cosmetic dentistry_ beauty & science

36 I I industry news _ water flossing Fig. 1_Original Waterpik oral irrigator introduced to the dental profession in 1962. Fig. 2_Waterpik Ultra Water Flosser with ten pressure settings and six tip designs. cosmeticdentistry 1_2013 _Dental school graduates from the 1960s, 1970s and1980shaveprobablyheardoftheWaterpikWater Flosser,butaskthemtotellyouwhatitdoesorwhether it is effective, and they generally either do not know or else believe that it is not very effective at removing plaque.Graduatesafter2000maynotevenknowwhat thistechnologyisorwhatitdoes. Thehydrodynamictherapyactionofanoralirriga- tor is not a new concept to the dental profession. The innovations lie in our improved understanding of the pathogenesis of oral disease, the role of plaque as a biofilm,andapplyingclinicalevidencetomakeclinical decisions. Recent and ongoing research and applica- tions have shown how the oral irrigator is a self-care productthatwarrantsattentioninthe21st century. Theoriginaloralirrigator(knownasadentalwater jet, and more recently a water flosser) was developed by Dr Gerald Moyer, a Fort Collins, Colorado, dentist, and Dr John Mattingly, a hydraulic engineer at Colo- rado State University (Figs. 1 & 2). Moyer was looking for a product that could clean areas of the oral cavity that are not readily assessable by traditional methods such as toothbrushing and dental flossing. Together they designed a device that provided a controllable pulsating water stream for the targeted delivery of a solutionandtheself-cleansingofinaccessibleareasby the patient. The current terminology, “water flosser”, willbeusedthroughoutthisarticle. Thewaterflosserdeliversapulsatingstreamofwa- ter or other solution that results in successive com- pression and decompression phases of the gingival tissue (Fig. 3).1 The solution strikes the toothatthegingivalmargin,the impact zone, and is deflected subgingivally and interdentally, the flushingzone (Fig. 4). It was anecdotally believed that the water flosser was simply flush- ing out debris without remov- ing plaque or having a positive impactonoralhealth.However, as early as 1969, studies were reporting significant plaque and calculus reduction in groups using the water flosser.2, 3 More recently, significant plaque reduction has been demonstrated in studies with subjects with mild to moderate gingivitis,4 periodontitis,5 ortho- donticappliances6 anddiabetes.7 The above studies used the traditional validated plaque indices, which provide a 1-D perspective; the presence of plaque is determined by disclosing solu- tion. In 2009, Dr Bill Costerton and his team took this a step further to evaluate the removal of biofilm from the tooth surfaces using a water flosser. This ex vivo study utilised periodontally involved teeth that were extractedandinoculatedwithsalivatogrownewbio- filmoverexistingdeposits.Theteethweretreatedwith a water flosser for three seconds at medium pressure andthenpreparedandviewedunderascanningelec- tron microscope (SEM). The removal of biofilm was evident as seen in Figures 5a & b, with almost 100 per centremovalfromtreatedareas.8 _Self-care technology Brushing is considered the first line of defence for maintaining good oral hygiene. Some power brushes arequitesophisticated;theyhelptheuserknowwhen to change quadrants, when the two-minute brushing time is reached, and how the user is doing. They offer power selections that include cleaning action, mas- saging action or a gentle stroke for sensitive areas. There are different bristle configurations, brush-head sizes and designs, and angles and contours for clean- ingthelineangles,pits,fissuresandposteriorregions. Fig. 1 Fig. 2 What constitutes new technology? Water flossing revisited Author_Deborah M. Lyle, USA