Title Using a Water Flosser Can Be Effective in Managing Plaque During Orthodontic Treatment When Used in Conjunction With Other Oral Hygiene Modalities
Clinical Question For patients who are having a hard time cleaning their teeth effectively during orthodontic treatment, is a Waterpik flosser as effective as regular floss with regards to plaque control?
Clinical Bottom Line For patients struggling with effective oral hygiene during orthodontic treatment with fixed appliances, there is some evidence that shows that using a Waterpik can help to reduce plaque accumulation but not all evidence shows that this treatment is better than traditional flossing or using a manual toothbrush exclusively. A RCT with 34 subjects showed that there was no significant difference between using Super Floss and using a water flosser. This RCT did show that both methods significantly reduced the overall plaque score. A different clinical trial showed that a water flosser was more effective than traditional floss.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
36090126Sawan/202234 subjects with an equal number of males and femalesRandomized Controlled Trial
Key resultsThere was no significant difference between using Super Floss or a water flosser for patients undergoing orthodontic treatment, but there was significant overall reduction in the plaque score for both methods. This study was conducted using split mouth protocol on young adult orthodontic patients with a mean age of 23.7 +/- 7.7 yrs.
15711898Kossack/200540 patients split into four groups randomlySingle blind 4 way crossover clinical trial
Key resultsThe Sonic Speed brush in combination with a Waterpik was the only method used that was found to be significantly better than a manual toothbrush after 4 weeks of application. This improvement was mainly attributed to the Waterpik and was more effective than dental floss. It is important to note that “in patients with good oral hygiene, no improvement was observed with any of the cleaning aids.”
37203873Tyler/202340 patients between 10-20 yo in fixed appliancesRandomized Controlled Trial
Key resultsThere was no significant difference in the plaque index, gingival index or interdental bleeding index when comparing results from patients using only a manual toothbrush and patients using a Waterpik in addition to a manual toothbrush.
Evidence Search Waterpik + orthodontic treatment AND Waterpik + plaque control
Comments on
The Evidence
These studies were randomized clinical trials and provide a high level of evidence. There were control groups for two of the studies and the third was a crossover clinical trial so both experimental treatments were completed on the same patient, just on different sides of the mouth.
Applicability The patients in the included studies were mostly young adults so it would be difficult to apply these findings to children or younger patients undergoing orthodontic treatment. It also does not address the challenges some patients face using floss and threading it between the brackets. Dexterity and the time necessary to floss are not factors that were considered.
Specialty (Orthodontics)
Keywords Waterpik, orthodontic treatment, fixed appliances, oral hygiene, plaque
ID# 3538
Date of submission 10/17/2023
E-mail meyern1@livemail.uthscsa.edu
Author Nicole Meyer
Co-author(s) Jeremy Haqq
Co-author(s) e-mail abdulhaqq@livemail.uthscsa.edu
Faculty mentor Maria Karakousoglou
Faculty mentor e-mail Karakousoglo@livemail.uthscsa.edu
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?)
None available
Comments and Evidence-Based Updates on the CAT
None available