cosmetic dentistry_ beauty & science

industry news _ water flossing I Carefulanalysisdeterminesthe individual recommendation of the right toothbrush for each patient. Toothbrushing targets only supragingival plaque, however. Numerous studies have indicated that significant plaque can remain after brush- ing.9 And all toothbrushing, whether power or manual, fails to clean interdentally, an area that the patient must address separately.Itcanbearguedthat interdental cleaning should be the first step, since that is the area where the risk of periodontaldiseaseandinfectionishigher. While dental floss is not a state-of-the-art tech- nology, it is still considered the first choice for inter- dental cleaning among dental professionals. A major problem is that patients do not like to floss,10, 11 tend to avoid the practice, and often demonstrate a tech- nique that is less than adequate.12 Dentists and dental hygienists need to find alternative methods toaccomplishinterdentalcleaning. There are many products available that are de- signed or marketed to clean between the teeth and to motivate individuals to perform this task; how effectivearethey,andcantheybeusedeasilybymost individuals? Interdental brushes have been shown to reduce plaque and gingivitis,13 but require a large enoughembrasurespaceforaccess.Eventhesmallest designs may not fit into all interdental spaces or ef- fectivelycleantheproximalsurfaceconcavitiesofthe teeth. Floss holders are designed to make it easier to use floss, but do not eliminate all the dexterity chal- lenges that patients face. Wooden sticks,14 rubber tips andtoothpicksarenotinterdentalcleaners. Therecentadventof“waterflosser”asadescriptor is based on clinical findings from three studies (Table 1).Thefirststudyinthisgroupwaspublishedin2005, anddemonstratedthatthewaterflosserwithaclassic jettipandeitherapowertooth- brush or a manual toothbrush were significantly better at re- ducing bleeding and gingivitis when compared with a manual toothbrush and string floss.15 This was followed by a 2008 study that compared the ef- ficacy of a water flosser with an orthodontic tipand a man- ual toothbrush to a manual toothbrush and string floss in 11- to 17-year-olds with fixed orthodontics.16 The water flosser group had significantly reduced plaque and bleeding over four weeks compared with the string floss group. The most recent study published in 2011 found that the water flosser with either the classic jet tiporatipwithindividualbristletuftswasuptotwice as effective as dental floss in as little as two weeks. The differences between the tips and floss were even moredramaticatfourweeks.17 _How does a water flosser stand out from other self-care products? The documented research on water flossers is ex- tensive, spanning over 50 years. These studies were designed to address new developments in dentistry. The link between periodontal disease and systemic disease has been studied extensively and reported in theliterature;someassociationsareverystrongwhile others are less conclusive. It is well known that people livingwithdiabeteshaveanincreasedriskofperiodon- tal disease that starts earlier and leads to more severe complications in both children and adults. Controlling oral inflammation is important and may be more dif- ficult to accomplish than in non-diabetic individuals. Awaterflosserwascomparedwithtraditionaloralhy- gieneinacohortofType1orType2diabeticsubjectsover threemonths.Thegroupthatusedthewaterflosserhas significantlybetterimprovementsingingivitis,plaque, and bleeding on probing compared with the group thatcontinuedwithtraditionaloralhygienemethods.7 Fig. 3_Decompression phase where the tissue is extended from the tooth, allowing access to the subgingival area. Fig. 4_The impact zone is where the solution hits the tooth and the flushing zone encompasses the subgingival and interdental areas around the tooth. Figs. 5a & b_Before and after using a water flosser on medium pressure for three seconds: biofilm on tooth under SEM (a); 99.9 % removal of biofilm from tooth surface under SEM (b). I 37cosmeticdentistry 1_2013 Fig. 5a Fig. 5b Fig. 3 Fig. 4