What is plaque and how does it form?

Dental plaque, also known as microbial plaque or dental biofilm, is the snowy white stuff that can be easily scraped off of teeth after consuming food or sugary beverages. When we eat foods containing carbohydrates, simple sugars and starches, they combine with saliva to form the plaque. When plaque is not removed within 24-72 hours, minerals from saliva will then combine with the plaque to harden and form tartar. Once tartar forms, you will need the help of a dental professional such as a hygienist or dentist who will use special tools to remove the tartar. Therefore, it is extremely critical to remove the soft plaque within 24-72 hours after eating before it can harden into tartar!

Spotting the early signs of plaque

Look for a pale yellow, fuzzy substance and a dull appearance to your teeth. Perfectly clean teeth will always have a very shiny appearance. So even if you cannot see the plaque per se, if the teeth are dull, there is a small coat of plaque on them. There are certains aids that you can use to help you identify the plaque such as a disclosing solution or toothpaste such as Plaque HD. Plaque HD is a specially formulated toothpaste with Targetol technology, which identifies and stains the plaque a green color, making proper removal easier. This is especially helpful for young children learning to brush or teens with braces. We always tell patients using this product to brush until all the green is gone.

Brushing is NOT enough

Even with all of the great toothbrushes and products available, brushing alone is not enough to maintain good oral hygiene. Just brushing only gets 60% of the surface area of your teeth. Flossing is REQUIRED in order to clean the other 40%! The problem with flossing is that most people find it too time consuming, too difficult, or they are doing it incorrectly. If this sounds like you, a WaterPik water flosser is a GREAT alternative! Studies have shown that using a WaterPik is 51% more effective than flossing for reducing gingivitis, 2X as effective at reducing gingival bleeding, 29% more effective at removing plaque, and it is much easier to do than flossing! In addition, you eliminate the manual dexterity required to reach each tooth correctly or getting far enough into the gum line to properly clean.

How to use a WaterPik

  • Fill the reservoir with WARM water! There is no need to use mouthwash or anything fancy.
  • Hold the tip of the waterpik perpendicular to the gumline. The tip should be resting on the gumline!
  • Trace each tooth along the gumline for 3 seconds per tooth. That’s 1 Mississippi...2 Mississippi...3 Mississippi
  • When executed properly, this will cause a syphoning effect to pull the plaque and bacteria out of the pockets.
  • Using a different tip can be helpful if you have appliances such as braces, especially Hidden braces which are difficult to see/ clean properly.

Gingivitis and Peridontitis

If you have heard your dentist or hygienist call out numbers during your cleaning appointments, they were measuring the pocket size, or the space between your gums and your teeth, in millimeters. Generally speaking, 1-3 mm is considered healthy and 4 or more mm is usually indicative or gingivitis or periodontal disease. Traditional flossing is only shown to reach 2-3 mm into the pockets, whereas WaterPik products can reach much deeper, cleaning up to 5 mm pockets. So if you have pockets that are greater than 3 mm, flossing alone is not going to cut it! By brushing and flossing with a WaterPik you are working to prevent dental and periodontal disease. For those of you in braces who do not brush and floss properly, you might might also notice little white spots forming on your teeth around your brackets, which is decalcification. These white spot lesions are permanent and will present a challenging cosmetic problem to correct! While bleaching can help camouflage the the decalcification, the only real solution is to get veneers or crowns on every tooth with white spot lesions. As veneers and crowns tend to require replacing every 5-10 years, this is quite aggressive and very expensive. So the moral of the story? Try and protect the set of teeth that you have!

Effectiveness of the WaterPik

The Classic Jet tip has been shown in studies to remove 99.9% of the plaque and biofilm from the treated area after a 3-second exposure. The Orthodontic Tip removed 99.8% of plaque and biofilm. For most patients I would recommend the Jet Tip, or the Orthodontic Tip if you have braces. There are other tips included with most models that you purchase, but make sure you read the instructions in order to use these tips correctly. But I would still recommend only using those other tips only when necessary and reverting back to the classic jet tip for the majority of your use.

Retail vs. Professional

Retail models normally do not offer as many features as the professional and often have a “governor” on them to limit the settings. For example, the professional models have features like automatic timers, led lights, and extra accessories. The build quality is significantly different because the retail models are made at a much lower price than the professional. However, the big thing to check is the PSI. This setting is what controls the effectiveness of the removal of the plaque and biofilm. If you purchase a retail flosser that does not provide enough pressure, then the unit will not effectively clean your gums or teeth. In the long run, this can cause more harm than good. Make sure that wherever the flosser is purchased, you look for the ADA seal of approval. WaterPik brand is currently the only water flosser brand that is ADA approved to effectively clean your teeth and gums. If a product is not ADA approved, it has not undergone (or failed) the rigorous testing that demonstrates its effectiveness in removing plaque and preventing gingivitis and periodontal disease. Many products that are not ADA approved are sold at popular places like Target and Amazon. These companies will often make false claims to the design and effectiveness of their product, so check for that seal of approval from the American Dental Association.

Which Waterpik Model Should I buy?

When choosing a Waterpik, we have many choices and it can be overwhelming to make the right choice. When considering your options, try to consider which type would suit your lifestyle best and give you the greatest chance of success because you are more likely to use it.


Aquarius (Professional) $99.99

This is Waterpik’s flagship and most popular model. It features the largest reservoir which can run for 90 seconds and therefore does not need to be refilled during a session. It typically comes with multiple interchangeable tips and can be shared by a family, using different tips for each family member. It has a maximum PSI of 100 with a dial that goes from 1 to 10. In order to achieve the 99.9% plaque removal, you must use at least 70 PSI. Therefore, the dial needs to be on a 7 or higher. When you first use a Waterpik, a high pressure may be uncomfortable for you. If this is the case, I recommend starting on a lower pressure and working your way up. The only negative to this model is that it does take up additional countertop space and is not portable for travel.

Tip: When using a waterpik at the sink, it can be easy to make a large mess and get water everywhere. I recommend keeping your head low right over the sink and face down toward the sink. Keep your mouth closed as you use the waterpik and just let the water waterfall out of your mouth into the sink. If you stand upright and look at the mirror, it is very easy to accidentally get water all over the mirror and countertop!

Cordless Advanced $99.99

This model is cordless and waterproof, which means it can be used in the shower. It is also somewhat portable and can also be used for traveling, although I’ve found that the design of the buttons and soft carry case can lend to the buttons getting accidentally depressed in your suitcase! This is a great option for those who have limited countertop space in their bathroom or for those who prefer waterpiking in the shower and not having to worry about making a mess getting water everywhere. The one downside is that the reservoir is smaller, so you do have to refill it once or twice during one session in order to get the whole mouth clean. The maximum PSI of this model is only 75 PSI, and it can only be used in a low, medium, or high setting. Therefore, in order to get 99.9% plaque removal, you must use this particular model on the HIGH setting.

Tip: Instead of holding the opening for the reservoir directly underneath the water from your showerhead, use your hand to funnel a larger volume of water into the opening. You can refill it this way much faster!

Sidekick $139.99

This is one of Waterpiks newer models and I’m pretty excited about it. I actually had tried traveling with my cordless model before I got the sidekick and the unit became damaged when the buttons accidentally got depressed for an extended period of time in my luggage. Thankfully Waterpik had stellar customer service and replaced it at no charge. I have since purchased the Sidekick, however, and much prefer this model for traveling. It is designed so that everything is self-contained in a compact package for traveling without any risk of buttons getting depressed and damaged. It also features a slightly larger reservoir than the cordless model and can run for 60 seconds, which I find to be enough to clean my entire mouth. The one downside to this model is that the tips are not interchangeable, which means they can never be replaced, and there is no on/off switch on the handheld portion of the unit itself. This is usually not an issue when you’re in a hotel bathroom because the on/off button on the base of the unit is well within arm’s reach. The PSI also goes up to 100 PSI, but the dial only has 5 settings, so make sure you use it on one of the last 2 settings to get 99.9% effective plaque removal.

Sonic Fusion (Professional) $199.99

I must admit I was pretty excited when this model first came out. Who would have thought that you could brush AND floss AT THE SAME TIME?! Imagine an electric toothbrush that also shoots out water onto your teeth while you are brushing and you’ve got the Sonic Fusion. It comes with a detachable cord and handy travel case so that it can actually function as just an electric toothbrush as well. There’s a separate button to turn on the brushing function and water flossing function, which is a nice feature if you only wanted to do one thing at a time. It all sounds great and all, but what I’ve found instead is that it’s rather mediocre at both. It’s kind of trying to be a jack of all trades, but is a master of none. I’ve found that I actually need to brush first without the water flossing function turned on in order to get an adequate amount of toothpaste on all my teeth. If I don’t do this, I’ve found that the water coming out actually just washes away all the toothpaste before I’ve had a chance to use it on all my teeth. In addition, while the PSI supposedly can get up to 100 PSI, I feel that the design of the brush head prevents you from delivering an effectively targeted water jet so it feels significantly weaker than the other 3 Waterpik models. The toothbrush is still definitely better than simply using a manual toothbrush but it does not hold up to my Sonicare in getting my teeth sparkling clean. The build quality is not as great and the toothbrush heads are more expensive due to them being for water flossing as well. Overall, my teeth just don’t seem to feel as clean when using the Sonic Fusion compared to using my Sonicare followed by one of the other 3 Waterpik models. Unfortunately, there currently is no study that makes this exact comparison.

Tip: Brush your teeth without the floss function on for a full minute BEFORE turning the flossing function on in order to ensure that the toothpaste adequately coats all of your teeth.

So which Waterpik model should you buy?

Honestly, I have all of them and use all of them on the regular, except for my Sonic Fusion. I keep my Cordless one in the shower and will sometimes use it there, depending on my mood. I use the Aquarius when I need to floss but am not in the shower. Finally, I use my Sidekick whenever I travel. Whichever one is best for you is going to be very dependent on your personality and lifestyle. If you already have an electric toothbrush that you love, then I would recommend the Aquarius, Cordless, or Sidekick. If you have a small bathroom with limited counter space or like the idea of having less mess by water flossing in the shower, then get the Cordless. If you’re the type of person who thinks you’d be too lazy or don’t have the patience to refill the reservoir multiple times during one session, then don’t get the Cordless and get the Aquarius instead. If you have a large family and all want to share, get one Aquarius and a separate tip for each family member. Finally, if you are a jetsetter and travel all the time, get the Sidekick. It functions well on your bathroom counter at home as well, with the one caveat being that you can’t ever replace the tip and the reservoir is slightly smaller than the Aquarius. Finally, if you need a decent toothbrush and want to get everything done as quickly as possible, get a Sonic Fusion. Check out the table below to compare the models side by side.

Does the WaterPik completely replace flossing?

In short, no. Floss goes between your teeth to break the contact that the teeth have with each other. This contact MUST be broken in order to prevent dental cavities that occur on the surfaces of your teeth that are contacting adjacent teeth. The WaterPik is very effective, and actually even more effective than string floss, at reducing gingivitis, reducing gingival bleeding, and removing plaque. It also can clean deeper into periodontal pockets than floss can. They are both great oral hygiene aids, but it's important to note that they serve different functions. In an ideal world, you would do both. However, I am realistic and know that the majority of us are not going to do that. So try to switch it up and alternate between flossing and waterpiking if you don’t have time to do both.

If you have ANY questions or want a recommendation on what would be right for you, feel free to call the office or ask at your next visit!


* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.