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Journal

of

Clinical Periodontology: 1978:

5:

95-104

Key words: Gingiviiis

-

ptaque

prevention.

Accepted

for

publication: July

15. 1977.

ffect of the Water Pik device on

plaque accumulation

and development of gingivitis

ANDERS HUGOSON

The Department

of

Periodontology,

The Institute for Postgrad uate D ental Ed ucation,

Jonkoping, Sweden

Abstract.

The

influence

of the

water irrigating deviee. Water Pik,

on the

accumulation

of plaque anddevelopment of gingivitishasbeen studied usingthemodel, "experimental

gingivitis

in

ma n". T he investigation was carried

out on

41 patient vo lunteers w hose teeth

were thoroughly scaled

and

polished during

a

4-week period

of

intensive oral hygiene

preceding each experimental period. Gingival exudation. Plaque Index

and

Gingival Index

were registered

at the

beginning

af the

experimental periods.

The

participants were then

divided into four groups. Groups A and Babandoned all forms of active oral hygiene.

Group

A,

however, were given W ater

Pik

devices

as the

only oral hygiene aid. G roups

C

and

D

continued

to

clean their teeth using

a

toothbrush

and

Group

C

were given Water

Pik devices

as a

supplementary

aid.

After

14

days, gingival exuda tion. P laque Index,

Gingival Index and soft tissue injuries were re gistered. Theresults showed that, while

both groups

A and B

dem onstrated extensive plaqtie deposits

and

gingivitis, these were

present

to a

significantly lesser degree

in

Water

Pik

users.

The

toothbrushing groups

(C

and D)

failed

to

demonstrate

any

further redn ction

of

plaque

or

gingivitis when

WaterPikwas introduced as an additional measure.Nosoft tissue injuries w ere found .

Extensive clinical and epidemiological re- viding a pulsating stream of water under

search has clearly shown that dental plaque adjustable pressure, e.g.Water Pik.These

is

an

essential aetiological factor

in the

water irrigating devices have even been used

development of caries and periodontal dis- as ameansofconveying d ifferent antiseptic

ease (Socransky 1970, Waerhaug 1971, medicaments to the oral cavity (Lobene

Genco 1973).It hasalso been shown that et al.1972, Agerbaek et al. 1975).

both these diseases can be prevented or Many investigators have tried to deter-

treated by adequate plaque control (Lov- mine the valueof the water irrigating device

dahlet al.1961 , Axelsson Lindhe 1974, as an oral hygiene aid. Thefindings have

Lindhe Nyman 1975).Formany years, varied greatly. Accordingtocertain authors,

various water irrigating devices have been itsabilityto remove plaqueis insignificant

advertised

as

supplements

to

the established

or

non-existent (Emslie 1964, Lobene 1969,

methods of mechanical plaque control. Covin et al. 1973, Matsuzaki et al.1974),

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96

HUGOSON

inflammation. Some investigators on the

other hand, have reported reductions in both

plaque and debris (Bhaskar et al. 1971, Gup-

ta et al. 1973, Agerbaek et al. 1975), and

gingiva inflamm ation (Lobene 1969, Lain-

son et al. 1970, Gupta et al. 1973).

Loe et al. (1965) and Theilade et al.

(1966) used an experimental model to in-

vestigate the initiation and development of

gingival inflammation. From tbeir studies

it was possible to demonstrate clearly the

close relationship between bacterial plaque

accumulation and the development of gin-

givitis. The aim of this investigation was

to study the effect of the Water Pik device

on plaque accumulation and tbe develop-

ment of gingivitis using the same model.

Materials and Methods

A total of 41 individuals were selected

from a group of volunteers to participate

in the investigation. The selection process

excluded individuals with advanced gingival

recession and pathological deepening of the

gingival crevice.

Pre-experiniental Period

After a thorough oral examination, tbe par-

ticipants were motivated and instructed in

the use of the toothbrush and wooden tooth-

pick twice daily. The teeth were then scaled

and polished so that no plaque could be dis-

closed upon application of a basic fuchsin

solution. During the 4 weeks which fol-

lowed, the participants' teeth were polished

at least twice weekly. At the same time, an

effort was made to ensure that oral hygiene

measures were being carried out satisfac-

torily. By the end of the pre-expcrimenta

period, both Plaque Index and Gingival

Index scores were extremely low.

Experimental Period 1

On day zero the patients were randomly

accumulation and gingival inflammation

were registered along with the gingiva

exudation from 13-^23 (Brill 1959). Thi

was done according to the intracrevicula

method (Egelberg 1964). Each strip (filte

paper, 1.5 mm X 10.0 mm N o 3, Munktell

Sweden), was held parallel to the tooth and

introduced into the mesiolabial part of the

gingival crevice until slight resistance wa

felt. Five strips were collected from each

patient at each examination. The strip

were left in position for 3 min after which

tbey were removed and stained with a

0.2 solution of ninhydrin. After drying

the length of the stained segment of each

strip was measured to the nearest 0.2 mm

using a sliding caliper. The average length

of the stained area on the five strips was

taken to represent the individual exudate

value. The participants were then scored

according to tbe Plaque Index (Pll) system

(Silness & Loe 1964) and Gingival Index

(GI) system (Loe & Silness 1963). Four

surfaces and four gingival areas of each

tooth in the dentition were examined.

The individuals in group A were then

trained in the use of the Water Pik. It

was to be employed twice daily and in

accordance witb the manufacturer's instruc-

tions using the highest available pressure

and a full reservoir of water. No other

forms of oral hygiene were allowed. The

participants

oi

group B were asked to

abandon all forms of oral hygiene during

this period.

The trial was terminated after 14 days.

Gingivai exudation, Pll and GI were again

noted. The participants were also examined

for possible soft tissue injuries.

Intermediate Period

After this 14-day trial, the participants'

teeth were again polished and the intensive

oral hygiene program reintroduced. The

measures taken during tbis 4-week period

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WATER PIK AS A PLAQUE CON TROL DEVICE 97

pre-experimental period. The aim was to

re-estahlish a zero baseline as a starting

point for the next part of the investiga-

tion.

Experimental Period II

On day zero, the patients were randomly

divided into two groups (C and D). As in

the first trial, the gingival exudate, PII and

GI was noted for each individual.

The participants of group C were al-

lowed to continue active oral hygiene in

the form of toothbrushing twice daily. As

a supplementary measure, they were in-

structed in the use of the Water Pik de-

vice. The participants of group D were,

however, limited to toothbrushing twice

daily. Neither in group C nor in group D

was the use of toothpicks allowed during

this experimental period.

The trial was terminated after 14 days.

The gingival exudate, PII and GI were

again registered. The participants were also

examined for evidence of soft tissue injuries

inflicted during the test period.

All registrations and measurements of

Table 1. Oral hygiene. All tooth surfaces. Frequency distribution of tooth surfaces exhibiting

Piaqu e Indice s of 0, 1, 2 and 3 at the baseline exam ination (day 0) and at the end of ihe

experim ental periods (day 14). M ean values and S.E.M. are given for both experim ental

periods

Orale Hygiene. A lle Zahnoberfliichen. Frequenzverteiiung der Zahnoberflachen mit den Flaque-

indizes 0, 1, 2 und 3 wdhrend der Ausgangsuntersuchung (Tag 0) und der abschliejienden

Un tersuchung (Tag 14). Fiir die beiden Versuchszeilpnnk le werden die M ittelwerte itnd der Stan-

dardfehler des Mitlcls angegeben

Hyg iene bucco-d entaire. Totitcs les faces denlaires. Distribution de frequen ce des faces den-

laires presentant les Indices Plaque 0, 1, 2 ct 3 a I'exatnen initial (jour 0) et a la fin des

periodes experimeniales (jour 14). Les valeurs moyenties et I'erreur-type de la moy enne sont

donnees pour les deux periodes experimentales

Experimental period I

Experimental period II

Score Group A Group B

Group C Group D

Day 0

105,6

( .2)

3.8

(0.8)

0.3

106.3

(1.1)

3.8

(0,9)

0.7

NS

NS

96,6

(3.0)

11.7

(2.8)

1.3

0.5)

1.3)

8.8

(1.3)

1.7

(0.4)

NS

NS

NS

Day 14

9.2

(2.4)

34.0

3.2)

53.6

(3.6)

12.9

6.7

1.7)

22.4

(3.6)

39.6

(4,0)

42.5

N S

76.7

(3.2)

26.8

(2,1)

6.1

(1.7)

74.4

(3.9)

26.8

(2.7)

9.3

(1.9)

NS

NS

N S

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98

HUGOSON

the stained strips were carried out by two

examiners, both of whom were unaware of

the purpose of the study.

Since Plaque and Gingival Index scoring

was carried out on an ordinal basis rather

than at interval level, nonparametric sta-

tistics (Mann-Whitney U-test) were used

far campadng the total plaque and gingival

relatianships af the corresponding groups.

However, when camparisans were made of

the number af surfaces with a certain score.

Student's t-test was utilized. This was also

used for analysing the gingival exudate

data.

Results

At the start of the investigation tbere were

no differences between the groups as re

gards age, sex and number af existing teeth

This was alsa the case concerning the num

ber af surfaces harbauring plaque and th

gingival conditian af all sites examine

priar ta bath experimental periads (Table

1 & 2). Following bath pre-experimeota

and intermediate periods, law readings fo

PlI and GI were obtained as a result af th

intensified orai hygiene procedures.

During the first trial (Experimental Pe

riod I), the group using Water Pik as tb

sale means of oral hygiene (Group A) and

the group abandoning all forms af ara

hygiene (Graup B) bath shawed an in

crease in gingivai exudation. No statisticall

significant difference between these tw

groups could be found (Table 3).

Table. 2. Gingival cond ition. All tooth surfaces. Frequen cy distribution of to oth surfaces ex

hibiting Gingival Indices of 0, 1 and 2 at the baseline exam ination (day 0) and at the en

of the experim ental periods (day 14). M ean values and S.E.M. arc given for both exper

mental periods

Zustand der Gingiva. Alle Zahnoberfldehen. Frequenzverteilung der Zahnoberfldehen mit de

dazu gehorenden Gingival-Indizes 0, 1, 2 und 3 wahrend der Ausgangsuntersuchung (Tag 0

und wdhrend der Abschlu0untersuchung (Tag 14). Eiir die beiden Versuchszcitpunkte werde

die Mittelwerte und der Standardfehter des Mittels angegeben

Etat de la gencive . Toutes les faces dentaires. Distribution dr. frequence des fac es dentaire

presentan t les Indices Gingiva tix 0,1 et 2 a I'exam en initial (jour 0) et a la fin des periode

experimentales (jour 14). Ees valeurs moyennes et I'erreur-type de la moyenne sont donnee

pour les deux periodes experimentales

Day 0

Day 14

Score

0

1

1

0

1

2

Experimental period I

Group A

99.3

(2.7)

(2.4)

0.5

57.0

(5.0)

44.5

C3-?)'

8.3

Group B P

105.2 NS

(1.3)

5.8 NS

(1.4)

0.1

34.5

(5.4)

55.2 -

(3.5)

21.6 **

Experimental period

Group C

97,7

(2.7)

11.8

(2.6)

0.1

82.1

(3.9)

25.8

(3.4)

1.7

Group D

100.4

(2.0)

9. 9

(1.9)

0. 2

84.7

(3.3)

23.0

(2.6)

3.3

11

P

N S

N S

-

N S

N S

N S

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WATER PIK AS A PLAQUE CON TROL DEVICE

99

Table 3. Gingival exudation. Mean values and S.E.M. for gingiva] exudation in each group at

the haseline examination {day 0) and at the end of the experimental periods (day 14)

Gingivale Exsudation. Mittelwerte und der Slandardfehler des M ittels fiir die gingivale Exsu da-

tion bei jeder Gruppe. Ausgangsuntersuchung (Tag 0) und Abschhifi der Versuchsperioden

(Tag 14)

Exstidation gingivale. Valeurs m oyenne s et erreur-lype de la moy enne pou r I'exsudation gin-

givale dans ehacun des groupes a l'exame n initial (jour 0) et d la fin de s periodes experim en-

tales (jour 14)

Experimenta] period I

Experimenta] period II

Group A

0.99

(0.11)

1.61

(0.14)

Group B

1.05

(0.09)

1.92

(0.12)

P

N.S.

N.S.

Group C

1.37

(0.13)

1.41

(0.16)

Group D

1.53

(0.22)

1.62

(0.22)

P

N.S.

N.S.

Day 0

Day 14

Table 4. Ora ] hygiene. Bueca], ]ingual, and prox ima ] surfaces. Frequen cy distribution of tooth

surfaces exhibiting Plaqu e Indices of 1, 2 and 3 at the end of the experim ental pe riods (day 14).

Mean va]ues and S.E.M. are given for both experimenta] periods

Orale Hygiene. Bukkale, linguale und approximate Oberfldchen. Frequenzvertethmg der Zahn-

oberfldchen mit Plaque-Indiz.es 1, 2 und 3 bei AbscJ ilu^ der Versuch sperioden (Tag 14). Fiir

beide Ve rsuchszeitpunkte werden die M ittelwerte u nd der Standardfeh ler des M itlels angegeben

Hygiene bucco-dentaire. Faces vestibulaires, linguales et proximales. Distribution de frequence

des faces dentaires presentant les Indices Ptaque J, 2 et 3 a la fin des periodes experim enlales

(jour 14). Les valeurs moyennes et I'erreur-type de la moyenne (S.E.M.) sont donnees pour les

deux periodes experimeiitales

Experimenta] period I

Experimenta] period II

Score

Group A Group

B

Group C Group D

Mean (S.E.M.) Mean (S.E.M.) M ean (S.E.M.) M ean (S.E.M.)

Group of

surfaces

Proximal

Buecal

Lingual

0

1

2

3

0

1

2

3

0

1

2

3

1.2 -

12.9 (2.1)

35.0(2.2)

5.9(1.7)

4.1 (LO)

9.7 (1.2)

9.2(1.1)

4.4 (0.9)

3.9(1.1)

11.5 (0.9)

9.4 (1.0)

2.6 (0.6)

1.1 -

7.7 (2.1)

22.3 (3.4)

24.4 (4.4)

2.6 (0.8)

4.8(1.1)

8.7 (1.1)

11.7(2.0)

3.0(0.8)

9.9(1.1)

8.6 (0.8)

6.5 (1.0)

-

N.S.

N.S.

N.S.

N.S.

N.S.

N.S.

25.7 (2.7)

23.6 (1.6)

5.5 (1.6)

- -

26.1 (0.4)

1.2 (0.3)

0.2 -

- -

25.0(0.7)

2.0 (0.7)

0.4 -

23.7 (3.5)

23.6 (2.4)

8.0 (1.8)

- -

26.4 (0.3)

0.8 (0.2)

0.4 -

- -

24.1

(0.5)

2.5 (0.4)

0.9 -

_ _

N .S

N .S

N .S

-

N.S

N .S

-

N .S

N .S

-

-

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100

H U G O SO N

Table 5.

Gingival condition. Buccal, lingual and proxim al surfaces. Freq uenc y distribution

tooth surfaces exhibiting Gingival Indices of 0, 1 and 2 al tbe end of tbe experimental perio

(day 14). Mean values and S.E.M. are given for both experimental periods

Zusland der Gingiva. Bukkale, U nguale und approximate Oberfldchen. Frequenzverleilung d

Zahnoberflachen mit Gingival-Indizes von 0, 1 und 2 bei AbschlufI der Versuchsperioden (Ta

14). Fiir die beiden Versuchszeitpunkte werden M ittelwerte und der Slandardfehler des M

tels angegeben

Etal de la gencive . Faces vestibulaires, Hng uales et pro ximales. Di.'itribution de frequence d

faces dentaires presenlant les Indices Gingivatix 0, 1 et 2 a la fin des periodes experimental

(jour 14). Les valeurs moyennes et I'erreur-type de la moyenne sont donnees pour les de

periodes experimentales

Group of

surfaces

Experimental period [

Experimental period II

Score

Group A Group B

Mean(S.E.M.J Mean(S.E.M.)

Group C Group D

IVlean(S.E.M.) Mean (S.E.M.)

Proximal

Buccal

Lingual

24.6 (3.0)

24.8(1,9)

5.5(1.4)

14.3 (1.6)

10.8 (1.2)

2.5 (0.7)

18.6(1.1)

8.9 (1,0)

0.3 (O.i)

14.4 (2.6)

26.5 (2.0)

14.6 2.4)

8.2(1.5)

14.5(1.2)

5.1(1.1)

11.6(1,8)

14.2 1.4)

1.9 (0.5)

N.S.

N.S.

34.8

18.5

1.5

22.3

4.9

0.1

25.0

2.3

0,1

(2.6)

(2.3)

(0.4)

(1.2)

(1.1)

-

(0.6)

(0.5)

_

37.2 (2.3)

15,2(1.8)

2.9(1.0)

23.2 (0.9)

4.0 (0.9)

0,4 -

23.6 (0.7)

3.9 (0.6)

0.1 -

N .S

N .S

N .S

N .S

N ,S

-

N ,S

N.S

During the second trial (Experimental

Period JI), the group using Water Pik as a

supplement to toothbrushing (Group C)

showed no significant difference in amount

of gingival exudate compared with the

group limited to toothbrushing alone

(Group D) (Table 3).

The PII atid GI values registered on

day 0 for groups A and B, showed a defi-

nite increase during the first trial period.

Even duritig the second trial period, both

groups C and D showed small increases in

plaque accumulation and gingival inflam-

mation (Tables ] & 4 aud 2 & 5 respective-

ly)-

The number of surfaces in each group

harbouring dental plaque at the end of both

trials (day 14) is shown in Tables 1 & 4.

The difference between groups A and B in

distribution of the total scores is highly

lar difference between groups C and

could not be found,

Tn Tables 2 & 5 the gingival condition o

ail groups at the end of both trials (day 1

is given using the Gingival Index, Th

difference between groups A and B

distribution of the total scores is high

significant (z 3.01;

P =

0.0026). No s

tistically significant difference betwee

groups C and D could be found.

Neither in group A nor in group C cou

any soft tissue injuries be found whic

could be related to the use of the Wat

Pik.

Discussion

In the model system "experimental gi

givitis in man" (Loe et al. 1965, Theilad

et al. 1966), the effect of complete elim

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WATER PIK AS A PLAQUE CONTROL DEVICE

101

in regard to plaque aeeumulation and the

development of gingivitis. In the present

investigation, the frequency distribution of

the Pll and GI scores for eertain teeth and

tooth surfaces corresponded to the general

pattern reported above. Furthermore, the

increase in Pll and GI, after the partici-

pants had eeased to perform all forms of

active oral hygiene, was in accordance with

this same model. To compensate for partici-

pants who were lost after the first period,

a number of new individuals were intro-

duced for the second experimental period.

Due to this substitution of patients, the

statistical evaluation was limited to eom-

parisions between Water Pik groups (A

and C) and the corresponding control

groups (B and D) respectively. At the be-

ginning of the study, there were no signifi-

cant differences between the randomly

selected groups, concerning age, sex, num-

ber of existing teeth, degree of plaque ac-

cumulation and degree of gingivitis.

Significantly less plaque was found at

the end of the experimental period in the

group using Water Pik as the sole means

of oral hygiene compared with the group

who abandoned all forms of active oral

hygiene. TTiese results confirm the findings

of Krajewski et al. (1964), Toto et al.

(1969) and Hoover & Robinson (1971),

who reported a reduction of plaque and

calculus by comparision with control

groups. It is also apparent from this in-

vestigation that the main plaque-reducing

effect of Water Pik is in areas where plaque

accumulation is greatest, i. e. interproximal-

ly. These findings may be compared with

those claiming that Water Pik's main attri-

bute is in the removal of oral debris

(Krajewski et al. 1964, Toto et al. 1967,

Bhaskar et al. 1971).

There was an increase in gingival inflam-

mation in both groups, A and B, during the

the sole means of oral hygiene (Group A).

This is at variance with the findings of

Lobene et al. (1972), Lainson et al. (1970)

and Gupta et al. (1973), who reported a

reduction in gingivitis when employing

water irrigating devices. Dissimilarities in

the nature of the experimental model and

the parameters for registration may explain

these differences. It must be emphasized,

however, that in spite of the smaller ac-

cumulation of plaque and development of

a lesser degree of gingivitis amongst Water

Pik users compared to those abandoning

all forms of oral hygiene, the Water Pik

did not completely prevent extensive plaque

accumulaion and development of gingivitis

from taking place. From these results the

Water Pik cannot be said to fulfill the

requirements of a satisfactory plaque con-

trol device. The validity of this conclusion

is strengthened when the relatively high

scores, recorded for the group using the

Water Pik alone (Group A), are compared

with the extraordinarily low scores for Pll

and GI in the toothbrushing groups C

and D.

The Water Pik was marketed as a supple-

ment to conventional mechanical methods

of tooth cleaning. This study, however, has

demonstrated that toothbrushing, properly

performed, is sufficiently effective to leave

only small amounts of plaque, and these

are resistant to removal by the Water

Pik.

Several authors have reported the oc-

currence of soft tissue injuries resulting

from use of water irrigating devices (Ber-

man 1966, Bhaskar et al. 1969b). In a study

carried out by Bhaskar et al. (1969a) it was

shown, however, that no soft tissue injuries

occurred in connection with the use of pul-

sating water devices, provided the pressure

was not allowed to exceed 70 PSL In this

investigation, the device used (Water Pik)

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102

HUGOSON

was 70 PSI. No soft tissue injuries eould

be found. This observation has already

been confirmed by several other authors

(Bhaskar et al. 1969a, Hoover & Robinson

1971).

Acknowledgements

The author would like to express his deep

gratitude to Mr, Rolf Karlsson for his help

with the statistical analysis and to the den-

tal hygienists Monica Edstrom and Lilian

Grondahl for their valuable assistance.

Zusammenfassung

Die Wirkung des Water Pick-Hlifsmittels

auf die Ansamm lung von Plaque und die

Entwicklung der Gingivitis

Der EinfluB des Wassersplilgerates Water Pick

auf das Ansammeln dentaler P]aque und die

Entwicklung von Gingivitis ist mit dem Ver-

suchsmode]] Experimente]le Gingivitis am

Menschen untersucht worden. Die Untersu-

ehung wurde mit Hilfe von 41 freiwiiligen

Patienten durchgefuhrt, an deren Zahnen wah-

rend einer Zeitspanne von vier Woehen der

Zahnstein griindlich entfernt worden war und

die dann nach der Zahnsteinentfernung poliert

wurden. Diese Periode intensiver oraler Hygi-

ene ging jeder experimente]]en Periode voraus.

Am Anfang der Experimentperiode wurde das

gingivale Exsudat, der Plaque-Index und der

Gingiva]-Index registriert. Die Probanden wur-

den sodann in vier Gruppen elngeteilt. Die

Gruppen A und B ste]]ten jede Form aktiver

oraler Hygiene ein. Der Gruppe A wurden

jedoch Water-Pick-Hi]fsmitte] a]s einzig er-

]aubtes Hi]fsmitte] fur orale Hygiene uberlas-

sen. Die Gruppen C und D durften zur Zahn-

reinigung die Zahnburste anwenden und der

Gru ppe C wu rden Water-Pick-Hi]fsmittel als

zusatzliches orales Hygieneinstrument Iiber-

]assen. Nach 14 Tagen wurde wiederum das

gingiva]e Exsudat, der P]aque-Index, der Gin-

gival-Index und Verletzungen der Weich-

gewebe registriert. Die Resultate zeigten, daB

die beiden Gruppen A und B extensive Plaque-

ansammlungen und Gingivitis aufwiesen, je-

doch bei den Probanden die den Water Pick

angewendet hatten in einem signifikant ge-

ringerem Grade. Bei den Gruppen, die ihre

doeh keineriei weitere Verminderung der

Plaque und Gingivitis gesehen werden wenn

Water Piek als zusatzliche Hilfsmittel zur An-

wendung kam. WeichteHschaden wurden nieht

beobachtet.

Effet de I'appareil Water Pik sur l'accumula-

tion de la plaque et sur le developpement de

la gingivite

L'inOuence de I'appareil a irrigation d'eau

Water Pik sur raccu mn lation de a plaque

et sur le deveioppement de la gingivite a

ete etudiee en utilisant eom me mo dele a

gingivite experimentale chez ]'homme. Cette

etude a ete effectuee chez 41 patients

vo]ontaires dont ]es dents ont ete soi-

gneusement detartrees et polies pendant une

periode de quatre semaines de soins in-

tenses d'hygiene bucco-dentaire avant eha-

cune des periodes experimenta]es. Au debut

de chaque periode experimenta]e, on a en-

registre I'exsudation gingivale, ]'Indice P]aque

et ]'Indice Gingiva]. Les participants ont a]ors

ete repartis en quatre groupes. Le groupe A

et ]e groupe B ont renonce a toutc forme de

soins actifs d'hygiene bucco-dentaire. On a

cependant re>mis au groupe A des apparei]s

Water Pik, devant servlr d'unique aide pour

I'hygiene bucco-dentaire. Les groupes C et D

eontinuaient a se brosser ]es dents, et ]e

groupe C recevait de p]us des apparei]s Water

Pik eomme aide supplementaire. Au bout de

14 jou rs, on a enregistre l'exsudation gingivale,

I'lndice P]aque, I'lndice Gingiva] et ]es ]esions

inf]igees aux tissus mous. Les resultats ont

montre que, tandis que ]es groupes A et B

presentaient tous deux des depots de p]aque

et une gingivite considerab]es, ]e degre en

etait cependant significativement moins eleve

chez les utilisateurs du Water Pik. Les groupes

uti]isant ]es brossages de dents (C et D) ne

presentaient pas de reduction ulterieure de ]a

p]aque ou de ]a gingivite lorsque ]e Water

Pik etait uti]ise comme adjuvant. On n'a en-

registre aucune lesion infligee aux tissus mous.

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