Is Water Flossing Better Than String Flossing?

Everyone's been there: You have a dentist appointment tomorrow and you’re madly flossing because you’re worried about bleeding gums. You promised your dentist at your last appointment that you'd floss more, but you haven't.

As a dentist for a long time, I saw patients that simply didn’t floss and wondered if there was a better way to floss than the traditional string and finger method.

Bleeding gums and periodontal disease are common and serious problems. Even though flossing helps prevent them, a lot of people don't want to do it. For dentists, it's a losing battle.

Is there a magic solution to this problem? Many patients ask if there’s an alternative to flossing. Until recently, the answer was no. However, water flossers have now provided an interesting option.

waterpik water flosser

A Solution to an Age-Old Problem

Since dental floss was introduced nearly 200 years ago, oral healthcare providers have consistently promoted or even pushed floss use, but flossing compliance has been an ongoing challenge.

Regularly flossing is just a hard thing to achieve for many people. That anxiety before dental appointments could often be alleviated if the need to floss would just go away.

The basic premise of a water flosser is to use a water stream to remove biofilm. Besides dislodging plaque and food debris, a water flosser also helps to prevent gum disease and inflammation by flushing away bacteria responsible for gingivitis and other oral infections.

Some data shows that the water flosser and standard floss were equivalent in plaque biofilm removal. The water flosser, though, may add an extra dimension to plaque removal. The oral microbiome is more complicated than simply the ‘amount of plaque’ present.

Bleeding gums and gum disease begin when pathogenic bacteria increase in hidden pockets inside your mouth. As bleeding gums progresses to gum disease, there is an increase in fluid to the crevice. These may carry factors that help the growth of harmful bacteria.

Water flossers may provide an extra edge in fighting this process.

The American Dental Association stresses that flossing is important for gum health.

Do You Really Need to Floss?

Before we even get into the different methods of flossing, let’s attack the problem at a head. If you don’t feel that flossing is important, there’s no fancy gadget that’s going to convince you to do it.

The areas between your teeth account for a large percentage of plaque build-up, and these areas are prone to gingivitis which will lead to gum disease if left untreated. Flossing is designed to clean the plaque in your mouth that builds up in these areas.

Gingivitis and bleeding gums are very common conditions. They are signals of inflammation in your mouth and body.

Oral hygiene is designed to prevent the build-up of harmful bacteria on your teeth and gums. Between the teeth, particularly, are areas where bacterial imbalances can first begin to happen.

Flossing is designed to prevent bacterial changes that lead to gum disease. Gum disease has been linked to heart conditions, diabetes, and lung infections.

Research on Flossing

Remember, we’re trying to find a solution to something that may not have been a huge problem in the first place. In 2015, the FDA declared that the evidence behind flossing wasn’t justified to specifically recommend it. They stated the following:

"The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year. Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy.”

Now before you throw the floss away, there are limitations to the referenced studies.

For one, it’s hard to "blind" the studies, making accurate results difficult to achieve. The problem is that participants obviously know whether they're actually flossing. Plus, people lie to the dentist all the time about how much they floss.

As a dentist, I’ve seen people’s gums benefit from flossing. This is anecdotal evidence that many dentists agree with. So, the story isn’t clear cut, but we can certainly conclude that conventional floss may not be the answer for everyone.

Water Flosser Research 

So what do the studies say? The water flosser has been evaluated more than 50 times since its introduction in 1962. Clinical findings for reducing bleeding and gingivitis are supported by positive outcomes from more than 20 clinical trials.

One study in 2013 showed that a water floss in combination with brushing to be significantly more effective than a manual brush and string floss in removing plaque from tooth surfaces.

Other studies have shown significant reduction in plaque over interdental brushes, such as air floss.

Advantages of Water Flossers

A water flosser offers several advantages over traditional floss.

Better Around Restorations and Implants

Maintenance of dental restorations and implants is critical to their long-term survival, and water flossers are safe and gentle on them.

A three-month study comparing water flossing with 0.06 percent CHX (chlorhexidine, an active ingredient in mouthwash) delivered with the Pik Pocket™ Tip to rinsing with 0.12 percent CHX found that those who used the water flosser had superior reductions in:

  • Plaque (29% vs. 9%)
  • Bleeding (62% vs. 33%)
  • Gingivitis (45% vs. 10%)

Cleaning Around Orthodontic Appliances

Keeping orthodontic appliances clean can be tedious and challenging, especially for teenagers. Water flossing makes it easier.

In a study, adolescents ages 11 through 17 who used a water flosser with the orthodontic tip every day for 4 weeks had three times the reduction in plaque vs. those who used a manual brush and floss, and five times the reduction than those who only brushed.

The water flosser group reduced bleeding by 84.5% from baseline, which was 26% better than brushing and flossing and 53% better than tooth brushing alone.

It's Easy to Use

Using a water flosser is easier than string flossing because it requires less manual dexterity. It takes about a minute to cleanse the entire mouth.

Beyond the initial investment, all you need is water (although the water flosser can also accommodate most mouth rinses.) Water flossers are appropriate for people of almost any age, even children as young as 6, as long as they have supervision.

Despite some benefits, water flossers have had some negative feedback from users, who don't like that they:

  • Are bulky and difficult to carry
  • Require batteries, refilling, and maintenance
  • Are more expensive than regular floss

A Word From Verywell

If there’s anything I’ve learned as a dentist, it’s that people are different. It’s important to know your own preferences. But if there’s one thing we can agree on, it's that your teeth and oral health are important!

If regular flossing isn't getting the results you're looking for, a water flosser might be the best option for you.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Periodontal disease.

  2. American Dental Association. Floss/Interdental cleaners.

  3. American Dental Hygienists’ Association. Interdental cleansing.

  4. American Dental Association. Floss/interdental cleaners.

  5. MedlinePlus. Gingivitis.

  6. Cleveland Clinic. Gingivitis and periodontal disease (gum disease).

  7. Dhadse P, Gattani D, Mishra R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ?J Indian Soc Periodontol. 2010;14(3):148-54. doi:10.4103/0972-124X.75908

  8. Lyle DM. Relevance of the water flosser: 50 years of dataCompend Contin Educ Dent.

  9. Goyal CR, Lyle DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single useJ Clin Dent.

  10. Sharma NC, Lyle DM, Qaqish JG, Schuller R. Comparison of two power interdental cleaning devices on plaque removalJ Clin Dent.

By Steven Lin, DDS
Steven Lin, DDS, is a dentist, TEDx speaker, health educator, and author.