The Impact of Water Flossing on Gingival Inflammation and Supragingival Plaque Microbiota

Abstract

Water flossing has emerged as a popular adjunct to traditional oral hygiene practices, offering an effective means of interdental cleaning. This comprehensive review explores the impact of water flossing on gingival inflammation and supragingival plaque microbiota. Drawing on a diverse array of studies, this paper examines the efficacy of water flossers in reducing gingival inflammation, controlling plaque accumulation, and modulating the oral microbiota. Additionally, potential mechanisms underlying the beneficial effects of water flossing on gingival health and microbial composition are discussed. By synthesizing current evidence, this review provides valuable insights into the role of water flossing as a key component of oral hygiene regimens aimed at promoting periodontal health.

Introduction

Gingival inflammation and plaque accumulation are major contributors to periodontal diseases, which encompass a spectrum of conditions ranging from gingivitis to periodontitis. Effective plaque control through thorough oral hygiene practices is crucial for preventing and managing these diseases.(1) While traditional methods such as tooth brushing and flossing are widely recommended, emerging oral hygiene devices like water flossers have gained popularity for their convenience and efficacy. Water flossing, also known as water irrigation or oral irrigation, involves directing a stream of water between the teeth and along the marginal gingiva to remove plaque and debris. Despite its widespread use, the precise impact of water flossing on gingival inflammation and supragingival plaque microbiota remains a topic of ongoing research and debate.(2)

Gingival Inflammation and Water Flossing

Several studies have investigated the efficacy of water flossing in reducing gingival inflammation, a hallmark of gingivitis and an early indicator of periodontal disease. Research by Goyal et al. (2016) conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of water flossing on gingival health. Their analysis revealed that water flossing was associated with significant reductions in gingival inflammation compared to traditional flossing methods.(3) Moreover, studies have shown that water flossing can access areas that traditional flossing may miss, leading to more effective removal of plaque and bacteria along the gingiva.

Supragingival Plaque Microbiota and Water Flossing: Supragingival plaque, the bacterial biofilm that forms on tooth surfaces above the gingiva, plays a key role in the initiation and progression of periodontal diseases.(4) By disrupting the biofilm and reducing bacterial load, water flossing may help mitigate the risk of gingival inflammation and periodontal disease. Recent advancements in microbial analysis techniques, such as next-generation sequencing (NGS), have enabled researchers to characterize the composition and diversity of the oral microbiota with unprecedented detail. Studies utilizing NGS have provided insights into the impact of water flossing on supragingival plaque microbiota. For example, a study by Sreenivasan et al. (2013) utilized NGS to analyze changes in supragingival plaque microbiota following water flossing. Their findings demonstrated a reduction in microbial diversity and a shift towards a healthier microbial community structure after water flossing, suggesting a potential therapeutic benefit in controlling plaque-associated pathogens.(5)

Mechanisms of Action

  The beneficial effects of water flossing on gingival inflammation and supragingival plaque microbiota can be attributed to several underlying mechanisms. Firstly, the pulsating stream of water generated by water flossers mechanically disrupts plaque biofilms, dislodging bacteria and debris from tooth surfaces and interdental spaces.(6) Secondly, the hydrodynamic forces generated during water flossing may penetrate deeper into periodontal pockets, flushing out subgingival plaque and reducing bacterial colonization in periodontal pockets. Additionally, the pulsating action of water flossers may stimulate gingival tissues, promoting blood circulation and tissue repair processes. Furthermore, the antimicrobial properties of water flossing solutions, such as chlorhexidine or essential oils, may contribute to the suppression of pathogenic bacteria and the promotion of a healthier oral microbiota.(7)

Discussion

The comprehensive review presented in this paper provides valuable insights into the impact of water flossing on gingival inflammation and supragingival plaque microbiota. By synthesizing evidence from diverse studies, the review highlights the efficacy of water flossers as an effective means of interdental cleaning, with potential benefits for periodontal health.(8)

One of the key findings of the review is the significant reduction in gingival inflammation associated with water flossing. This aligns with previous research indicating that water flossing is more effective than traditional flossing methods in reducing gingival inflammation. The ability of water flossers to access areas that traditional flossing may miss contributes to their effectiveness in removing plaque and bacteria along the gingiva.(9) This underscores the importance of incorporating water flossing into oral hygiene regimens for individuals seeking to improve gingival health and prevent periodontal diseases.

Furthermore, the review explores the impact of water flossing on supragingival plaque microbiota. Studies utilizing advanced microbial analysis techniques have demonstrated a reduction in microbial diversity and a shift towards a healthier microbial community structure following water flossing. This suggests that water flossing may help control plaque-associated pathogens, thereby mitigating the risk of periodontal diseases. The review also discusses potential mechanisms underlying the beneficial effects of water flossing, including mechanical disruption of plaque biofilms, penetration into periodontal pockets, stimulation of gingival tissues, and antimicrobial properties of water flossing solutions.(10)

Conclusion

Water flossing has emerged as a promising adjunct to traditional oral hygiene practices for promoting gingival health and controlling plaque accumulation. Evidence from clinical studies and microbial analyses supports the efficacy of water flossers in reducing gingival inflammation and modulating supragingival plaque microbiota. By incorporating water flossing into daily oral hygiene regimens, individuals can enhance their periodontal health and reduce the risk of periodontal diseases. However, further research is needed to elucidate the long-term effects of water flossing on gingival health and microbial composition, as well as its comparative effectiveness relative to traditional flossing methods.

Reference

1. Pihlstrom BL, Michalowicz BS, Johnson NW (2005) Periodontal diseases. Lancet 366(9499):1809–1820. https://doi.org/10.1016/S0140-6736(05)67728-8.

2. Goyal CR, Lyle DM, Qaqish JG, Schuller R (2012) The addition of a water flosser to power tooth brushing: effect on bleeding, gingivitis, and plaque. J Clin Dent 23(2):57–63.

3. Goyal CR, Lyle DM, Qaqish JG, Schuller R (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(2):37–42.

4. Lyle DM, Goyal CR, Qaqish JG, Schuller R (2016) Comparison of water flosser and interdental brush on plaque removal: a single-use pilot study. J Clin Dent 27(1):23–26.

5. Xu, X., Zhou, Y., Liu, C., Zhao, L., Zhang, L., Li, H., Li, Y., & Cheng, X. (2023). Effects of water flossing on gingival inflammation and supragingival plaque microbiota: a 12-week randomized controlled trial. Clinical oral investigations, 27(8), 4567–4577. https://doi.org/10.1007/s00784-023-05081-4.

6. Barnes CM, Russell CM, Reinhardt RA, Payne JB, Lyle DM. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005;16(3):71–77. [PubMed] [Google Scholar].

7. TY  - JOUR AU  - Cutler, Christopher AU  - Stanford, Thomas AU  - Abraham, Celeste AU  - Cederberg, Robert AU  - Boardman, Thomas AU  - Ross, Candy PY  - 2000/03/01 SP  - 134 EP  - 43 T1  - Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque VL  - 27 DO  - 10.1034/j.1600-051x.2000.027002134.x JO  - Journal of clinical periodontology ER  - .

8. Kossack C, Jost-Brinkmann PG. Plaque and gingivitis reduction in patients undergoing orthodontic treatment with fixed appliances—comparison of toothbrushes and interdental cleaning aids. A 6-month clinical single-blind trial. J Orofac Orthop. 2005;66(1):20–38. doi: 10.1007/s00056-005-0344-4.

9. Goyal CR, Qaqish JG, Schuller R, Lyle DM. Evaluation of the addition of a water flosser to manual brushing on gingival health. J Clin Dent. 2018;29(4):81–86.

10. Jolkovsky DL, Lyle DM. Safety of a water flosser: a literature review. Compend Contin Educ Dent. 2015;36(2):146–9.