Wednesday, 29 November, 2023

28 Aug 2021 | Oral Hygiene

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My patient will not floss. Now what?

New Products Patient Education Prevention

Are you still telling your patients they need to floss? Maybe it's time to try a different approach.

It's clear that dental flossing is not a favourite pastime and most people would rather do an unpleasant task like cleaning the toilet than flossing their teeth.1 What if a patient said to you, "I'm not going to floss. What else can you suggest?" Do you have an informed answer?

It's time to shift from telling our patients they need to floss to "It's important to clean between your teeth and here are some of the ways you can accomplish that task". Some of you may think flossing is the gold standard but let's look at the facts. A 2019 systematic review2 reported:

  • Dental floss - some evidence it may be more effective at reducing gingivitis (GI) but no clear difference in bleeding sites compared to brushing alone;
  • Interdental brush - some evidence they are more effective at reducing gingivitis (GI) but no clear difference in bleeding sites compared to brushing alone;
  • Wooden sticks - may reduce bleeding sites compared to brushing alone; and
  • Elastomeric interdental sticks - no difference for gingivitis or bleeding compared to brushing alone.

The studies used in the systematic review provided very low or low-certainty evidence. You can recommend floss if the patient is proficient with the technique. You can recommend interproximal brushes if the interdental space is large enough for it to fit. Keep in mind it may require multiple sizes to clean all areas. Tooth picks or wood sticks are not designed to reach through the interproximal space and anatomy impedes cleaning the convex surface.

Did you ever consider a Waterpik® Water Flosser?

Recently, the Waterpik Water Flosser was paired with a manual, sonic and oscillating rotating tooth brush.3-5 Regardless of toothbrush used, adding the Water Flosser was more effective than brushing alone for removing plaque and reducing gingival inflammation and bleeding.

There are several choices for your patients. Find the right combination for their needs and abilities. If you have not tried a Waterpik Water Flosser, it's time to see - and feel - for yourself what all the talk is about. The evidence is unequivocal; only the Waterpik Water Flosser is clinically proven more effective than flossing, interdental brushes and air floss for improving oral health.6

Get all the benefits of power brushing and water flossing in one convenient device - Introducing the Waterpik Sonic-Fusion®.


  1. American Academy of Periodontology. National Survey. 2015. Available at
  2. Worthington HV, MacDonald L, Poklepovic Pericic T et al. How use of interdental cleaning devices, in addition to tooth brushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD012018. DOI: 10.1002/14651858.CD012018.pub2. Available at
  3. 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(1):81-86.
  4. Goyal CR, Lyle DM, Qaqish JG, Schuller R. The addition of a water flosser to power tooth brushing: effect on bleeding, gingivitis, and plaque. J Clin Dent 2012; 23(2):57-63.
  5. Lyle DM, Goyal CR, Qaqish JG, Schuller R. Efficacy of the use of a water flosser in addition to an electric toothbrush on clinical signs of inflammation: 4-week randomized controlled trial. Comp Contin Ed Det 2020; 41(3):170-177.
  6. Study information available at




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