One unconventional oral hygiene tool that I and my patients have found useful is the water flosser. As an orthodontist dealing with a significant number of patients with braces, traditional floss is incredibly time-consuming with braces and requires a high level of manual dexterity. As a teenager myself, I remember spending 20 minutes trying to thread floss under the wire and between each pair of teeth every night. Water flossing simplifies the task and makes adherence to the daily flossing requirement more realistic. While traditional floss is still effective, the time and patience required make widespread adoption unrealistic.
Integrating a water flosser into my routine as a teenager meant that flossing could be done every night rather than just occasionally. The water stream can remove plaque biofilm and food debris from areas that string floss struggles to access: under fixed retainers, around orthodontic brackets, under bridges, and in gum pockets where periodontal disease is a concern.
Water flossing is often considered unconventional, yet studies show it can reduce gingival bleeding and inflammation more effectively than string flossing. While plaque index improvements are usually similar between water flossers and other methods, a study by Goyal (2013) found that brushing combined with waxed string floss reduced whole-mouth plaque by 57.7%, while brushing combined with a water flosser achieved a reduction of 74.4%. Water flossers are also easier to use for people with braces, implants, or limited dexterity.
The key isn't replacing traditional methods altogether but layering tools. I still advise patients to use string floss, ideally two to three times per week (a minimum of once weekly), which they can save for those nights when they have time, perhaps on weekends. However, water flossers remove the daily requirement for string floss, dramatically improving a realistic hygiene regimen.