What is a Water Flosser and Should You Use One?

Many people struggle to maintain a daily flossing routine, even though cleaning between the teeth is one of the most effective ways to prevent cavities and gum disease. Water flossers are gaining popularity as an easier, gentler option. But do they really work, and should they be added to your routine?

Karim El Kholy, DDS, an associate professor at Columbia’s College of Dental Medicine, explains what water flossers do, who they help, and how to use them effectively.

First, why is flossing important?

Bacteria are always present in the mouth, and they create sticky, gooey materials that attach to the teeth, known as bacterial plaque or biofilm. The plaque can harden into tartar, leading to gum disease (gingivitis) and even tooth loss if it’s not removed. When you eat, the bacteria thrive on the food particles that get stuck on your teeth.

What is a water flosser?

A water flosser is a small device that jets pressured water into different areas in the mouth to help dislodge food particles between the teeth or in hard-to-reach places that string floss cannot reach.

How is water flossing different from string flossing?

Brushing and string flossing remove bacterial plaque mechanically. Water flossers can dislodge some food particles and remove some superficial bacteria; they can also reach pockets or gaps around the teeth and deeper into those areas. However, they won't necessarily dislodge or disrupt the biofilm. We still need to string floss and a brush to clean adequately.

Does a water flosser work as well as regular floss?

We don't have long-term evidence yet, but based on some existing evidence, we still recommend string flossing and brushing. Water flossing can be added to your routine, but it should not replace these methods.

Who can benefit most from a water flosser?

It may be very difficult for some of our patients to get string floss under, around, or between hard-to-reach areas. Water flossers can be especially helpful for people who:

• Have braces, bridges, or dental implants
• Have gum disease or inflamed gums
• Have limited hand mobility
• Want an easier, more comfortable way to floss

Are there people who should not use a water flosser?

No, but I recommend that patients who have a gag reflex from the pressured water spray not use one.

Can a water flosser be used after dental surgery or gum infections?

No. With gum surgery, we often sever the attachment of the gums to the teeth or the underlying bone, creating a wound-healing space that is initially stabilized by a clot and later develops into tissue during the healing process.

In the initial period, which can last from two days to one week, we often instruct patients to avoid brushing that area, especially if we're performing regenerative procedures and grafts to protect the clot from being destabilized. Pressure from a water flosser might disrupt this healing process. There are specific toothbrushes to use after surgery.

Can you give advice on how to use a water flosser correctly?

Water flossing and string flossing require a bit more training than a toothbrush. If somebody buys a water flosser off the shelf, I recommend they take it to their next cleaning and have their hygienist demonstrate how to use it, as well as toothbrushes and string flossers.

We want you to become a participant and a partner in your oral hygiene care, along with your provider. Our patients who are on top of their oral hygiene will be the ones to come in and tell us, “I can feel something there that I can't get to.” And we can instruct them to open or close their mouth to get to those areas.

Does it matter in which order you do your oral hygiene routine?

The correct order is the one that you will perform consistently and effectively. But you can start with the water flosser to remove food particles, then use string flossers, and finally finish with toothbrushing. However, the goal is to do all three; the order is the least important. Every tool tackles something a bit different, but they all help maintain good oral health. And the more you do on your end, the less we have to do on ours.

Karim El Kholy, DDS, is an associate professor at Columbia’s College of Dental Medicine.