Evaluation of the Addition of a Water Flosser to Manual Brushing on Gingival Health

J Clin Dent. 2018 Dec;29(4):81-86.


Objectives: The purpose of this clinical trial was to compare the use of a manual toothbrush plus water flosser to a manual toothbrush alone on clinical signs of inflammation.

Methods: Seventy-two subjects were randomized into two groups and completed this four-week, single-blind, parallel, clinical trial. Group 1 used a Waterpik®Water Flosser (WF) once daily and brushed with a manual toothbrush twice a day. Group 2 brushed twice a day with a manual toothbrush only (MT). Subjects in group 1 were provided written and verbal instructions for the water flosser and all participants used the toothpaste and manual brush provided, brushing as they normally do. Data were evaluated at baseline (BSL), two weeks (W2), and four weeks (W4) for bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification of the Navy Plaque Index (RMNPI).

Results: Both groups showed a significant reduction from BSL for BOP, MGI, and RMNPI at W2 and W4, except for MT W2 facial proximal MGI (p = 0.153) and marginal RMNPI (p = 0.324). The WF was significantly more effective than the MT for reducing BOP, MGI, and RMNPI at W2 and W4 for all areas measured. The WF was 3.13 times as effective for reducing BOP, 2.69 times for MGI, and 2.44 times for RMNPI at W4 (p < 0.001) for whole mouth scores.

Conclusions: The addition of the Waterpik®Water Flosser to manual tooth brushing is significantly more effective for improving gingival health than manual tooth brushing alone.

Keywords: Modified Gingival Index; Rustogi Modification of the Navy Plaque Index; Waterpik; bleeding; bleeding on probing; gingivitis; toothbrush; water flosser.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Dental Devices, Home Care
  • Dental Plaque Index
  • Dental Plaque* / therapy
  • Equipment Design
  • Gingivitis* / therapy
  • Humans
  • Periodontal Index
  • Single-Blind Method
  • Toothbrushing
  • Water


  • Water