The dental water jet
The dental water jet was developed by a dentist and hydraulic engineer and introduced in the United States in 1962. Since then it has been recommended or dispensed by dental professionals all over the world. Collectively, the research has evaluated safety and efficacy demonstrating a significant reduction in bleeding, gingivitis, plaque, calculus, pocket depth, and periodontal pathogens. More recently, researchers have looked at the impact of daily irrigation with a dental water jet on the inflammatory process reporting a significant reduction in the pro-inflammatory mediators associated with bone loss. Very few self-care devices have a body of research that shows consistent reduction in inflammation and infection and the ability to reach interproximally and subgingivally.
The efficacy from using a dental water jet is based on the direct application of a pulsed stream of water or other agent. The ideal combination is pulsations of 1,200 per minute and pressure settings ranging from 55–70psi. The combination of pulsations and pressure creates two zones of hydrokinetic activity, the impact zone where the solution initially contacts the tooth surface at the gingival margin, and the flushing zone where the solution is flushed subgingivally and interproximally. The majority of published clinical studies have been conducted using the Waterpik dental water jet especially those that measured the subgingival access of a solution. Using a traditional jet tip, Eakle et al found that a solution delivered by a dental water jet could penetrate 71% in shallow pockets (0–3mm), 44% for moderate pockets (4–7mm) and 68% for pockets > 7mm. Using a specialised tip that is placed about 2mm below the gingival margin, Braun and Ciancio demonstrated penetration up to 90% of a 6 mm pocket and 64% for pockets equal to or greater than 7mm.
Compliance with interdental cleaning using dental floss is extremely low and often frustrating for dental professionals. The existing research using a dental water jet is extensive, but there were no studies that directly compared irrigation to flossing. Now there is. In a single center, examiner blind, parallel, randomised clinical trial, Barnes and colleagues compared three different regimens and measured the impact on bleeding, gingivitis and plaque. One hundred five subjects were randomised into one of three groups. Group 1 used a manual toothbrush and dental floss, group two used a manual toothbrush and dental water jet, and group three used a sonic toothbrush and dental water jet. At the end of four weeks, the addition of a dental water jet resulted in significantly better oral health, regardless of the brush used compared to manual brushing and flossing. Specifically, the dental water jet was up to 93% better in reducing bleeding and up to 52% better at reducing gingivitis than traditional dental floss.
If you have not been recommending the dental water jet to your patients, it is time to reconsider. Beneficial outcomes have been shown in patients with orthodontic appliances, implants, crown and bridge, gingivitis and those non-compliant with dental floss. Research has also shown a benefit for diabetics and patients in periodontal maintenance programs.