Plaque – the never-ending story

The fight against plaque is never-ending; dental plaque is constantly forming in the mouth, twenty-four hours a day, seven days a week. It is therefore important to ensure that patients regularly remove any food residue and bacteria, taking particular care with areas that are hard to reach.

A quick glance at the most recent Adult Dental Health Survey confirms that plaque is very much a part of our patients’ lives. Two-thirds[i] (66%) of dentate adults were found to have visible plaque (bacterial material which collects on teeth and/or other oral structures such as dentures) on at least one tooth. A similar proportion (68%) presented with calculus in at least one sextant of the mouth, suggesting that inefficient cleaning could be an issue.

Considering that most adults claim they are brushing their teeth twice a day (75%)i and are using a fluoride toothpaste (76%)i we might assume that there is room for improvement in their cleaning technique.

Dental floss is by far the most frequently used of the various interproximal cleaning methods currently available, however just 22%[ii] of adults include flossing in their oral hygiene routine.

Patient compliance with string floss is typically short lived or entirely absent and many of the most willing and physically capable patients find it difficult to develop an effective flossing technique. There are also questions being raised as to the efficacy of using string floss, with evidence indicating that it brings little benefit in reducing plaque and gingival inflammation[iii].

Conversely, there is a wealth of evidence to validate the efficacy of a quality Water Flosser, demonstrating its considerable advantages over string floss in reducing bleeding[iv], gingivitis[v] and plaque[vi]. A recent study[vii] establishes the plaque removal superiority of the Waterpik Water Flosser compared to dental floss combined with a manual toothbrush after a single use. The Water Flosser group removed significantly more plaque from the marginal (33%), lingual (39%) and facial (24%) regions after just one cleaning session.

The 2009 Adult Dental Health Survey found that just 17%[viii] of dentate adults in the UK had very healthy gums. The efficient removal of plaque for every individual would transform the health of the country’s population, reducing the proliferation of gingivitis and perhaps even the number or the severity of associated systemic complications and disorders.

It falls to the dental profession to educate patients on the importance of self-care, along with instruction on the most appropriate techniques. With 78%i of adults receiving oral hygiene advice from their dentist, hygienist or therapist, there is a palpable opportunity to improve our communication with patients and, as a result, enhance their hygiene habits and help them to enjoy optimal oral health.

At best, tooth brushing can only reach up to 60% of the tooth’s surface; targeted interdental and subgingival care is needed. Rather than attempt to impose dental floss upon patients as the primary adjunctive cleaning method, given the clinical evidence, the Water Flosser would be a far better addition to the average household’s bathroom.

 To learn more about the Waterpik Water Flosser and the other products in the Waterpik Range go to



[i] Adult Dental Health Survey – England, Wales, Northern Ireland, 2009: Preventative Behaviour and Risks to Oral Health. NHS. P6. Available through: [Accessed 25th April 2013].

[ii] Adult Dental Health Survey – England, Wales, Northern Ireland, 2009: Preventative Behaviour and Risks to Oral Health. NHS. P8. Available through: [Accessed 25th April 2013].

[iii] Berchier CE, Slot DE, Haps S, van der Weijden GA. The effect of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dental Hygiene 2008;6(4):265-279.

[iv] Rosema NAM et al (2011) The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 13(1):2-10.

[v] Barnes CM et al (2005) Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent 16(3):71-77.

[vi] Sharma NC, Lyle DM, Qaqish JG, Galustians J, Schuller R (2008) Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Ortho Dentofacial Orthoped. 133(4):565-571.

[vii] Goyal CR et al (2013) Evaluation of the Plaque Removal Efficacy of a Water Flosser Compared to String Floss in Adults After a Single Use. J Clin Dent 24:37-42.

[viii] Adult Dental Health Survey – England, Wales, Northern Ireland, 2009: Oral Health and Function. NHS. P13. Available through: [Accessed 26th April 2013].





Biographical Information for Deborah M. Lyle, RDH, MS


Deborah received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri – Kansas City.  She has 18 years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy.  Along with her clinical experience, Deborah has been a full time faculty member at the University of Medicine & Dentistry of New Jersey, Forsyth School for Dental Hygienists and Western Kentucky University.  She has contributed to Dr. Esther M. Wilkins’ 7th, 8th, 9th and 10th editions of Clinical Practice of the Dental Hygienist and the 2nd and 3rd edition of Dental Hygiene Theory and Practice by Darby & Walsh.  She has written numerous evidence-based articles on the incorporation of pharmacotherapeutics into practice, risk factors, diabetes, systemic disease and therapeutic devices.  Deborah has presented numerous continuing education programs to dental and dental hygiene practitioners and students and is an editorial board member for the Journal of Dental Hygiene, Modern Hygienist, RDH, and Journal of Practical Hygiene and conducted several studies that have been published in peer-reviewed journals.  Currently, Deborah is the Director of Professional and Clinical Affairs for Waterpik, Inc.



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