Interdental cleaning is a necessary habit for maintaining a healthy mouth, preventing both gingivitis and the development of cavities between teeth. Traditional string floss involves physically scraping the surfaces, while a water flosser uses a targeted stream of water for cleaning.
The Action of String Floss Versus Water Flosser
String floss relies on a mechanical action to clean the tight spaces between teeth, requiring the user to physically slide the material against the tooth surface. This method demands a careful technique, specifically wrapping the floss into a “C” shape around each tooth to scrape away sticky plaque biofilm from the enamel and just beneath the gum line. The cleaning is achieved through friction and direct contact with the tooth surface.
A water flosser employs hydrokinetic energy by projecting a thin, pulsating stream of water. This targeted stream works to flush out food debris, loosely attached bacteria, and soft plaque from the interdental space and the shallow pocket between the tooth and gum. Instead of scraping, the water flosser cleans by disruption and rinsing.
Clinical Effectiveness and Plaque Removal
When considering a direct replacement, the ability to remove the stubborn, sticky plaque biofilm is the primary factor. String floss is known for its effectiveness in physically disrupting and shearing the plaque directly from the proximal tooth surfaces, provided the user employs the proper C-shaped technique. This scraping ability is what many dental professionals have historically relied upon to prevent decay.
Water flossers have demonstrated high efficacy in reducing gingivitis, which is characterized by gum inflammation and bleeding. In some trials, the addition of a water flosser to regular brushing has shown a significantly greater reduction in gingival bleeding and gingivitis scores compared to brushing with string floss. This improvement is attributed to the pulsating action of the water stream, which not only cleans but also provides a massaging effect to the gum tissue, improving health.
However, the efficacy of water flossers for removing the most adherent interproximal plaque is often debated, though some recent studies suggest they can be at least as effective as string floss. For instance, some research indicates that water flossers can remove comparable amounts of plaque after a single use. Despite this, professional consensus often positions the water flosser as an effective alternative or an adjunct to string floss, especially for individuals who find traditional flossing difficult or painful.
Situations Where Water Flossers Excel
For certain dental situations, a water flosser provides a clear advantage over traditional string floss. Patients undergoing orthodontic treatment, for example, benefit immensely from the water jet’s ability to easily clean around the complex hardware of brackets and wires. Flossing with string requires tedious use of floss threaders and can be nearly impossible to perform effectively.
The gentle flushing action is also highly beneficial for individuals with complex dental restorations, such as bridges, crowns, or dental implants. Using string floss around implants can sometimes be challenging or even counterproductive, but the water flosser, especially with specialized tips, can clean around the delicate implant abutments without snagging or causing trauma. Clinical studies show that the water flosser can be up to two times more effective than string floss for improving gum health around implants.
Furthermore, the water flosser can be a superior option for people who struggle with manual dexterity due to conditions like arthritis, making the daily interdental cleaning routine more manageable and consistent. Those with sensitive or inflamed gums may also find the pulsating water stream to be a gentler, more comfortable cleaning method than the physical friction of string floss. Ultimately, the best tool is the one that the patient will use consistently.