What Is the Best Daily Oral Hygiene Routine?

Your question mentions three different approaches: mechanical disruption (floss and Soft-Picks), pulsating fluid (WaterPik), and pressurized air/microdroplets (AirFloss). We already know that mechanical debridement/disruption is the gold standard of therapy—if you can reach/contact every square millimeter. So the problem becomes access, particularly in teeth with periodontal breakdown that have loss of attachment. Floss will not be effective in the mid-proximal concavities and vertical attachment deviation in areas of bone loss and pocket formation. Once a patient presents with loss of attachment, I no longer encourage them to use floss because it will only contact/disrupt the convex portion of proximal surfaces and the coronal-most aspect of periodontal pockets. Dental floss is effective at preventing periodontal disease, but once there is breakdown and concavities are exposed in areas of pocketing, the floss is not only a waste of the patient’s time, it fails to address the most virulent Gram-negative biofilm that remains undisturbed in the deep recesses of roots. I don’t want them to think they are doing something beneficial in the control of their current disease. Soft-Picks are effective for accessing tight contacts and abutment surfaces, and—like floss—can also be instrumental in preventing periodontal disease, but once again, they are not designed to reach into deep mid-proximal concavities beyond a millimeter or so of the flexible flange, nor can they be directed apically into pockets with anything more than cursory disruption. Wooden toothpicks, however, are highly effective for reaching into mid-proximal concavities within periodontal pockets as well as oblique and vertical access into furcations. This is an effective approach for mechanical disruption for those patients with periodontal breakdown, as long as access is not hampered by prosthetics. Powered home devices are good options for those patients who are averse to flossing, but particularly beneficial for patients with periodontal breakdown as well as prosthetic challenges such as a three-unit bridge and crown contours that complicate accessibility. Both the WaterPik water flosser and the Sonicare AirFloss have been shown to be effective at reducing interdental plaque/biofilm, with evidence-based studies to back their claims. In my own clinical experience, I’ve had numerous patients with excellent self-care present with chronic, nonbleeding 4 mm to 5 mm pockets that suddenly improved to 3 millimeters once we instituted a bleach protocol with the WaterPik (1/2 tsp sodium hypochlorite in a full reservoir of hot water). The WaterPik Aquarius unit is recommended for this approach. For patients with dental implants, WaterPik has a Plaque Seeker Tip—especially effective for safe and effective cleaning around dental implants. In the end, it is a matter of clinical judgment (what the practitioner deems best suited for addressing the patient’s self-care challenge) along with patient preference and compliance (what they will use on a consistent basis, with success). I hope this information has been helpful!