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cosmetic dentistry_ beauty & science

38 I I industry news _ water flossing Studiesbetween1990and2000continuedtoshow the benefits of a water flosser in reducing bleeding, gingivitis and plaque.18–21 Some of the researchers proposedthatthesignificantresultsfromusingawa- ter flosser were associated with a change in the host response. With a new focus on host inflammatory modulation, a randomised controlled study was con- ducted comparing routine oral hygiene with routine oral hygiene plus a water flosser.5 The investigators used traditional bleeding, gingivitis and plaque in- dices, but also measured pro-inflammatory mediator interleukin-1ß (IL-1ß) and prostaglandin E2, anti-in- flammatory mediator interleukin-10, and interferon- gamma, a cytokine key in killing bacteria. The study results demonstrated that the water flosser group had a significant reduction in plaque, bleeding and gingivitis indices plus probing depth compared with the control group. The cytokine profile was changed in the water flosser group, showing a decrease in the pro-inflammatory mediators and an increase in the anti-inflammatorymediators.Sincethemeasurements were taken from gingival crevicular fluid, the resear- chers prevented a dilution effect by waiting eight hours after the subjects had used the water flosser. Keyfindingsinclude: _Both groups had reduced plaque biofilm compared with baseline, but only the water flosser group had decreasedinflammatorymediatorIL-1ß. _Thereductionofbleedingonprobingcorrelatedwith thereductionofIL-1ßnotthereductionofplaque. _The selective reduction of pro-inflammatory mediators demonstrates a modulation effect In the diabetes study mentioned above, the in- vestigators measured the serum cytokine profile of the subjects. Over the three months of the study, the testgroupthatusedthewaterflossershowedsignifi- cantreductionsinIL-1ßandprostaglandinE2.7 _Conclusion Thewaterflosserhasanextensivebodyofevidence thatdemonstratesitssafetyandefficacywithmultiple patientsanddifferentoralcareneeds,forexamplegin- givitis, orthodontics, implants, crowns and bridges, in- dividualsinperiodontalmaintenanceprogrammes,and particularly those with good oral health. Studies in the past decade have addressed new areas such as host response, impact on systemic health, and the effect on biofilm at the microscopic level. The water flosser has the ability to provide individuals with an easy and ef- fective way to maintain good oral health by accessing the areas that are not readily reachable and cleansable by traditional methods. Not all oral irrigators, dental waterjetsorwaterflossershavethesamecombination ofpulsationsandpressure.Theoverwhelmingmajority of studies have been done using the Waterpik Water Flosser. Dental professionals need to evaluate the evi- denceforeachspecificproduct,asstudiesarenottrans- ferablebetweentechnologiesandmanufacturers._ Editorial note: A complete list of references is available fromthepublisher.PhotographscourtesyofWaterPik,Inc. cosmeticdentistry 1_2013 Deborah M.Lyle RDH,MS New Jersey USA dlyle@waterpik.com _contact cosmeticdentistry Reference Title Design No. of subjects Products used Groups Barnes et al. Comparison of irrigation to floss RCT 105 Waterpik Water Flosser (WP-60) MT + FL as an adjunct to toothbrushing: Parallel (10 subjects across with traditional jet tip and water (WF); MT + WF Effect on bleeding, gingivitis, Examiner Blind the groups had to be Oral-B 35 manual toothbrush PT + WF and supragingival plaque 4 weeks dismissed owing to (Procter and Gamble, MT); illness, antibiotic use Waterpik Sensonic Toothbrush (SR-700, PT); or corticosteroid use) Reach floss, unflavoured, waxed (Johnson and Johnson, FL); Crest Cavity Control toothpaste (Procter and Gamble, MT) Sharma et al. Effect of a dental water jet with RCT 106 Waterpik Ultra Water Flosser (WP-100) MT + FL orthodontic tip on plaque and Parallel (1 subject withdrew with orthodontic tip and water; MT + WF bleeding in adolescent patients Examiner Blind because he did not Oral-B 35 manual toothbrush; MT only with fixed orthodontic appliances 4 weeks want to floss) Reach floss, unflavoured, waxed; GUM Eez-Thru floss threaders (Sunstar Americas); Crest Cavity Control toothpaste Rosema et al. The effect of different interdental RCT 108 Waterpik Ultra Water Flosser (WP-100) with MT + WF (S) cleaning devices on gingival bleeding Parallel (2 subjects withdrew standard jet tip (S) or prototype tip (P) with MT + WF (P) Examiner Blind because of scheduling 3 bristle tufts; Reach floss, unflavoured, waxed; MT + FL 4 weeks conflicts, 1 moved and Oral-B Indicator 35 manual toothbrush; 1 withdrew for personal Everclean fluoride toothpaste (HEMA, Netherlands) reasons) Table 1_Overview of studies comparing water flosser to string floss. (Reprinted with permission from the Compendium of Continuing Education in Dentistry.) Table 1