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Is water flossing more efficient than string flossing to remove plaques from tooth surfaces?

I present below what I have found so far. In the following:

  • Waterpik is a manufacturer of water flossing devices. By extension, Waterpik = a type of water flossing device.
  • oral irrigator = water flossing device

{1} (published in 2013) says:

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.

and {3} (published in 2009) says:

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.

whereas https://www.livestrong.com/article/287399-waterpik-vs-floss/ (mirror) says, without citing any scientific study:

The downside: A Waterpik doesn’t remove plaque from teeth as well as floss. “Flossing scrapes off the sticky film of bacteria, while a Waterpic just rinses it,” Hayes explains. MayoClinic.com says (mirror) using a Waterpik isn't a substitute for flossing.

and {2} (published in 2008) says:

As an adjunct to brushing, the oral irrigator does not have a beneficial effect in reducing visible plaque. However, there is a positive trend in favour of oral irrigation improving gingival health over regular oral hygiene or toothbrushing only.

I wonder if there now exists a scientific consensus on the efficiency of water flossing compared to string flossing for removing plaques from tooth surfaces.

References:

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The latest systematic review in this issue found: there is only weak, very low quality and unreliable evidence avalaible for floss the magnitude of the effect was small, for woodsticks and oral irrigators was weak and for interdental brushes was large

Main conclusions are:

There is weak evidence that flossing plus toothbrushing compared to toothbrushing alone has a small but significant effect on gingivitis. However, there is a lack of evidence for a concomitant reduction in plaque scores.

The evidence for woodsticks and toothbrushing as compared to toothbrushing alone was weak and showed that there is a benefit of unclear magnitude with respect to bleeding scores but lacking evidence for a concomitant reduction of plaque.

Moderate evidence was available for the efficacy of interdental brushes in addition to toothbrushing as compared with toothbrushing alone. This corresponded to a 34% reduction in gingivitis and a 32% reduction in plaque scores, when standardizing the results retrieved from the use of different indices.

There is weak evidence that the oral irrigator plus toothbrushing compared to regular oral hygiene has an effect on gingivitis. The magnitude remained unclear and it also lacked evidence on a concomitant reduction of plaque scores.

In all there is consistent evidence that suggests that inter-dental brushes are the most effective devices to remove inter-dental plaque. In addition, they are appreciated best by the patients.

Anyway, you have to keep in mind that there there was insufficient evidence to determine whether interdental brushing reduced or increased levels of plaque when compared to flossing (source).

UPDATE Feb 2018: Higher frequency of interdental cleaning was correlated with increased periodontal health.

Source: J Clin Periodontol. 2015 Apr;42 Suppl 16:S92-105. doi: 10.1111/jcpe.12363.

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