Download Effect of a Dental Water Jet with Orthodontic Tip on

Waterpik® Dental Water Jet
How it Works
Results You can Count On
©2008, Water Pik, Inc; 1730 E Prospect Rd, Fort Collins CO USA
Learning Outcomes
 Discuss the importance of pulsation and pressure in efficacy
 Distinguish depth of delivery between the Waterpik® dental water jet
and other self care devices
 List the oral health outcomes demonstrated by the Waterpik® dental
water jet
 Compare the use of the dental water jet to dental floss
 Identify the benefits of the Waterpik® dental water jet for people in
periodontal maintenance and with gingivitis, implants, orthodontics,
and diabetes
 Understand that the Waterpik® dental water jet is a safe and
effective device for daily use
The First Waterpik® Dental Water Jet
The Octopus ~ 1962
Waterpik® Ultra Dental Water Jet
Model WP-100W
 Innovative Design
– Quieter operation
– Compact, contemporary
– High volume reservoir
– Covered reservoir and tip
storage
– Advanced pressure control
system for a customized
experience
 Large selection of accessories
– Standard Jet Tips
– Tongue Cleaner
– Pik Pocket™ Tip
– Orthodontic Tip
– Toothbrush Brush Tip
Waterpik® Ultra Cordless Dental Water Jet
Model WP-450W
 Rechargeable power control
system
 Easy to fill reservoir
 Advanced ergonomic design
with no-slip grip
 Easy slide on and off
 Dual pressure control system
 Push button tip release
Clinically Proven Pulsation
Precisely Controlled Pressure
Pulsation
 1,200-1,400 per minute
 3x more effective than continuous stream devices
 Pulsation creates a decompression phase that permits the tissue to expel
debris and bacteria
Pressure
 Ranges from approximately 20 – 90 psi
 Most effective at 60 psi and above except for Pik Pocket™ tip, which must
be used at lowest pressure setting
Massaging Action of the Dental Water Jet
What is the Result of Pulsation and Pressure?
1. Removes plaque and bacteria
 Interproximally and subgingivally
 Deeper than brushing and
flossing
2. Massages & Stimulates the gums
Product
Penetration
Comments
Toothbrush
1-2 mm
No toothbrush, power or
manual has clinically proven
subgingival access
Rinsing
2 mm
Can reach less accessible
areas, but penetrates
subgingival areas minimally
Toothpicks/
woodpoints
Depends on
embrasure size
Effectiveness depends on
sufficient interdental space
Interdental
brushes
Depends on
embrasure size
Most effective with an open
interdental space
Floss
3 mm
Cannot reach into deeper
pockets
Waterpik® dental
water jet
6 mm and beyond
Clinically proven to remove
supra and sub gingival plaque
biofilm and bacteria
Depth of Penetration with Brushing
Depth of Penetration with Flossing
Standard Jet Tip
 Good for full mouth cleansing
 Start out on low and increase
pressure as comfortable
 Depth of penetration
– 0 – 3 mm = 71%
– 4 – 7 mm = 44%
– >7 mm = 68%
 In 60% of sites > 7 mm,
penetration was ≥ 75%
Depth of Penetration – Jet Tip
Pik Pocket™
Subgingival Irrigation Tip
 Site-specific tip
 Ideal delivery for the delivery of
antimicrobials
 Good for furcations, deep
pockets, hard-to-access areas
 Designed to be used at lowest
pressure setting
 Latex-free
 Reaches up to 90% of the
depth of pockets < 6 mm
and up to 64% in pockets > 7
mm
Depth of Penetration– Pik Pocket™ Tip
Orthodontic Tip
 Designed to brush and
irrigate hard to reach areas
around orthodontic
appliances and other dental
work
– Gently glide the tip along
the gingival margin
– Pause to gently brush
between teeth and
around bracket and wires
Cleaning Action with the Orthodontic Tip
Tongue Cleaner
 Tongue cleaning contributes
to fresher breath
 Adding tongue cleaning to
daily routine use of the
dental water jet contributes
to optimal oral health
The Toothbrush Tip
 Can be used with or without
toothpaste
 Use a light pressure to
vibrate the brush back and
forth with short strokes
similar to a manual
toothbrush
 Water will flow through the
brush to simultaneously
brush and irrigate
Plaque/Biofilm Removal
Biofilm Removal with a
Dental Water Jet
Gorur A, Lyle, D, Schaudinn C,
Costerton, JW, 2008
Compendium Continuing Dental
Education, 2009; 30(Spec Issue
1): 1-6.
Biofilm Removal with a Dental Water Jet
Gorur A et al, Compend Contin Dent Ed, 2009
Methods and Materials
 8 teeth were extracted from a patient with aggressive
periodontitis
– From four teeth, thin slices were cut and sterilized by autoclaving
– The tooth slices were inoculated with saliva and incubated for four days
to grow a biofilm
 4 teeth slices were treated with the standard jet tip for 3 seconds
at a pressure setting of 6 (medium).
 4 teeth slices were treated with the orthodontic tip for 3 seconds
at a pressure setting of 6 (medium).
 2 teeth slices were untreated and served as the control
 Two teeth that had not been inoculated with saliva were treated
by the orthodontic tip, in order to assess the effect on the
calcified biofilm.
Biofilm Removal with a Dental Water Jet
Gorur A et al, Compend Contin Dent Ed, 2009
Results
 Controls were examined under a
scanning electron microscope
and found to have biofilm
spanning the entire surface.
Biofilm Removal with a Dental Water Jet
Gorur A et al, Compend Contin Dent Ed, 2009
Results
 Treated teeth were examined under the scanning electron microscope
– The standard jet tip treatment for 3 seconds on teeth slices showed
extensive areas of biofilm removal in comparison with the untreated
“control” slice
 Standard tip removed 99.9% of the biofilm
Biofilm Removal with a Dental Water Jet
Gorur A et al, Compend Contin Dent Ed, 2009
Results
 Treated teeth were examined under the scanning electron microscope
– The orthodontic jet tip treatment for 3 seconds on teeth slices showed
extensive areas of biofilm removal in comparison with the untreated
“control” slice
 Orthodontic tip removed 99.8% of the biofilm
Biofilm Removal with a Dental Water Jet
Gorur A et al, Compend Contin Dent Ed, 2009
Conclusions
 The pressure and pulsation combination of the Waterpik®
dental water jet significantly removes biofilm with either the
standard jet tip or orthodontic tip
 Daily use of a Waterpik® dental water jet can significantly
reduce the bacterial load and the risk for periodontal disease
Bacterial Reduction
Additional Studies
 Drisko C et al, Journal Periodontology, 1987;58:381
 Water irrigation of 3 & 6 mm pockets reduced spirochetes to
depths of up to 6 mm
 Chaves ES et al, Journal of Periodontology, 1995; 65:116
 When water irrigation, CHX irrigation, CHX rinsing, and
toothbrushing were compared, only the irrigation groups
significantly reduced periodontal pathogens
 Cobb C et al, Journal Periodontology, 1988, 59:155
 Home irrigation with water reduced pathogenic subgingival
bacteria up to 6 mm
Reduces Plaque, Bleeding & Gingivitis
Comparison of Irrigation
to floss as an Adjunct to
Tooth Brushing: Effect on
Bleeding, Gingivitis, and
Supragingival Plaque.
Barnes CM, Russell CM,
Reinhardt RA, Payne JB,
Lyle DM
Journal Clinical Dentistry, 2005;
16(3): 71-77.
Comparison of Irrigation to floss as an Adjunct to Tooth Brushing:
Effect on Bleeding, Gingivitis, and Supragingival Plaque.
Barnes et al. J Clin Dentistry 2005
Method
4 week randomized trial with 105 subjects:
 To compare the efficacy of the addition of daily oral irrigation to
both power and manual toothbrushing and flossing
 To determine which regimen has the greatest effect on the
reduction of bleeding, gingivitis, and supragingival plaque
Comparison of Irrigation to floss as an Adjunct to Tooth Brushing:
Effect on Bleeding, Gingivitis, and Supragingival Plaque.
Barnes et al. J Clin Dentistry 2005
Conclusions
 A manual or power toothbrush plus
the use of a dental water jet, once
daily with plain water, is an
effective alternative to traditional
dental floss for reducing bleeding,
gingivitis, and plaque and in some
cases may provide superior results
for reducing bleeding and
gingivitis.
 The dental water jet was up to 93%
more effective at reducing bleeding
and up to 52% more effective at
reducing gingivitis
Comparison of Irrigation to floss as an Adjunct to Tooth Brushing:
Effect on Bleeding, Gingivitis, and Supragingival Plaque.
Barnes et al. J Clin Dentistry 2005
Conclusions
 Significant improvements in oral
health occurred regardless of
toothbrush type so it is likely that
many patients currently using a
power toothbrush may get further
improvements in oral health by the
addition of a dental water jet
 The recommendation of a
Waterpik dental water jet is a
viable choice to achieve desired
outcomes for non-compliant
individuals or those who cannot
floss effectively
Reduces Bleeding and Inflammation
Additional Studies
 Cutler C et al; Journal Clinical Periodontology, 2000; 27:134
 Reduced the pro-inflammatory mediators, IL-1ß and PGE2
associated with attachment and bone loss
 Newman MG et al; Journal of Periodontology, 1994; 65:224
 Reduced bleeding and gingivitis in periodontal maintenance
patients significantly more than patients using traditional methods
 Flemmig TF et al, Journal Clinical Periodontology,1995; 22:427
 Reduced bleeding by 50% over a 6 month time frame
 Flemmig TF et al, Journal of Periodontology; 1990; 61:112
 Reduced marginal bleeding and bleeding on probing significantly
better than CHX rinsing
Benefits to Patients in Orthodontics
Effect of a Dental Water Jet
with Orthodontic Tip on
Plaque and Bleeding in
Adolescent patients with
Fixed Orthodontic
Appliances
Sharma NC, Lyle DM, Qaqish JG,
Galustians J, Schuller R.
American Journal of Orthodontics
& Dentofacial Orthopedics, 2008;
133(4): 565-571.
Effect of a Dental Water Jet with Orthodontic Tip on Plaque and
Bleeding in Adolescent patients with Fixed Orthodontic Appliances.
Sharma N et al, Am J Orthod Dentofacial Orthop 2008.
Methodology
 Design: randomized, single blind, parallel
 Subjects: 106 adolescents (11 – 17 years old) with full orthodontic
brackets and wires
 Three treatment groups
– Group I: Waterpik ® dental water jet with orthodontic tip +
manual toothbrush
– Group II: Floss threader with traditional floss + manual
toothbrush
– Group III: Manual toothbrush only
 Clinical outcomes measured – baseline, 14 & 28 days
– Turesky modification of the Quiqley-Hein Plaque Index
– Gingival Bleeding Index
Effect of a Dental Water Jet with Orthodontic Tip on Plaque and
Bleeding in Adolescent patients with Fixed Orthodontic
Appliances.
Sharma N et al, Am J Orthod Dentofacial Orthop 2008.
Plaque Removal:
 3.76 times the reduction of
floss & 5.83 times the
reduction of toothbrushing
only at 4 weeks
Bleeding Reduction
 84.5% reduction in bleeding
from baseline at 4 weeks a
26% greater reduction than
flossing
Effect of a Dental Water Jet with Orthodontic Tip on Plaque and
Bleeding in Adolescent patients with Fixed Orthodontic
Appliances.
Sharma N et al, Am J Orthod Dentofacial Orthop 2008.
Conclusions
 The Waterpik® dental water jet
was statistically significantly
better than the other two groups
at 2 & 4 weeks in reducing
plaque and bleeding:
 The tapered brush tip at the end
of the jet tip likely enhanced
plaque removal as it was able to
clean around the brackets and
archwires while simultaneously
irrigating
 Subjects reported they were
more likely to use a dental water
jet over floss
Benefits for People with Diabetes
Comparative Evaluation of
Adjunctive Oral Irrigation in
Diabetes,Al-Mubarak S et al, J
ClinicalPeriodontology, 2002;
29:295-300.
 Treated 52 individuals with type 1 or 2
diabetes with ultrasonic scaling
followed by 3 months of either routine
oral hygiene (ROH) or ROH plus twice
daily water irrigation via the Pik
Pocket™ tip
 At 12 weeks, those who added the
Waterpik® dental water jet to routine
oral hygiene had 44% better reduction
in bleeding over those with ROH
Benefits for People with Implants
Effects of Subgingival Chlorhexidine
Irrigation on Peri-Implant
Maintenance, Felo A et al,
American Journal Dentistry, 1997;
10:107-110
 Irrigation Pik Pocket™ tip with
0.06% CHX was 87% more
effective at reducing bleeding
than rinsing with 0.12% CHX.
 The dental water jet was
significantly better than rinsing
with 0.12% CHX in reducing
plaque and gingivitis
Safe and Effective
Ultrastructural Examination
of Human Periodontal
Pockets Following the Use
of an Oral Irrigation Device
in Vivo.
Cobb CM, Rodgers RL, Killoy WJ
Journal of Periodontology 1988;
59(3):155-163.
Ultrastructural Examination of Human Periodontal Pockets
Following the Use of an Oral Irrigation Device in Vivo.
Cobb et al, J Periodontol 1988
Method
 32 teeth scheduled for extraction due to advanced chronic adult
periodontitis
 Randomly assigned to test or control
 Prior to extraction, teeth in the test group were irrigated by a
Waterpik® dental water jet for 8 seconds at 60 psi
 Test and control specimens were obtained by a combination of tooth
extraction and biopsy to allow the pocket soft tissue wall to remain
attached during extraction
 All specimens were processed and examined by scanning electron
microscope (SEM)
Ultrastructural Examination of Human Periodontal Pockets
Following the Use of an Oral Irrigation Device in Vivo.
Cobb et al, J Periodontol 1988
Results
 There was no observable difference between control
and test specimens concerning the pocket soft
tissue wall
 There were no differences between control and test
specimens with regard to bacterial penetration
Conclusion
 Pulsating oral irrigation effects a qualitative change
on subgingival plaque and is not injurious to soft
tissues
American Academy of Periodontology,
Journal of Periodontology, November 2005
 Supragingival irrigation can assist individuals with gingivitis or poor
oral hygiene. The greatest benefit is for those who perform
inadequate interproximal cleansing
 The greatest advantage of subgingival irrigation is that it
permits patients to participate in maintaining the bacterial
reduction that was previously obtained during root planing
Position Paper: The role of supra and
subgingival irrigation in the treatment of periodontal diseases
Canadian Dental Hygienists’ Association
Canadian Journal of Dental Hygiene, June 2006
“Many flossing aids and interdental cleaners
including floss holders, automated flossers,
interdental brushes, picks, wooden sticks, and
some home irrigators, are viable alternatives to
manual finger flossing.”
CDHA Position Paper: Flossing
David L. Jolkovsky, DMD, MS
Diplomate, American Board of Periodontology
Private Practice Limited to Periodontics, USA
“The Waterpik® dental water jet is a great help for my
patients. Studies show it is safe and can reduce bleeding
even more than flossing. For some, using a Waterpik®
dental water jet is the only way they have been able to
stop gingival bleeding. It is especially important for
patients who have many crowns because it can flush
areas between teeth that flossing cannot reach.”
Dental Water Jet & Solutions
“Several studies have shown that
water or other antimicrobial
medicaments provide an
increased reduction of gingivitis
and BOP over normal oral
hygiene alone in maintenance
patients”
Drisko C,
Annals of Periodontology, 1996
Dental Water Jet & Evidence-based Solutions
Water
 A true “natural” product
 No side effects
 Cost effective
 Readily available
 Efficacy demonstrated through
numerous clinical trials
Essential Oil
 Effectiveness documented via
full strength not dilutions
Chlorhexidine
 Because of better interproximal and
subgingival penetration compared
to rinsing, dilution is acceptable for
daily irrigation
Effective Dilutions of CHX (based
on 0.12%)
 0.02% = 5 parts H2O + 1 part CHX
 0.04% = 3 parts H2O + 1 part CHX
 0.06% = 1 part H2O + 1 part CHX
Using a Dental Water Jet
Advise your patients:
 Do not turn on the unit until the tip is in the
mouth
 Bend from the waist over the sink
 Close the lips slightly to avoid splashing but
allow the water to flow freely from the mouth into
the sink
 Before removing the tip, pause the flow or turn
the unit off
Important Tips!
Be sure to review manufacturer’s complete
instructions PRIOR to recommending or
demonstrating to a patient
Solution used, including water, should be at room
temperature for maximum comfort
The first time the dental water jet is used, have the
patient start out at the lowest setting and then
increase as comfortable
If any solution other than water has been used, fill
half of the reservoir with water, remove the tip and
flush the system
The Jet Tip & Ortho Tip
 Start in the molar area and
follow the gingival margin
 Stop at each interproximal area
briefly
 With the Ortho Tip, sweep
around brackets and wires for
gentle cleaning
 Continue using the irrigation tip
until all areas around and
 Hold the tip at a right (90) angle to the
between the teeth have been
long axis of the tooth at the
interproximal space almost touching the irrigated
tooth
Pik Pocket™ Tip
 Using a mirror, check tip
placement
 Slide pressure control to the
lowest setting
 Hold the tip in place briefly
 Irrigate all areas as
recommended
 Place the tip slightly
subgingivally
Reasons to Recommend a
Waterpik® Dental Water Jet
1. Fights periodontal disease on multiple levels
including reducing plaque biofilm, bacteria,
gingivitis, and bleeding
2. It is safe and effective on people in
periodontal maintenance and with gingivitis,
orthodontic appliances, implants, and
diabetes.
3. It is an easier and more effective alternative
to traditional dental floss for reducing plaque
biofilm, gingivitis and bleeding
Professional Support Materials
Visit our website at www.waterpik.com
 Newsletter
 Patient Education Brochures
 Instruction Manuals & Quick Start Guides
 Educational video clips for patients & practitioners
 Complimentary Self-study Continuing Education
Courses
– The Dental Water Jet: The Key to Optimal Oral Health
– The Diabetes Epidemic: The Impact on Oral Healthcare Providers
– The New Challenges of Child and Adolescent Health: Implications
for Oral Health Care Practitioners
– Seniors & Boomers: Living Longer, Living Healthier