Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque.
Level 2 - randomized trial
Individual randomized controlled trial
What was done
In a 28-day, single-blind clinical trial, 105 participants were randomized to one of three oral hygiene regimens (n=35 per group): Group 1 used a manual toothbrush and dental floss; Group 2 used a manual toothbrush and a dental water jet (500 ml lukewarm water on medium setting once daily); and Group 3 used a sonic toothbrush and the dental water jet. All subjects brushed twice daily for two minutes with provided paste. Blinded examiners evaluated bleeding (Carter and Barnes Bleeding Index), gingival inflammation (Löe and Silness Gingival Index), and supragingival plaque (Proximal/Marginal Plaque Index) at baseline, day 14, and day 28 following a 12-hour oral hygiene abstinence period. Group comparisons for percentage change from baseline were evaluated with one-tailed t-tests.
What was found
A total of 95 participants completed the study (31 in Group 1, 32 in Group 2, and 32 in Group 3). Exact numerical scores and standard deviations were not reported in the abstract. Both irrigation groups (Groups 2 and 3) achieved statistically significantly greater reductions in bleeding index compared to manual brushing and flossing (Group 1) at days 14 and 28 (p <= 0.05). For gingival index on facial surfaces, both irrigation groups showed significantly greater reductions than floss at day 14; at day 28, Group 2 showed significantly greater reduction than Group 1 on both facial and lingual surfaces. For plaque, Group 3 was significantly more effective than Group 1 on facial surfaces at days 14 and 28, and on lingual surfaces overall. Group 2 had greater plaque reduction than Group 1 on facial surfaces at day 14, but differences between Groups 1 and 2 were not significant at day 28.
Why it matters
This study provides comparative evidence that incorporating an oral water jet alongside manual or power brushing is at least as effective as, and for bleeding endpoints superior to, standard flossing over a 4-week period.
Limits
The abstract reports only p-value significance without point estimates, absolute numerical scores, or variance measures. The statistical analysis utilized one-tailed t-tests, which increases the risk of false-positive findings relative to standard two-tailed testing. The intervention period was short (28 days), blinding was limited to evaluators (single-blind), and long-term periodontal health outcomes were not evaluated.
Cited by
- supports Studies demonstrate that pulsating water flossers (such as Waterpik), when used correctly, are more effective than traditional dental floss at cleaning periodontal pockets.