Oral Irrigation Research Articles

Use of the Water flosser to control dental biofilm: An integrative literature review

Water flosser oral irrigators have been used as a means to control oral biofilm, but there are still doubts as to the indication and effectiveness of these devices as a single or adjuvant means for oral hygiene. Thus, the present study aimed to perform an integrative literature review in the databases to investigate the importance of Water Flosser in the disintegration of dental biofilm and its best indication of clinical use. We defined the sample selection considering a period of 15 years prior to September 2023, accessing online databases such as Periódicos da Capes, SciElo, Web of Science, SCOPUS and PubMed. We used terms related to the literature, such as "Water Flosser", "Oral Irrigator", "Water Flosser and Biofilm", "Biofilm", "Mechanical Control of Biofilm" and "Gingivitis and Water Flosser". The most recent studies have shown beneficial results in controlling inflammation and biofilm comparable to brushing and flossing techniques. However, the results should be carefully analyzed, as these studies were published by only one group of researchers and a conflict of interest was found. On the other hand, these devices can improve the patient's interest in biofilm control, improving their compliance and consequently the maintenance of oral health.

Enhancing Periodontal Health with Oral Irrigation Devices: A Review

Oral irrigation devices are mostly used for oral physiotherapy in homes & dental clinics all over the world. The broad perspective in the use of oral irrigation devices has been the possibility of injury to the sulcular epithelium & underlying tissue. The existing oral irrigation devices exerts immense pressure on the sulcular epithelium. The patient found the procedure pleasant & neither injuries nor staining were noted. The technique may be useful in patients whose interdental areas can’t be assessed properly. This study focuses on reduction on plaque, gingival bleeding & may therefore, be an adjunct to normal oral hygiene.

Cleansing efficacy of an oral irrigator with microburst technology in adolescent orthodontic patients. A randomized-controlled crossover study

ObjectivesSimplifying interdental space cleaning is a constantly discussed topic. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in adolescent patients with fixed braces after four weeks of home-use.Materials and methodsThe study design is a randomized, single-blinded cross-over study. Following a twenty-eight-day period of product utilization in a home setting, a comparative analysis was conducted on hygiene indices, the Rustogi Modified Navy Plaque Index (RMNPI) and the Gingival Bleeding Index (GBI), between the test group (oral irrigator) and the control group (dental floss).ResultsSeventeen adolescent individuals completed the study. After 28 days of cleaning with the oral irrigator, RMNPI was 58.81% (55.31–66.47) compared to 59.46% (52.68–68.67) with dental floss (p = 0.070). Subgroup analyses did not indicate the superiority of either method. GBI after the test phase with the oral irrigator was 28.93% (23.21–33.97) and insignificantly higher compared to 26.40% (21.01–31.41) achieved with dental floss (p = 0.1585).ConclusionsNeither of the two products demonstrated statistically significant superiority in terms of cleaning efficacy. Therefore, no recommendation can be made in favor of one over the other. It was found that the high initial hygiene indices for fixed orthodontic appliances could be improved through increased awareness and precise instruction.Clinical relevanceFor adolescent patients who struggle to use interdental brushes an oral irrigator may be suggested as a simple alternative in hard-to-reach areas, such as those around a fixed dental appliance.

Training in the use of the water jet and cold atmospheric plasma jet for the decontamination of dental implants

ObjectivesClinical trials testing new devices require prior training on dummies to minimize the "learning curve" for patients. Dentists were trained using a novel water jet device for mechanical cleaning of dental implants and with a novel cold plasma device for surface functionalisation during a simulated open flap peri-implantitis therapy. The hypothesis was that there would be a learning curve for both devices.Materials and methods11 dentists instrumented 44 implants in a dummy-fixed jaw model. The effect of the water jet treatment was assessed as stain removal and the effect of cold plasma treatment as surface wettability. Both results were analysed using photographs. To improve treatment skills, each dentist treated four implants and checked the results immediately after the treatment as feedback.ResultsWater jet treatment significantly improved from the first to the second implant from 62.7% to 75.3% stain removal, with no further improvement up to the fourth implant. The wettability with cold plasma application reached immediately a high level at the first implant and was unchanged to the 4th implant (mean scores 2.7 out of 3).ConclusionA moderate learning curve was found for handling of the water jet but none for handling of the cold plasma.Clinical relevanceScientific rational for study: Two new devices were developed for peri-implantitis treatment (Dental water jet, cold plasma). Dentists were trained in the use of these devices prior to the trial to minimize learning effects.Principal findings: Experienced dentists learn the handling of the water jet very rapidly and for cold plasma they do not need much training.Practical implications: A clinical study is in process. When the planned clinical study will be finished, we will find out, if this dummy head exercise really minimised the learning curve for these devices.

Oral Irrigation Devices: A Scoping Review.

Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps. The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting. Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices. Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.

Intervention of a Multi-channeled Oral Irrigation Device for Improving Oral Health in Rehabilitation Patients After Stroke

Intervention of a Multi-channeled Oral Irrigation Device for Improving Oral Health in Rehabilitation Patients After Stroke

The Multi-Channeled Oral Irrigation (MCOI) Device Offers Simultaneous Oral Cleaning and Oral Health Assessment for a Stroke Patient with Underlying Dementia: A Case Report

The Multi-Channeled Oral Irrigation (MCOI) Device Offers Simultaneous Oral Cleaning and Oral Health Assessment for a Stroke Patient with Underlying Dementia: A Case Report

Combined Efficacy of Advanced Oral Hygiene Aids and Active Reminders in Maintaining the Oral Hygiene of Patients with Fixed Orthodontic Appliances: A Randomized Clinical Trial

Objectives To evaluate the efficacy of water irrigating devices, powered toothbrushes, and active repeated oral hygiene reminders on oral hygiene of fixed orthodontic patients. Materials and Methods This was a randomized, examiner-blind clinical trial involving fixed orthodontic appliance patients. Patients were recruited within six months of bonding on both the arches. Eighty patients were randomly assigned to four groups; groups 1 and 3 subjects received standard oral hygiene procedures and used manual orthodontic toothbrushes, and subjects in groups 2 and 4 used powered toothbrushes and water irrigators for oral hygiene maintenance during the study period. In addition, repeated oral hygiene reminders via SMS were sent to subjects in groups 1 and 2, whereas groups 3 and 4 subjects received only oral motivation. The principal investigator assessed the plaque index (PI) and gingival index (GI) at baseline (T0) and after 2, 4, 8, and 12 weeks, that is, T1, T2, T3, and T4, respectively. Results Group 2 and group 4 subjects showed statistically significant reduction in PI ( p < .001) and GI ( p < .001) scores at the end of study interval; however, the magnitude of decrease was less in group 4 in comparison to group 2. Intergroup comparisons between group 1 versus group 3 and group 2 versus group 4 were made to evaluate the efficacy of reminders. Statistically significant reduction was observed in group 2 as compared to group 4 at T4 ( p < .001) when compared to T1 ( p < .87). Conclusion Using powered toothbrushes and oral irrigators resulted in a statistically more significant reduction in plaque and gingivitis scores than conventional procedures. Active reminders had a catalytic effect in improving the oral hygiene.

Effect of Water and Chlorhexidine with Different Pressures of Oral Irrigation Device on the Surface Roughness and Topography of Giomer

Effect of Water and Chlorhexidine with Different Pressures of Oral Irrigation Device on the Surface Roughness and Topography of Giomer

Mechanical plaque removal in step-1 of care.

Maintaining a regular oral hygiene routine is essential for taking care of our mouths, ensuring healthy teeth, and achieving fresh breath. Patient education on oral hygiene is an important component of their overall treatment. Firstly, patients should be informed about the direct connection between bacteria in dental plaque and oral diseases. It is important for patients to understand that these conditions can be treated, but the success of treatment greatly depends on their level of oral hygiene. This journey begins by selecting the appropriate toothbrush and mastering the correct brushing technique to effectively remove dental plaque while avoiding any potential damage to the gums. In addition to toothbrushes, there are other devices available for comprehensive dental cleaning, such as floss, interdental sticks, interdental brushes, and oral irrigators. These aids are particularly beneficial for eliminating dental plaque from hard-to-reach areas. Moreover, tongue brushing or tongue scraping can effectively reduce breath odor and tongue coating. Currently, self-care recommendations for dental implants are primarily based on existing knowledge regarding natural teeth cleaning. Evidence-based recommendations are derived from comprehensive systematic evaluation of various oral hygiene aids.

Interdental oral hygiene interventions elicit varying compositional microbiome changes in naturally occurring gingivitis: Secondary data analysis from a clinical trial.

To evaluate the effect of different oral irrigators on the sub-gingival microbiome composition in patients with naturally occurring plaque-induced gingivitis. Sub-gingival plaque was collected from adults participating in a clinical trial assessing the efficacy of oral hygiene with two different oral irrigators (Waterpik Water Flosser [Group 1] and Oral-B Water Flosser [Group 2]) versus dental flossing (Group 3) for microbiome analysis. Plaque samples were reflective of naturally occurring plaque-induced gingivitis at baseline and of gingival health at the endpoint (4 weeks). Clinical measures of gingival inflammation were collected, and the sub-gingival microbiome was analysed by 16S rRNA sequencing to identify amplicon sequence variants. Oral hygiene instruction with self-performed manual toothbrushing and water-jet irrigation led to significant reductions in inflammation for all groups; both oral irrigators outperformed flossing in bleeding-on-probing reduction (p < .001). Microbiome diversity of sub-gingival plaque remained relatively stable over time, but significant changes were noted in certain taxa, consistent with increases in the relative abundance of commensals and reductions in late colonizers and periodontal pathogens in the water-jet groups. Reduction in gingival inflammation at 4 weeks within the water-jet groups is accompanied by slight but critical changes in microbiome composition. Although biodiversity does not substantially change within 4 weeks during the resolution of naturally induced gingivitis, significant relative increases in commensal early colonizers such as Streptococcus, Veillonella and Fusobacterium were accompanied by a shift towards a less anaerobic microbiota associated with return to health. These changes were contingent upon the type of interdental hygiene, with Group 1 exhibiting more significant alterations in microbiome composition towards a periodontal-health-compatible community.

What’s new for the clinician – summaries of recently published papers

Interdental cleaning devices in the form of dental floss and interdental brushes have traditionally being used as adjuncts to plaque removal in the interproximal areas of teeth. However, their routine use among younger adolescents has been reported in many studies to be less than optimal. In orthodontic patients, fixed braces promote supra- and subgingival accumulation of biofilm by impeding oral hygiene resulting in an altered oral microbiome, enamel decalcification and gingivitis1. It was recently shown that patients with upper and lower multibracket appliances are affected significantly more frequently by gingivitis (65%) and white spot lesions (30%).1 Additionally, in the predominantly young orthodontic patients, interdental spaces are often too narrow to use interdental brushes and flossing is challenging and time-consuming. Oral irrigators are easy to use even in the presence of orthodontic braces and are therefore favoured by many patients. Most oral irrigators use a stream of water only to mechanically remove plaque from interproximal areas but there are also oral irrigators which use a mixture of air and water, called microburst technology.

The effectiveness of dental water jet in reducing dental plaque and gingival bleeding in orthodontic patients: A systematic review and meta-analysis of randomized clinical trials.

This systematic review and meta-analysis tests the effectiveness of dental water jet (DWJ) with manual toothbrushes (MTB) compared to MTB alone in oral health maintenance in orthodontic patients. Four databases were systematically searched: PubMed, Scopus, Web of Science (WoS) and Cochrane Library until 6 January 2022 using a combination of medical subject heading (MeSH) terms and keywords. Randomized clinical trials (RCTs) were only included and critically appraised using the Cochrane Risk of Bias (ROB) tool. The mean difference (MD) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to compare both study groups (p-value < 0.05). After reviewing 5881 studies from a systematic search, six were selected for inclusion, with four involved in the quantitative analysis. The risk of bias was low in two studies, moderate in two studies and high in the remaining two studies. The meta-analysis showed a significant improvement in plaque index and bleeding scores in DWJ + MTB group compared MTB alone group in orthodontic patients with generalized gingivitis (MD = -0.75, 95% CI [-1.29, -0.22], p = 0.006) and (MD = -0.17, 95% CI [-0.27, -0.08], p = 0.0003), respectively. However, no significant improvement was detected between both groups in the gingival index. The use of DWJ as an adjunctive device in addition to MTB can be an effective strategy for maintaining oral hygiene in orthodontic patients with gingivitis. However, more high-quality RCTs are needed to confirm the findings.

Effect of a multichannel oral irrigator on periodontal health and the oral microbiome

Oral biofilms or dental plaques are one of the major etiological factors for diverse oral diseases. We aimed to evaluate the effect of a multichannel oral irrigator (MCOI) on periodontal health in 29 participants randomly divided into two groups: the MCOI group and the control group. To evaluate the effect of the MCOI on periodontal health, the modified Quigley Hein Plaque Index (PI), Mühlemann-Son Sulcus Bleeding Index (SBI), bleeding on probing (BOP), and swelling were evaluated and compared before and after MCOI use for 3 days. Although PI and SBI showed statistically significant increases in the control group, the MCOI group showed no significant changes in either parameter. Moreover, the percentage of BOP was significantly lower in the MCOI group. Saliva samples were analyzed by 16s rRNA amplicon sequencing to investigate changes in the oral microbiome. Sequencing results showed that Porphyromonas spp. were significantly increased in the control group, whereas no significant change was detected in the MCOI group. Using the MCOI, enriched populations and functional pathways were detected in pioneer species comprising non-mutans streptococci. These findings provide evidence of the effectiveness of the MCOI in maintaining periodontal health and a healthy microbial ecology in the oral cavity.

The efficacy of the dental Water Jet, orthodontic, and conventional toothbrushes in plaque removal around orthodontic braces in adolescents: A randomized controlled trial.

Orthodontic treatment improves both masticatory function and the aspects of facial esthetics through the correct alignment of the teeth. If oral hygiene is neglected during fixed orthodontic treatment, it may lead to plaque accumulation and gingivitis. The aim of this randomized controlled trial was to evaluate the effectiveness of the dental Water Jet (DWJ), and orthodontic toothbrush (O-TH) in removing dental plaque around the orthodontic braces compared to conventional toothbrush (C-TH) in adolescents. This was a three-arm, double-blind, and parallel-group randomized active-controlled trial. Forty-five patients were randomly allocated into three groups: DWJ, the O-TH, and the C-TH (control group). The primary outcome measure was dental plaque accumulation change from the baseline (t0 ) to post-cleaning (t1 ), and plaque scores were recorded using the Orthodontic Plaque Index (OPI). The current clinical trial was registered and approved by Australian New Zealand Clinical Trials Registry (ACTRN12623000524695). A statistically significant difference was noted in the OPI scores between different time points in the DWJ group, the O-TH group, and the C-TH group (p < .05). However, no significant difference was noted between the groups after the cleaning procedure (p > .05). The level of oral hygiene was not satisfactory in patients undergoing fixed orthodontic treatment. In addition, the efficacy of the DWJ was not superior to O-TH nor to C-TH in plaque removal.

Dextran Sulfate Sodium Salt (DSS) induced enteritis in Orange-spotted grouper, Epinephelus coioides

The enteritis is a common disease in fish farming, but the pathogenesis is still not fully understood. The aim of the present study was to investigate the inducement of Dextran Sulfate Sodium Salt (DSS) intestinal inflammation on Orange-spotted grouper (Epinephelus coioides). The fish were challenged with 200 μl 3% DSS via oral irrigation and feeding, an appropriate dose based on the disease activity index of inflammation. The results indicated that the inflammatory responses induced by DSS were closely associated with the expression of pro-inflammatory cytokines including interleukin 1β (IL-1β), IL-8, IL16, IL-10 and tumor necrosis factor α (TNF-α), as well as NF-κB and myeloperoxidase (MPO) activity. At day5 after DSS treatment, the highest levels of all parameters were observed. Also, the severe intestinal lesions (intestinal villus fusion and shedding), strong inflammatory cell infiltration and microvillus effacement were seen through histological examination and SEM (scanning electronic microscopy) analysis. During the subsequent 18 days of the experimental period, the injured intestinal villi were gradually recovery. These data is beneficial to further investigate the pathogenesis of enteritis in farmed fish, which is helpful for the control of enteritis in aquaculture.

Cleansing efficacy of an oral irrigator with microburst technology in orthodontic patients—a randomized-controlled crossover study

ObjectivesOrthodontic patients struggle with interdental cleaning calling for simpler mechanical devices to reduce the high plaque levels. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in patients with fixed braces after 4 weeks of home-use.Materials and methodsThe study design is a randomized and single-blinded cross-over study. After 28 days using the products at home, hygiene indices (Rustogi Modified Navy Plaque Index (RMNPI); gingival bleeding index (GBI)) were compared between test (oral irrigator) and control product (dental floss).ResultsSeventeen adult individuals finalized the study. After 28 days of cleaning with the oral irrigator, RMNPI was 54.96% (46.91–66.05) compared to 52.98% (42.75–65.60) with dental floss (p = 0.029). Subgroup analysis revealed that the higher cleansing efficacy of the dental floss is attributable to buccal and marginal areas. GBI after the test phase with the oral irrigator was 12.96% (7.14–24.31) and statistically significantly higher compared to 8.33% (5.84–15.33) with dental floss (p = 0.030) which could be seen in all subgroups.ConclusionsOral irrigators do not remove plaque and reduce gingival bleeding as efficiently as dental floss in easily accessible regions. However, in posterior regions, where the patients struggled with the application of dental floss, the oral irrigator showed similar results.Clinical relevanceOral irrigators should only be recommended to orthodontic patients who cannot use interdental brushes and are not compliant with dental flossing.

Combined Effect of Electric Toothbrush and Oral Irrigator- “Aqua Brush”

The efficacy and effectiveness of electric toothbrushes in comparison to manual toothbrushes lead to superior full-mouth and interproximal plaque removal and reduction of gingivitis, periodontitis and dental caries. Additionally, the use of an irrigator has been shown to improve the overall oral health. The aim of this study was to design and develop a utility model for the combined effect of the oral irrigator and tooth brush for maintaining oral health. The design of the modified toothbrushing unit comprises of an electric toothbrush and an oral irrigator. This was achieved by removing the electric toothbrush head to place a drill in the centre of the brush head for the insertion of irrigator head. The irrigator which was attached to a 50 ml water container with a detachable irrigator head powered by a 12 V external battery source was used to pump the water. The outcome was that a multifunctional working model combining the electric tooth brush and oral irrigator is designed successfully. Aqua Brush can be incorporated into the regular oral hygiene regimen making it convenient for the patient as it can be used as a single brushing unit and/or with the added irrigation enhancing the maintenance of oral hygiene.

Effect of interproximal home oral hygiene on clinical parameters and inflammatory biomarkers in patients receiving periodontal maintenance.

The purpose of this 6-week, single-blinded, randomized clinical trial was to determine if the use of an interproximal brush, with or without a tracking device, is more effective than an oral irrigator in improving interproximal probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and inflammatory markers. Seventy-six patients with Stages III-IV, Grade B periodontitis and a 5-7mm posterior interproximal PD with BOP were randomized: (1) interproximal brush alone (IB; n=26), (2) interproximal brush with tracking device (TD; n=23), (3) oral irrigator (OI; n=27). Participants used devices once daily for 6weeks. Clinical measurements (PD, CAL, PI, BOP, GI) and gingival crevicular fluid (GCF) samples were collected at baseline and 6weeks. All groups showed a significant reduction in PD and CAL (≥1.1mm, p<0.0001) and improvement in BOP (≥56%, p<0.0001) and GI (≥82%, p<0.001) at the experimental site with no differences among groups. The IB and IB+TD groups showed a significant reduction in PI (≥0.9, p ≤ 0.01). Interleukin (IL)-1β was reduced in all groups (p=0.006), but IB+TB more than OI (p ≤ 0.05). IL-10 was reduced among all groups (p=0.01), while interferon-gamma significantly increased (p=0.01) in all groups. IB and OI improved clinical parameters of PD and CAL and reduced inflammatory markers (BOP, GI, GCF IL-1β). IB had better interproximal plaque reduction. Tracking did not significantly improve clinical parameters compared with the IB and OI groups, suggesting future modifications are needed.

Digital imaging and qPCR analysis and comparison of short-term plaque removal effects of tooth brushing

PurposeDigital image technology and a real-time fluorescent quantitative polymerase chain reaction (RQ-PCR) were used to determine the changes in dental plaque caused by different toothbrushing tools.MethodsA total of 120 subjects were selected and divided into four groups: a manual toothbrush group, a manual toothbrush combined with an oral irrigator group, an electric toothbrush combined with an oral irrigator group, and an electric toothbrush group. We compared the changes in plaque count, plaque area, and colony colonization of the four groups after different cleaning tools had been used for a period of time.ResultsDental plaque count and plaque area decreased in all four groups. The decreases in plaque count and Streptococcus mutans in the electric toothbrush combined with an oral irrigator group were significantly higher than those in other groups.ConclusionElectric toothbrush combined with an oral irrigator shows a good result for plaque removal effect. Digital image analysis combined with biological methods can be used to evaluate dental plaque.