A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

Water Flossing Found To Be a Top Tool For Reducing Gingivitis

Research demonstrates the safety and efficacy of water flossers in maintaining oral health.


Waterpik water flosserDental professionals know that interdental cleaning is a critical component in achieving and maintaining optimal oral health. Traditionally, dental floss is the first tool recommended for interproximal cleaning. Yet this has shifted over the last decade or so, as reviews of flossing and other interdental aids — including water flossing — have yielded results that have disrupted traditional thinking. 

In March 2020, a clinical practice guideline on the treatment of periodontitis (stages I to III) concluded, “We do not suggest flossing as the first choice for interdental cleaning in periodontal maintenance patients.”1 The investigators determined that interdental brushes, including those with rubber/elastomeric filaments, and water flossers reduce inflammation and are preferred by patients.1 This supports a 2018 meta-analysis by Kotsakis et al2 which found that interdental brushes and water flossers ranked high for reducing gingival bleeding, while toothpicks and dental floss ranked last. A 2019 review by Ng and Lim3 provides further support, as the authors determined that interdental brushes and water flossers are effective for reducing inflammation and preferred over dental floss for implant maintenance.


Several studies have compared water flossing to string floss4–8 and interdental brushes.9,10 In each study, water flossing improved oral health significantly better than string floss or interdental brushes. Barnes et al5 demonstrated that the water flosser was superior to string floss when paired with either a manual or power toothbrush, thus concluding it was the water flosser that provided the additional oral health benefits. While some believe that string floss is still required when using a water flosser, studies indicate it is unlikely patients would realize an additional benefit from adding string flossing to a water flossing regimen. 


Water flossing is safe and effective. The Waterpik brand of water flossers is supported by more than 80 published scientific studies. This depth of scientific support has earned the Waterpik water flosser the American Dental Association Seal of Acceptance for safety and efficacy.



  1. Sanz M, Herrer D, Kebschull M, et al. Treatment of stage I–III periodontitis — The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4–60.
  2. Kotsakis GA, Lian Q, Ioannou AL, et al. A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation. J Periodontol. 2018;89:558–570. 
  3. Ng E, Lim LP. An overview of different interdental cleaning aids and their effectiveness. Dent J. 2019;7:56. 
  4. Gorur A, Lyle DM, Schaudinn C. Biofilm removal with a dental water jet. Compend Contin Educ Dent. 2009;30(Special 1):1–6. 
  5. Barnes CM, Russell CM, Reinhardt RA, et al. Comparison of irrigation to floss as an adjunct to toothbrushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005;16:71–77. 
  6. Magnuson B, Harsono M, Stark PC, et al. Comparison of the effect of two interdental cleaning devices around implants on the reduction of bleeding: a 30-day randomized clinical trial. Compend Contin Educ Dent. 2013;34(Special 8):2–7. 
  7. Rosema NAM, Hennequin-Hoenderdos NL, Berchier CE, et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol. 2011;13:2–10.
  8. Sharma NC, Lyle DM, Qaquish JG, et al. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2008;133:565–571. 
  9. Goyal CR, Qaqish JG, Schuller R, et al. Evaluation of the safety of a water flosser on gingival and epithelial tissue at different pressure settings. Compend Cont Educ Dent. 2018;39(Suppl 2):8–13. 
  10. Goyal CR, Lyle DM, Qaqish JG, et al: Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: A randomized controlled pilot study. J Clin Dent. 2016;27:61–65.

From Decisions in Dentistry. December 2021;7(11):25.

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