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Comparison of the Plaque Removal Efficacy of Aquajet Water Flosser

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Comparison of the Plaque Removal Efficacy of Aquajet Water Flosser Sarlati F ,et al . J Res Dentomaxillofac Sci http://www.Jrdms.dentaliau.ac.ir e(ISSN): 2383 -2754 Journal of Research in Dental and Maxillofacial Sciences Comparison of the Plaque Removal Efficacy of Aquajet Water Flosser and Dental Floss in Adults After a Single Use. (A Prelimi- Nary Study) Sarlati F1, Azizi A2*,Zokaei N3, Mohaghegh Dolatabadi N3, Hasanzadegan Roudsari M4, Moradi Hajiabadi A5 1 Associate Professor, Periodontics Dept,Dental Branch of Tehran, Islamic Azad University, Tehran, Iran. 2Professor, Oral Medicine Dept, Member of Dental Implant Research Center, Dental Branch of Tehran, Islamic Azad University, Tehran, Iran. 3 General Practitioner. 4 Phd student, Chemical Engineering Dept., Science and Research Branch, Islamic Azad University, Tehran, Iran. 5 Mechanical Engineering Dept., Science and Research Branch, Islamic Azad University, Tehran, Iran. ABSTRACT ARTICLE INFO Article Type Background and Aim: Toothbrushes cannot reach all interdental areas. Interdental Orginal Article cleaning is an important part of oral hygiene care. The purpose of this study was to Article History Received: April 2016 compare the supragingival plaque removal efficacy of an interdental cleaning power Accepted: July 2016 device (Aquajet) and dental floss. ePublished: Oct 2016 Methods and Materials: Thirty subjects were enrolled in this single-blind, split Keywords: mouth clinical trial. All the subjects received both written and verbal instructions and Water flosser, demonstrated proficiency prior to the study. The subjects were asked to abstain from Periodontium, oral hygiene methods for 48 hours prior to the study. The subjects were scored using Plaque index the Proximal/Marginal Plaque Index (PMI). Then, the four oral quadrants were ran- domly assigned to one of two treatment groups: One upper and one lower quadrant: Aquajet and the other two quadrants: dental floss. The subjects were observed to en- sure that they have covered all areas and have followed the instructions. Afterwards, they were scored again using the PMI. The pre and post-cleaning plaque scores were evaluated using two-way repeated measure ANOVA. Results: Both Aquajet and dental floss showed significant reduction of the baseline PMI in all dental areas (P<0.05), but the difference between the groups was not sig- nificant (P>0.05). Aquajet was significantly more effective than dental floss in reduc- ing plaque on the mesial, mid-buccal and distal surfaces of upper first premolar and on the mesial and distal surfaces of upper second premolar and first molar (P<0.05). Downloaded from jrdms.dentaliau.ac.ir at 8:55 +0330 on Tuesday December 18th 2018 Conclusion:The results proved that oral irrigation with Aquajet is as effective as that with dental floss in plaque removal, and that Aquajet had significantly higher plaque removal efficacy at hard-to-reach dental surfaces. Please cite this paper as: Sarlati F, Azizi A,Zokaei N, Mohaghegh Dolatabadi N, Hasanzadegan Roudsari M, Moradi Hajiabadi A. Comparison of the Plaque Removal Efficacy of Aquajet Water Flosser and Dental Floss in Adults After a Single Use. (A preliminary study). J Res Dentomaxillofac Sci.2016;1(4):16-25. *Corresponding author: Arash 16 Azizi Journal of Research in Dental and Maxillofacial Sciences, Vol 1,No 4, Autumn 2016 http://www.Jrdms.dentaliau.ac.ir Email: [email protected] Comparison of the Plaque Removal Efficacy of Aquajet Water Flosser and Dental Floss Introduction: Aquajet water flosser (NPB future Co., Teh- Interdental cleaning is an important part of ran, Iran) is a battery-free water-powered device. oral hygiene care. Tooth brushing alone cannot It has a spray nozzle and no reservoir. It can be remove all the plaque from dental surfaces, even installed to faucets or wall-fixed shower heads when done correctly and thoroughly. Dental floss through an adaptor (water separator). It should is considered as the “gold standard” of interden- be noted that the water pressure can be adjusted tal care(1), although flossing is really difficult for manually. (Figure 1) some patients. Data indicate that only 2% to 10% of the population floss regularly, while a major part of the population never floss.(2, 3) Oral ir- rigators were invented 50 years ago, and have shown to reduce probing pocket depth, bleeding on probing, supragingival plaque and proinflam- matory cytokine levels.(4-11) There are many types of oral irrigators availa- ble. Some have pressure and pulsation character- istics, while the others are continuous stream de- vices.(1) In 2005, Barnes et al reported that there was no difference between “manual tooth brush and water flosser” and “manual tooth brush and string floss” in reducing plaque biofilm.(6) Lyle et Figure 1- Aquajet water flosser (NPB future Co.). al also reported that “If patients are brushing and flossing and they have no clinical, radiographic The participants followed the manufacturer’s or other signs of infection, no major intervention instructions and directed the nozzle towards the is needed. However, if they are not flossing or gingival margin and followed a pattern through- have clinical signs of gingival or periodontal in- out the mouth. fection, then perhaps it is time to recommend an In this randomized, single-blind, single-use, effective alternative such as water flosser.”(1) split mouth clinical trial, all the participants re- The objective of this study was to determine ceived both written and verbal instructions and the plaque removal efficacy of Aquajet water demonstrated proficiency prior to the study. They flosser (introduced recently to markets in Iran) in were also instructed on how to floss correctly. comparison with traditional string floss. (Oral B essential floss, Procter & Gamble, Ge- Downloaded from jrdms.dentaliau.ac.ir at 8:55 +0330 on Tuesday December 18th 2018 neva, Switzerland). The correct technique (wrap- ping the floss around the middle fingers, using Materials and Methods: the index fingers and thumb to guide the floss, Thirty healthy non-smoking dental students contour around the side and move up and down with the average age of 26.53±5.78 years were the tooth) was communicated in writing and ver- recruited for this study. All the subjects had at bally. The subjects were asked to abstain from least 20 scorable teeth excluding third molars. oral hygiene methods for 48 hours prior to their The students that had orthodontic appliances, appointment. An examiner who was blinded to implants, crowns and bridges or other applianc- the products was assigned and calibrated for es were excluded from the study. The protocol intra-examiner reproducibility of Proximal/Mar- of this study has been approved by the ethics ginal Plaque Index (PMI).(12 ). The PMI divides committee of the dental branch of Islamic Azad the buccal and lingual surfaces of each tooth into University of Tehran, Iran. The subjects com- 3 unequal segments, each of which can be given pleted the medical history record and signed an a score ranging from 0 to 5 according to Turesky- informed consent. The ethics code of the present Gilmore-Glickman modification of the Quigley- study is (IR.IAU.DENTAL.REC.1395,12). http://www.Jrdms.dentaliau.ac.ir Journal of Research in Dental and Maxillofacial Sciences,Vol 1,No 4, Autumn 2016 17 Sarlati F ,et al . Hein plaque index.( 0= No Plaque, 1= Separate surfaces of mandibular teeth (P>0.05). Maxil- flecks of plaque covering less than 1/3 of the lary and mandibular teeth were divided to four area, 2= Discrete areas or bands of plaque cover- groups: (Group1: maxillary and mandibular inci- ing less than 1/3 of the area, 3= Plaque covering sors and canines, Group 2: premolars, Group 3: 1/3 of the area, 4= Plaque covering more than first molars, and Group 4: second molars.). There 1/3 but less than 2/3 of the area, and 5= Plaque were significant differences between pre and covering 2/3 or more of the area).(14) The four post-cleaning scores at the surfaces of maxillary quadrants of the participants’ mouth were ran- premolar and first molar (P=0.035 and P=0.024, domly divided into two treatment groups: One respectively). The percentage of satisfaction was upper and one lower quadrants were cleaned us- 67% for Aquajet and 57% for dental floss. ing Aquajet alone, while the other two quadrants were cleaned using dental floss alone. These two Table 1- Pre and post-cleaning plaque scores quadrants were changed from one participant to (Mean±standard deviation) in maxillary teeth af- the other in a clockwise rotation. Subjects were ter using Aquajet observed to ensure they have covered all areas and have followed the instructions. Afterwards, the teeth were scored again by the same examin- er using the PMI. The percentage of satisfaction with each product was recorded through inter- viewing the study groups. Data were summarized using the descrip- tive statistics. The pre and post-cleaning plaque scores were evaluated by two-way repeated measure ANOVA. The level of significance was set at <0.05. Results: Both groups showed statistically significant changes from pre-cleaning to post-cleaning scores in all maxillary and mandibular teeth. (Tables 1 to 4) Aquajet was significantly more ef- fective in plaque removal at the mesial, mid-buc- Downloaded from jrdms.dentaliau.ac.ir at 8:55 +0330 on Tuesday December 18th 2018 cal and distal surfaces of upper first premolar in comparison with dental floss (P=0.035, P=0.053 and P=0.017, respectively). It was also more ef- fective than dental floss at the mesial and distal surfaces of upper second premolar (P=0.019 and P=0.027, respectively). Aquajet was also more effective in plaque removal at the mesial and distal surfaces of upper first molar (P=0.008 and P=0.007, respectively). There were no statistical- ly significant differences between the plaque re- moval efficacy of these two interproximal clean- ing aids at the surfaces of other maxillary teeth (P>0.05).
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