02 October 2023

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Water flosser and oral hygiene in patients with fixed orthodontic appliances

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Maintaining good oral hygiene when wearing orthodontic braces is proven to be very difficult, but extremely necessary. During orthodontic therapy with fixed appliances, a change occurs in the microbiome of the mouth with an increase in periodontal disease bacteria and cariogenic bacteria. The oral microbiome has been shown to remain “abnormal” for up to 2 years after braces removal.

Removing plaque using a normal toothbrush is widely recommended for oral hygiene when you have a fixed orthodontic device, but it is often not sufficient and even additional aids such as specific orthodontic toothbrushes, interdental brushes and dental floss sometimes seem completely effective for maintain adequate oral hygiene.

The water flosser (WaterPik®) is an oral hygiene aid that uses a variable power jet of water - it was introduced on the market in the 1960s - to remove plaque and food debris with a tube-shaped tip.

In recent years, an orthodontic tip has been proposed on the market characterized by a tapered brush through which the water is expelled and, if used appropriately, the orthodontic tip could mechanically remove the plaque in parallel with the cleaning action of the pulsating water.

Materials and methods

In a study published in the Journal of Orthodontic, the authors sought to determine whether the use of a water flosser (WaterPik ®) in association with a manual toothbrush (experimental group: WaterPik® + MTB) could be more effective for maintaining oral hygiene than the use of a manual toothbrush alone (control group: MTB) in patients treated with orthodontic appliances fixed.

The study was conducted in the Department of Orthodontics at York Hospital (York Teaching Hospitals NHS Foundation Trust, United Kingdom) on a total of 40 healthy participants aged between 10 and 20 years treated with fixed upper and lower orthodontic appliances.

Participants were randomly assigned, using stratified block randomization, to the control group (MTB) or the experimental intervention group (WaterPik® + MTB).

The bleeding index, gingival and interdental plaque index were recorded at baseline, 8 weeks, 32 weeks and 56 weeks to evaluate the differences between the two groups.

Results

The authors performed an analysis of the results on 40 recruited patients and with 85% of the data collected. Overall, mean differences between groups were as follows: plaque index = 0.199 (P = 0.88, 95% confidence interval [CI] −0.24 to 0.27); gingival index = −0.008 (P = 0.94, 95% CI −0.22 to 0.20); interdental bleeding index = 5.60 (P =0.563, 95% CI −13.22 to 24.42). No statistical difference was found between the two groups for any variable.

Conclusions

From the data of this study, which must be confirmed in other similar works, it can be concluded that in terms of oral hygiene there is no valid evidence to support the claim of benefit deriving from the use of a water flosser (WaterPik®) in addition to one manual toothbrush for patients with fixed orthodontic appliances.