The Water Flosser: An Evolutionary Step in Interdental Care - Waterpik

• The Orthodontic Tip can also be used around orthodonticbrackets.• With the Toothbrush Tip, brushing action should also beemployed. Toothpaste may be used.The Pik Pocket tip has been designed for low-pressure delivery.It is latex-free. Since this tip is site specific, individuals will need toknow exactly where in the mouth it should be used.To use the Pik Pocket Tip:• Turn the unit to the lowest pressure setting. Failure to do thismay shorten the life of the unit (Figure 25).• Gently place the tip just slightly below the gingival margin(Figure 26).• Use a mirror to check that the tip is in the correct place.• Briefly hold the tip in place before proceeding to another area.To use the Tongue Cleaner:• Turn the unit to the lowest pressure setting.• Place the Tongue Cleaner in the center/midline of the tongueabout halfway back.• Gently pull the Tongue Cleaner forward.• Repeat several times.Current ModelsThere are two basic types of models, a countertop version andcordless version. Both have a pulsation rate and pressure rangeconsistent with what is needed to achieve clinical outcomes. Theywill accommodate most types of antimicrobial agents.The Waterpik ® Ultra Water Flosser is a countertop model (Figure27). It is the number one choice with dental professionals. This unitis smaller and quieter than previous countertop models. It has tenpressure settings for optimal control. The high volume reservoirprovides a water capacity for 90 seconds of cleaning, enough tocleanse the entire mouth.The Waterpik ® Complete Care bundles the proven technology ofthe Water Flosser with a sonic toothbrush. Like the Ultra, there are10 pressure settings along with high volume reservoir that providesfor 90 seconds of cleaning. This product comes with five tips. Twotoothbrush heads are also included (Figure 19).The Waterpik ® Traveler is about 50% smaller than the Ultra modelis and comes with global voltage, perfect for the world traveler oranyone with limited counter space. It has three pressure settingsand comes with four tips (Figure 28).For children ages 6–12, the Waterpik ® Water Flosser For Kidscomes with a handle designed for smaller hands. There are threepressure settings, and it comes with two tips. To make WaterFlossing fun, the unit comes with 20 decals (Figure 29).SummarySince its introduction in 1962, the Waterpik ® Water Flosser hasbeen evaluated in numerous randomized clinical trials that havedemonstrated its safety and efficacy. It is clinically proven toimprove oral health through reductions in:• Plaque biofilm 17,20,41,45,48,49,50,51,58• Bleeding 27,32,35,36,37,38,39,40,41,45,48,49,50,57• Gingivitis 16,18,30,32,33,36,37,39,41,45,48,49,58• Periodontal pathogens 19,25,26,27,30,34,36,38• Pro-inflammatory mediators/cytokines 45The Waterpik ® Water Flosser has been tested on a wide variety ofpatients, most consistently in those with gingivitis or in periodontalmaintenance. It has also been shown to benefit people with uniqueand/or general health conditions including:• Orthodontic appliances 19,41,50 • Crown and bridge 9• Implants 37 • Diabetes 48More recently, the Waterpik ® Water Flosser has been compared tostring floss, and three studies have demonstrated that the WaterFlosser can reduce plaque, bleeding, and gingivitis as well as stringfloss does. 49,50,57 The studies have evaluated three types of tips, theClassic Jet Tip, 49,57 the Plaque Seeker ® Tip, 56 and the OrthodonticTip; 50 all have been shown to work as well in removing plaque andbetter in reducing bleeding than did string floss. The Water Flosserhas also been demonstrated to be superior to the Sonicare ® AirFloss. 57 When combined with a sonic toothbrush, the results aresignificantly better than when using only a sonic toothbrush. 58 Thismakes the Water Flosser an ideal choice for patients who cannot,will not, or simply do not like to floss.Product Disclaimer: Most studies referenced inthis course have been done using the Waterpik ®Water Flosser by Water Pik, Inc. While otherbrands of Water Flossers are available, productsare not equivalent when it comes to pressureand pulsations. Therefore, expectations ofsimilar clinical outcomes on products ofdifferent brands cannot be assumed.Figure 27: Waterpik ® Ultra WaterFlosser, Model WP-100WFigure 28: Waterpik ® TravelerWater Flosser, Model WP-300WFigure 29: Waterpik ® Water FlosserFor Kids, Model WP-260W9

References1. Zambon JJ. Periodontal diseases. Microbial factors. Ann Periodontol1996; 1:879–925.2. Bashkar S et al. Water jet devices in dental practice. J Periodontol1971; 42:658–664.3. Selting WJ et al. Water jet direction and periodontal pocketdebridement. J Periodontol 1972; 43:569-572.4. Bashkar S et al. Effect of high pressure water jet on oral mucosa ofvaried density. J Periodontol 1969; 40:593-598.5. Keblish DJ, DeMaio M. Early palatial lavage for the decontaminationof combat wounds: Historical review and point proposal. Mil Med1998; 165:844–6.6. Leutze-Hoffmann KA, Schafer DS. Pulsed lavage in wound cleansing.Phys Ther 2000; 80:292–300.7. O’Leary TJ et al. Possible penetration of crevicular tissue from oralhygiene procedures. I: J Periodontol 1970; 41:158–162.8. Manhold JH et al. Carbon penetration of gingival tissue by oralirrigating devices. J Prev Dent 1978; 5:3–6.9. Krajewski J et al. Evaluation of a water pressure cleaning device asan adjunct to periodontal treatment. J Amer Soc Periodont 1964;2:76-78.10. Cantor MT, Stahl SS. Interdental col tissue responses to the use of awater pressure cleansing device. J Periodontol 1969; 40:282–295.11. Wank HA et al. Quantitative measurement of bacteremia and itsrelationship to plaque control. J Periodontol 1976; 47:683–686.12. Roman AR, App GR. Bacteremia, a result from oral irrigation insubjects with gingivitis. J Periodontol 1971; 42:757–760.13. Felix JE et al. Detection of bacteremia after the use of an oralirrigation device in subjects with periodontitis. J Periodontol 1971;42:785-787.14. Berger SA et al. Bacteremia after the use of an oral irrigation device.Annals of Int Med 1974; 80:510-511.15. Tamimi GA et al. Bacteremia study using a water irrigation device.J Periodontol 1969; 40:4-6.16. Lobene R. The effect of a pulsed water pressure cleansing device onoral health. J Periodontol 1969; 40:51–54.17. Hoover DR, Robinson HBG. The comparative effectiveness of apulsating Water Flosser as an adjunct in maintaining oral health.J Periodontol 1971; 42:37–39.18. Lainson PA et al. A longitudinal study of pulsating water pressurecleansing devices. J Periodontol 1972; 43:444–446.19. Hurst JE, Madonia JV. The effect of an oral irrigating device on the oralhygiene of orthodontic patients. J Am Dent Assoc 1970; 81:678–682.20. Hugoson A. Effect of the Water Pik ® device on plaque accumulationand the development of gingivitis. J Clin Periodontol 1978; 5:95–104.21. Nunn ME. Understanding the etiology of periodontitis: an overviewof periodontal risk factors. Periodontology 2000, 2003; 32:11–23.22. Winter A. Rapid destruction caused by a water-irrigating device.Periodontal Case Reports 1981; 11,13–14.23. Forrest J et al. Introduction to evidence-based decision making.In M Newman, H Takei, P Klokkevold, F Carranza (Eds.) ClinicalPeriodontology, 10th ed. 2006. St Louis: Saunders Elsevier.24. Novak KF, Novak MJ. Aggressive periodontitis. In M Newman, HTakei, P Klokkevold, F Carranza (Eds.) Clinical Periodontology, 10thed. 2006. St Louis: Saunders Elsevier.25. Cobb CM et al. Ultrastructural examination of human periodontalpockets following the use of an oral irrigation device in vivo.J Periodontol 1988; 59:155–163.26. Drisko C et al. Comparison of dark-field microscopy and a flagellastain for monitoring the effect of a Water Pik on bacterial motility.J Periodontol 1987; 58:381–386.27. Ciancio SG et al. Effect of a chemotherapeutic agent deliveredby an oral irrigation device on plaque, gingivitis, and subgingivalmicroflora. J Periodontol 1989;60:310–31528. Eakle S et al. Depth of penetration into periodontal pockets with oralirrigation. J Clin Periodontol 1986; 13:39–44.29. Drisko CH. Non-surgical pocket therapy. Pharmacotherapeutics. AnnPeriodontol 1996; 1:491–566.30. Jolkovsky DL et al. Clinical and microbial effects of subgingival andgingival marginal irrigation with chlorhexidine gluconate.J Periodontol 1990; 61:663–669.31. Waki MY et al. Effects of subgingival irrigation on bacteremiafollowing scaling and root planning. J Periodontol 190; 61:405–411.32. Flemmig TF et al. Supragingival irrigation with 0.06% chlorhexidinein naturally occurring gingivitis. I. 6 month clinical observations.J Periodontol 1990; 61:112–117.33. Brownstein CN et al. Irrigation with chlorhexidine to resolve naturallyoccurring gingivitis: a methodologic study. J Clin Periodontol 1990;17:588–593.34. Newman MG et al. Irrigation with 0.06% chlorhexidine in naturallyoccurring gingivitis. II: 6 months microbiological observations.J Periodontol 1990; 61:427–433.35. Walsh TF et al. Clinical effects of pulsed oral irrigation with 0.2%chlorhexidine digluconate I patients with adult periodontitits.J Clin Periodontol 1992; 19:245–248.36. Chaves ES et al. Mechanism of irrigation effects on gingivitis.J Periodontol 1994; 65:1016–1021.37. Felo A et al. Effects of subgingival chlorhexidine irrigation on periimplantmaintenance. Am J Dent 1997; 10:107–110.38. Fine JB et al. Short-term microbiological and clinical effects ofsubgingival irrigation with an antimicrobial mouthrinse. J Periodontol1994; 65:30–36.39. Newman MG et al. Effectiveness of adjunctive irrigation in earlyperiodontitis: Multi-center evaluation. J Periodontol 1994; 65:224–229.40. Flemmig TF et al. Adjunctive supragingival irrigation withacetylsalicylic acid in periodontal supportive therapy. J Clin Periodontol1995; 22:427–433.41. Burch JG et al. A two-month study of the effects of oral irrigationand automatic toothbrush use in an adult orthodontic population.Am J Orthod Dentofac Orthop 1994; 106:121–6.42. Braun RE, Ciancio SG. Subgingival delivery by an oral irrigationdevice. J Periodontol 1992; 63:469-472.43. Kinane DF, Bartold PM. Clinical relevance of the host responses ofperiodontitis. Periodontology 2000 2007; 43:278–293.44. Just the Facts, Flossing. Survey Center. ADA News. Nov. 200745. Cutler CW et al. Clinical benefits of oral irrigation for periodontitisare related to reduction of pro-inflammatory cytokine levels andplaque. J Clin Periodontol 2000; 27:134–143.46. Gemmel E et al. Cytokines and prostaglandins in immunehomeostasis and tissue destruction in periodontal disease.Periodontology 2000 1997; 14:112–143.47. Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol1996; 1:821–878.48. Al-Mubarak S et al. Comparative evaluation of adjunctive oralirrigation in diabetes. J Clin Periodontol 2002; 29:295–300.49. Barnes CM et al. Comparison of irrigation to floss as an adjunctto toothbrushing: Effect on bleeding, gingivitis, and supragingivalplaque. J Clin Dent 2005; 16:71–77.50. Sharma NC et al. Effect of a dental water jet with orthodontic tip onplaque and bleeding in adolescent patients with fixed orthodonticappliances. Am J Orthod Dentofacial Orthop 2008; 133:565–571.51. Gorur A et al. Biofilm removal with a dental water jet. CompendContin Educ Dent 2009; 30 (Suppl 1):1–6.52. Greenstein G. Research, Science, and Therapy Committee of theAmerican Academy of Periodontology. Position paper: the role ofsupra- and subgingival irrigation in the treatment of periodontaldiseases. J Periodontol 2005; 76:2015–2027.53. Assadorian J. Canadian Dental Hygienists’ Association PositionStatement: Flossing. CJDH 2006; 40:1–10.54. Husseini A et al. The efficacy of oral irrigation in addition to atoothbrush on plaque and the clinical parameters of periodontalinflammation: A systematic review. Int J Dent Hygiene 2008; 6:304–314.55. Fried, JL. Standards in Practice: Interdental cleansing. Access 2012;26:22–2556. Rosema NAM et al. 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Post test Course #12–18The Water Flosser: An Evolutionary Step in Interdental Care1. Which statement is true?a. Pulsation is three times more effective than a steady orcontinuous streamb. Pulsation creates a compression and decompression phasec. A rate of 1,200 pulsations is key to effectivenessd. All of the above2. The ideal pressure setting range is:a. Low onlyb. Low to mediumc. Medium to highd. High only3. Which individuals with special needs have been shown tobenefit from a Water Flosser?a. People with implantsb. People with orthodontic appliancesc. People with diabetesd. All of the above4. Average estimated depth of delivery into the sulcus using theClassic Jet tip at a 90-degree angle is:a. 10%b. 25%c. 50%d. 100%5. Which statement is true regarding the Pik Pocketsubgingival irrigation tip?a. In pockets ≤ 6 mm, it reaches 52%;pockets ≥ 7 mm, it reaches 99%b. In pockets ≤ 6 mm, it reaches 90%;pockets ≥ 7 mm, it reaches 64%c. In pockets ≤ 6 mm, it reaches 52%;pockets ≥ 7 mm, it reaches 28%d. In pockets ≤ 6 mm, it reaches 76%;pockets ≥ 7 mm, it reaches 42%6. Which agents are the only ones with a body of scientificevidence to show they are effective when used with aWater Flosser?a. Chlorhexidine, Essential Oil, Waterb. Chlorhexidine, Sodium Chlorite, Povidone Iodinec. Chlorhexidine, Essential Oil, Povidone Iodined. Chlorhexidine, Sodium Chlorite, Water7. The Waterpik ® Water Flosser has been shown to reducepathogenic bacteria up to:a. 2 mmb. 4 mmc. 6 mmd. 8 mm9. When compared to string floss, the Water Flosser has beenshown to be twice as effective at reducing bleeding AND aseffective at reducing plaque biofilm.a. The first statement is true, the second statement is falseb. The first statement is false, the second statement is truec. Both statements are trued. Both statements are false10. The site specific Pik Pocket Tip is recommended for:a. Furcationsb. Deep pocketsc. Difficult to access areasd. All of the above11. The incidence of bacteremia from a Water Flosser rangesfrom 0–50%; the rate is similar to other self-care devices.a. Both statements are trueb. Both statements are falsec. The first statement is true, the second statement is falsed. The first statement is false, the second statement is true12. The Water Flosser has been demonstrated to reduce:a. Plaque biofilmb. Bleeding and gingivitisc. Periodontal pathogens and inflammatory mediatorsd. All of the above13. The use of the Water Flosser on people with implants:a. Reduced bleedingb. Reduced gingivitisc. Reduced calculusd. All of the above14. The use of a Water Flosser twice daily on people withdiabetes:a. Had no effect at all on oral healthb. Reduced calculus onlyc. Reduced bleeding, gingivitis, plaque, IL-1ß, and PGE 2d. Improved blood sugar readings15. When compared to the use of a sonic toothbrush or manualtoothbrush only, the combined use of a Water Flosser andSonic Toothbrush was:a. 52% more effective than the sonic brush only atreducing plaqueb. 70% more effective than the sonic brush only atreducing bleedingc. 159% more effective than manual toothbrush only atreducing bleedingd. All of the above8. When compared to Sonicare ® Air Floss, the Water Flosser was:a. 80% more effective at reducing gingivitisb. 70% more effective at reducing plaquec. 3 times as effective at removing plaque from thegingival margind. All of the above11

Obtaining ContinuingEducation CreditsCredits: 3 hoursIf you have questions about acceptance of continuingeducation (CE) credits, please consult your state or provincialboard of dentistry.Directions:• Fill out the Water Pik CE Registration Form and AnswerSheet.• Answers should be logged on the answer sheet. Pleasemake a copy of your post-test and answer sheet to retainfor your records.• Only one original answer sheet per individual will beaccepted.• Answers left blank will be graded as incorrect.• Please fill out the course evaluation portion.• The post-test may be submitted via mail, fax, or email to:Water Pik, Inc1730 East Prospect RoadFort Collins CO 80553Attn: Continuing Education Self Study ProgramFax: 1-970-221-6075Email: ce@waterpik.comScoring:In order to receive credit, you must answer 10 of the 15questions correctly.Results:By email: 6 weeks(Please make sure your email address is legible).By mail: 8-10 weeksQuestions regarding contentor applying for credit?Contact: Carol Jahn, RDH, MS, by email:cjahn@waterpik.com or phone: 630-393-4623Academy of General Dentistry ApprovedPACE Program Provider FAGD/MAGD Credit.Approval does not imply acceptance by astate or provincial board of dentistry or AGDendorsement. The current term of approvalextends from 06/01/2010–05/31/2014.CE REGISTRATION FORMAND ANSWER SHEETCourse #12–18: The Water Flosser:An Evolutionary Step in Interdental CareName:Credentials:Street Address:City:State:Email:Day Phone:Zip:@Cell or Home Phone:Answer SheetPlease circle the correct answer for each question.1. a b c d2. a b c d3. a b c d4. a b c d5. a b c d6. a b c d7. a b c d8. a b c d9. a b c d10. a b c d11. a b c d12. a b c d13. a b c d14. a b c d15. a b c dCourse EvaluationCircle your response: 1 = lowest, 5 = highestCourse objectives were met1 2 3 4 5Content was useful1 2 3 4 5Questions were relevant1 2 3 4 5Rate the course overall1 2 3 4 5How did you acquire this course:Internet DVD Tradeshow CE Handout Other____PN 20010208ARTFN 20010208ART-F AF R0111