hillary.key@gmail.com
Author Hillary Key
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
spacer
Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
None available
spacer

Return to Found CATs list