Impact of water flossers compared with dental floss on plaque and gingival inflammation: A randomized controlled trial

Background: To control and reverse gingival inflammation, management of plaque is essential. While traditional dental floss (DF) has been the gold standard for interdental cleaning, it’s been a highly sensitive technique, resulting in patient self-harm if not used in the appropriate way, leading to more periodontal tissue damage. One contemporary substitute for manual flossing is the water flosser (WF). This study aims to compare the impact of water flossing and conventional DF on clinical parameters in patients with gingivitis over a 1-month period. Methods: Thirty healthy and nonsmoking adults participated in a 4-week clinical study designed as a single-blind, parallel-group trial. The participants were randomly divided into three groups, with each group consisting of 10 individuals. Group A received a WF and a manual toothbrush (WF+MTB). Group B received DF and an MTB (DF+ MTB). Group C received an MTB only (MTB). Results: At the start and at 2 weeks, Group B has a significantly lower mean plaque index score, while at 4 weeks, Group A has a significantly lower plaque index score when compared with other groups. Intra-group comparison shows a decrease in plaque index scores in Group A (WF+MTB); the difference observed was statistically significant in Group A (WF+MTB). The MSBI values decreased over time for all groups; these changes were not statistically significant. Additionally, there were no statistically significant differences between the groups at any time point. Conclusion: The present study suggests that using a WF device is easier and more effective than manual flossing for improving gingival health and helps to get a lower plaque index score. New products with different mechanisms of action, different delivery methods, or specifications need to be compared clinically. Each product needs to be tested individually, and differences between devices should be clinically meaningful.