Cleaning between teeth is a fundamental part of oral health, traditionally accomplished with string floss. The water flosser, or oral irrigator, uses a pressurized stream of water to flush away debris and plaque. This comparison explores how each tool works, the clinical evidence for their effectiveness, and the practical factors that influence daily choice.
Mechanism of Cleaning Action
String floss operates through a mechanical scraping action. The user physically guides a thin strand of nylon or PTFE into the contact points between teeth. By wrapping the floss around the tooth in a “C” shape and moving it up and down, the user shears off the sticky, adherent biofilm known as plaque from the tooth surface and just below the gumline. This physical contact is effective for removing plaque that adheres tightly to the enamel.
The water flosser uses a hydrodynamic flushing action powered by a pulsating stream of water. This stream, which often operates at pressures between 50 and 90 psi, disrupts and rinses away soft plaque and loose debris. The rapid pulse rate creates a compression and decompression phase that effectively flushes the gingival sulcus—the shallow groove between the tooth and the gum—and areas string floss may not easily reach. It cleans primarily by irrigation rather than direct physical scraping.
Comparative Data on Plaque Reduction
For general plaque removal, evidence suggests that a water flosser is at least as effective as string floss, often showing a slight edge in studies. String floss’s ability to physically scrape plaque from the side surfaces of teeth remains a benefit, particularly in tight contact points. However, the water flosser’s ability to reach complex, less accessible areas, such as back molars or irregular tooth surfaces, often results in superior overall plaque reduction.
The primary clinical advantage for the water flosser is its ability to improve gum health and reduce inflammation, known as gingivitis. Studies show that when used alongside toothbrushing, water flossing leads to a greater reduction in gingival bleeding and gingivitis scores compared to string floss. This improvement is attributed to the massaging effect of the pulsating water stream, which stimulates the gums and flushes bacteria from the periodontal pocket. The water flosser can be up to 52% more effective at reducing gingivitis and 93% better at reducing bleeding than traditional floss in some trials.
When Water Flossers Are Recommended Over String
Certain oral health circumstances make the water flosser a beneficial choice over string floss. For individuals with orthodontic appliances like braces, the water stream easily navigates around brackets and wires that string floss struggles to clean. Specialized tips can further enhance cleaning around these fixed appliances, reducing plaque and bleeding.
The water flosser is also recommended for cleaning around complex dental work, such as bridges, crowns, and dental implants. The water jet cleans underneath bridges and around implants, areas where string floss is often ineffective or requires tedious threaders. People with limited manual dexterity, such as those with arthritis, find the water flosser much easier to use than manipulating string floss. The device is less technique-sensitive than string flossing, which requires a specific “C-shape” motion for maximum effectiveness.
Time, Cost, and Compliance Factors
Practical considerations of time and expense influence the choice of interdental cleaner. String floss is the winner on initial cost, typically costing only a few dollars for a long-lasting supply. A water flosser requires a higher initial investment, with quality models ranging from approximately $30 to over $100, plus the occasional cost of replacement tips.
The convenience and ease of use of the water flosser can positively affect user compliance. Many individuals find the water flosser to be a faster and less cumbersome process than maneuvering string floss, which can be challenging and time-consuming. While less portable and requiring counter space and a power outlet, the water flosser may lead to more consistent daily use because the user finds the method more comfortable and less irritating to sensitive gums.