ADHA Access February 2012 : Page 23
reductions in IL-1ß and PGE 2 . 14 Given the symbiotic relationship between diabetes and periodontal disease, oral self-care S 'H¿QLWLRQRI'HQWDO measures that curb Hygiene Practice the in À ammatory p7 Standard 1. III. d. process are critical to a diabetic patient’s oral and systemic well-being. Research suggests that water À ossing may decrease the toxic products generated by plaque bio ¿ lm and that a change in the host re-sponse could be the mechanism by which the Water Flosser achieves improvements in gingival health. 11-15 Mechanism of Action The Water Flosser’s mechanisms of action are central to its effectiveness. The two main physical features of water À oss-ing action include pulsation and pressure. Pulsation essentially regulates pressure. A combination of these two actions allows for disruption of bacterial activity, the expulsion of subgingival bacteria and the removal of loosely lodged debris and food particles. Research has determined the appropriate levels of pressure that should be applied during usage. Clinical effective-ness has been demonstrated in the 50–90 psi (pounds of pressure per square inch) range. These levels re À ect what both healthy and in À amed p5 Professional tissues can comfort-Responsibilities ably handle without and Considerations tissue damage. 22,23 Comparing Power Interdental Cleaners A recent randomized controlled trial compared the effectiveness of two power interdental devices, the Water Flosser and the Air Floss, when used as adjuncts 9HUVDWLOLW\%HQH¿WV to manual toothbrushing. Both groups showed signi ¿ cant reductions in gingivi-Those with diminished dexterity can tis, bleeding on probing, and plaque from easily use the Water Flosser. It requires the baseline for all regions and time points user to simply hold the handle at a 90-de-measured (p<0.001). Between groups, the gree angle to the tooth and irrigate the Water Flosser group showed signi ¿ cantly tissues at an appropriate pressure setting. higher plaque reductions for whole-mouth, With shifting demographics and a grow-marginal, approximal, facial and lingual ing elderly population, concerns related areas. For bleeding on probing, the Water to dexterity and other physical limitations Flosser group was numerically better than will grow. The elderly who suffer from The Waterpik ® Ultra Water Flosser™ is clinically SURYHQXSWRWZLFHDVHIIHFWLYHDVVWULQJÀRVVWR the Air Floss group for all areas and time arthritis or other conditions that compro-reduce bleeding and improve gingival health. points, with statistically signi ¿ cant ¿ nd-mise the use of their hands may ¿ nd the ings for whole-mouth and facial areas, at Water Flosser easy to manage and control. week 2 and for the facial area at week 4. Manufacturer’s instructions clearly state the The Water Flosser group was signi ¿ cantly more effective at reduc-desired power settings, and instructions are printed in readable type ing plaque and gingivitis at weeks 2 and 4 for all areas measured with accompanying graphics. (p<0.001). 16 The versatility of the Water Flosser also merits attention. In ad-dition to subgingival lavage with water, the Water Flosser can hold, deliver and direct antimicrobial solutions into the sulcus and inter-proximal regions. Thus, when patients are advised to use antimicrobial Systematic and Literature Reviews agents for home care, the Water Flosser is an appropriate choice. Six different water-À ossing tips can attach to the unit. These inserts Two comprehensive literature reviews and one systematic review are designed to address patient needs speci ¿ c to general and tongue conducted between 2005 to 2008 address the Water Flosser. 17-19 cleansing, orthodontic appliances, ¿ xed restorative appliances, deeper In its published report, the American Academy of Periodontology periodontal pocket areas and toothbrushing. emphasizes the value of the oral irrigation for use in periodontal The Water Flosser also is a safe and effective maintenance and for the treatment of gingivitis. A key advantage p7 Standard 1. II. d. 8. approach for cleansing between implants. 24 cited was the Water Flosser’s ability to attenuate bacterial reductions obtained during scaling and root planing. The Water Orthodontic patients, in particular, can ben-Flosser was recommended for patients who display e ¿ t from water lavage. 5 Food debris and plaque cling to orthodontic p6 Standard 1. I. a. inadequate interdental cleansing skills. 17 Husseini wires, brackets and plastic orthodontic appliances. Although people of all ages may require orthodontic care, the majority of orthodontic et al. found that in the majority of studies cited in patients typically are adolescents and young adults who tend to be their systematic review, the addition of oral irrigation to toothbrush-less amenable to the time commitment and labor intensity of À ossing. ing signi ¿ cantly reduced bleeding and gingivitis levels when compared Further, younger orthodontic patients may not have the dexterity to to toothbrushing alone. No differences in plaque accumulations were be skillful and effective when À ossing. The Water Flosser is ideal for found. 18 The Canadian Dental Hygienists’ Association’s 2006 position thorough cleansing of orthodontic ¿ xtures. paper on À ossing recommends the µ home irrigator’ (Water Flosser) as a viable alternative to µ¿ nger À ossing.’ 18 The paper cites the fact that patients often have dif ¿ culty removing interproximal plaque with Conclusion traditional string dental À oss. 19 Although dental À oss is routinely sug-gested as the option of choice for interdental cleansing, low compli-ance with À ossing has been reported. 20,21 Therefore, The Water Flosser offers convenience and ease of usage to a broad other evidence-based options must be prescribed to p9 Standard 5. III. consumer group. With today’s technology and a world of “quick and patients who have been unable to achieve effective-easy,” a large segment of the market is attracted to power-driven de-ness with dental À ossing and/or are noncompliant vices and oral hygiene practices that require minimal time and energy. with its usage. The Water Flosser is adaptable, easy to use, versatile and suitable for access FEB 2012 23
Publication List
Using a screen reader? Click Here