True confession: I use my Water Flosser on the #10 setting. When I tell this to other dental hygienists, I often hear, “But I heard that was dangerous,” or “My doctor (or the periodontist that we refer to) says it drives bacteria into the pocket and causes deeper pockets.”
It is difficult to know how this message got started or on what basis. In many cases, it seems to have emanated from an instructor or colleague. No one ever seems to be able to cite or locate a study or even know the specific patient case.
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The truth is the Water Flosser is safe to use at any setting including high. This year, the Waterpik Water Flosser earned the ADA Seal of Acceptance as the first powered interdental cleaner. The seal ensures professionals and patients that a product is safe and effective. The Waterpik Water Flosser earned the Seal of Acceptance for the removal of plaque between teeth and below the gumline and for the prevention and reduction of gingivitis.
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Let’s look at the evidence on the safety and efficacy of the Water Flosser.
Penetration of bacteria: In 1988 at the University of Missouri Kansas City, a periodontal researcher, Dr. Charles Cobb, conducted a safety study on the Water Flosser. His team looked at patients who needed extractions due to periodontitis. Some of the deep pockets were irrigated with a Water Flosser at the 60 psi setting; other pockets were not irrigated.
Any first-time user should always start on low so they can acclimate to the device.
Post extraction, the pockets were viewed under a scanning electron microscope. Dr. Cobb’s team found disruption of bacteria up to 6 mm in the irrigated pockets. In comparison, the nonirrigated teeth had thick mattes of bacteria. Researchers also viewed the pocket wall and found no trauma or damage. They concluded the Water Flosser is safe.1
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Pocket depth: Numerous studies on the Water Flosser and periodontal maintenance patients have evaluated pocket depth. None found an increase in probing depth. A 2000 study at Baylor University found that water flossing at 60 psi significantly reduced probing depth in as little as 14 days.2
Bacteremia: The incidence of bacteremia from using a Water Flosser has ranged from 7% in people with gingivitis3 to around 50% in those with periodontitis.4 This is similar to brushing and flossing (20%-68%), or chewing (51%).5
Confused by tips?
Tips are another area that cause confusion. People sometimes believe the Pik Pocket is the only safe tip to use because it is low-pressure delivery. Others are afraid to use it because it is placed subgingivally. Some fear that if the patient leaves the unit on high instead of turning it to low, it will be damaging to the tissue.
Figure 1: Pik Pocket Tip
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