COMPARATIVE EFFICACY OF WATER FLOSSERS AND TRADITIONAL DENTAL FLOSS IN THE CONTROL OF DENTAL PLAQUE: A SYSTEMATIC REVIEW OF CLINICAL EVIDENCE

Objective : This systematic review aims to evaluate and compare the efficacy of water flossers and traditional dental floss in the removal of dental plaque and food debris, considering their applicability across different patient populations. Methods: A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library up to August 2025. The search strategy combined MeSH and free-text terms: (periodontitis OR periodontal OR periodont* OR “gum disease” OR “periodontal infection” OR “periodontal inflammation” OR “chronic periodontitis”) AND (water flosser OR oral irrigator OR “water jet” OR “oral irrigation”) AND (dental floss OR interdental cleaning). Randomized controlled trials (RCTs), clinical trials, and systematic reviews published in English, Portuguese, or Spanish were included. Studies were managed in Zotero for duplicate removal. Titles and abstracts were screened independently by two reviewers. Full texts were assessed according to predefined eligibility criteria. Results: Twenty-five studies met inclusion criteria, comprising RCTs, integrative reviews, and systematic reviews. Both water flossers and dental floss significantly reduced plaque accumulation. Water flossers demonstrated superior efficacy in patients with orthodontic appliances, dental implants, prostheses, or motor limitations. Some trials showed marginal superiority of water flossers in plaque reduction (20–30% greater than dental floss), while others found no significant difference. Evidence suggests that water flossers enhance patient adherence and comfort, though concerns remain about microbial colonization of device tips and potential marginal microleakage in crowns. Conclusion: Both water flossers and traditional dental floss are effective in plaque and debris removal. Water flossers appear slightly superior in special populations and in accessing difficult interproximal regions. Individualized recommendations should be made based on patients’ clinical conditions, manual dexterity, and prosthetic or orthodontic status. Further high-quality, long-term RCTs are required to confirm the superiority of water flossers in different clinical contexts.