Abstract
ObjectiveTo assess whether bacterial colonisation in a power-driven water flosser can be prevented.Materials and methodsTwenty-four patients undergoing supportive periodontal treatment used 2 power-driven water flossers [Sonicare AirFloss (SAF), AirFloss Ultra (SAFU)] for 12 weeks each as follows: (a) with bottled water (BW); (b) with BW and cleaning the device extra-orally twice per week with chlorhexidine gluconate or (c) essential-oil-based (EO) mouth-rinse; (d) with EO only. Water-jet samples were taken after 6 and 12 weeks with the used nozzle and after exchanging to a brand-new nozzle. After 12 weeks, all devices underwent an intensive cleaning procedure. Samples were analysed by PCR-based method for cariogenic and periodontal pathogens and culture for staphylococci, aerobe gram-negative bacteria, and Candida sp.ResultsContamination of SAF/SAFU with Streptococcus mutans was found in > 95% of the samples; periodontal pathogens and aerobe gram-negative bacteria were detected in 19–56% of the samples, while Staphylococcus aureus and Candida sp. were identified only in few samples. Contamination rate was basically unaffected by time-point, device, or way of use. Further, exchanging the nozzle did not prevent transmission of a contaminated water-jet, but the intensive cleaning reduced most of the pathogens significantly, except of S. mutans.ConclusionNeither a specific way of use nor exchanging the nozzle prevented bacterial colonisation and transmission of biofilm components via the water-jet of SAF/SAFU.Clinical relevanceBacterial colonisation in a power-driven water flosser seems impossible to prevent; to restrict the risk of cross-contamination within a household, one device per person should be recommended.
Highlights
Regular mechanical cleaning of the teeth including the daily use of a toothbrush together with an interdental cleaning aid is essential to minimise the risk of oral disease [1,2,3,4,5]
A recent proof-of-principle study [13] reported that daily use of Sonicare AirFloss (SAF) for 3 weeks resulted in bacterial colonisation in the nozzle and/or device with both aerobic and anaerobic — oral — species, that are transmitted via the water-jet
3 patients were excluded because the device broke already within the first 6 weeks, 3 patients contributed with only 6 weeks data because the device broke thereafter, while 2 patients finished the 12-week period using SAFU, but the device stopped working during the intensive cleaning procedure
Summary
Regular mechanical cleaning of the teeth including the daily use of a toothbrush together with an interdental cleaning aid is essential to minimise the risk of oral disease [1,2,3,4,5]. In order to achieve long-term success, patients have to comply daily with the chosen/recommended method; e.g. previous studies have shown, that power-driven interdental cleaning devices might be a preferred alternative for many patients [6,7,8] Among these power-driven interdental cleaning devices, water flossers such as the Sonicare AirFloss or AirFloss Ultra (SAF/SAFU; Royal Philips N.V., Amsterdam, the Netherlands) have become popular. To transfer the water from the container to the nozzle and tip, the SAF contains an aqueous pipework; biofilm formation in aqueous pipework in general is a common phenomenon [18, 19] Such transmission of contaminated water-jet into the mouth may be a concern: (a) as potential source for re-infection during periodontal treatment similar to what has been discussed for microbial niches in the oral cavity other than periodontal pockets (e.g. tongue, tonsils) [20, 21], and (b) as potential source for cross-contamination among users similar to what was shown regarding cariogenic and periodontal bacteria from the mother to the child [22,23,24]. Since in the above-mentioned study [13] only water-jet samples transmitted via the used nozzle were analysed, no assumptions regarding the localization of the biofilm could be made
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