Waterpik Technologies DT400, D17511, 7500 User Manual

Disclosure Statement

• This course was designed, developed and produced by
Waterpik Technologies

• Waterpik Technologies manufactures and distributes
products addressed in this course

Course Objective

To provide the dental team with the information and
criteria needed to assist individuals in selecting a power
toothbrush appropriate to need

Learning Outcomes

• Discuss the clinical evidence from power toothbrush
research

• Identify which individuals will benefit from a power
toothbrush

• Recommend a power toothbrush appropriate to need

Introduction

Power brushes have been in existence for many years. In
the past, recommendations were often reserved for those
individuals with special needs. Today, with the wide vari­ety of products on the market, almost any individual can
benefit from a power brush.

1

A practice-based study that included 3,669 dental profes­sionals and 16,903 subjects demonstrates how typical den­tal office patients can benefit from a power brush. In the
study, power toothbrush use was considered by dental pro­fessionals to have a positive effect on the oral health of

80.5% of patients. Patients agreed, with 74% stating that

they thought the power brush resulted in better oral
hygiene. Ninety four percent (94%) of patients reported
that they would continue to use their power brush and
75% said they would recommend it to a friend.

2

Power brushes are good choices for many individuals.
They may be ideal devices for people who provide care to
the homebound or for those institutionalized or living in
a nursing home. In working with individuals, consider
those who present with any of the following as prime
candidates for using a power brush:

3,4

• Poor plaque (biofilm) control

• Gingivitis

• Periodontal maintenance

• Orthodontic appliances

• Implants

• Aesthetic restorations

• Crowns and bridges

• Physically challenged

• Gingival overgrowth

The Best Power Brush

A January 2003 systematic review5of power brushes by
the Cochrane Collaboration evaluated different types of
power brushes and tried to determine the superiority of
one type of brush over another. The reviewers evaluated
354 clinical trials published between 1964 and 2001. The
354 studies were reviewed for the following criteria:

5

• Study design had to be a randomized, controlled trial
comparing manual and power toothbrushes

• Comparisons between power brushes were excluded

• Crossover trials were eligible but not split mouth designs

• Subjects could not have a disability that would affect
toothbrushing; orthodontic appliances were allowed

• Brushing had to be unsupervised

• Combined interventions such as those with rinsing or
irrigating were excluded

• Study had to be a minimum of 28 days

• Outcomes measures had to include biofilm (plaque) and
gingivitis

From these standards, 29 studies fulfilled all inclusion cri­teria and had results that could be used for meta-analysis.
The total number of subjects in these trials was 2,547. Of
those, 239 or 9.4% were lost to follow-up.

5

The 29 trials were further categorized into groups based
on the mechanism of action. Six groups resulted. These
included:

5

• Side-to-side action with 8 studies

• Counter oscillation with 5 studies

• Rotation oscillation with 11 studies

• Circular with 3 studies

• Ultrasonic with 2 studies

• Unknown action with 0 studies

2

From the final review, the Cochrane group determined that
“Power toothbrushes with a rotational oscillation action
provided slightly better plaque removal and may provide
better protection against gum inflammation than manual
toothbrushes.”

5

The researchers discussed the weaknesses of their review
and noted:

5

• “One possible weakness of this review was the grouping
of toothbrushes by their modes of action.”

• “So many factors may influence the effectiveness of
toothbrushes including filament arrangement, orienta­tion, size, shape and flexibility, brush head size and
shape along with presence or absence and characteristics
of a timer that not all of them could be analyzed.”

• “None of the trials compared durability, reliability, and
cost of using manual versus powered brushes, it is
presently not possible to make a clear recommendation
on toothbrush superiority.”

In summary, the Cochrane review provides important
information on power toothbrushes, but is not without
flaws. Of consideration is that studies on older, obsolete
products with outdated technology were included in the
meta-analysis.

5

Many current power brushes with state­of-the-art technology have been able to show in well­designed scientific trials that they are superior to manual
brushes.

1,2,3,4,6,10,11,12

Individual Recommendations

Once clinical efficacy has been established, when recom­mending a power brush, individual preferences can play a
significant role in product acceptance. In fact, studies have
shown that when individuals play a more assertive role in
healthcare decisions, compliance and satisfaction
increase.

6

Therefore, it is unlikely that all the individuals
in a practice will like or benefit from the same type of
power toothbrush. Importantly, the individual oral health
needs along with personal preferences should influence
the brush recommendation.

1,3,6

There are a large number of power brushes on the market
with a wide array of features, which can influence acceptance
of the product. To help individuals find the product right
for them, there are multiple features to consider.

• Timer: Essential for those who need to extend
brushing time

• Handle size: Should be of adequate size and feel
comfortable

• Brush head motion and configuration: Size is important
as is dexterity

• Lifestyle: Frequent travelers may prefer a battery­operated unit

• Disposability: This generally means that neither the bat­tery nor the brush head can be replaced. Products gen­erally last around 3 months - the same as a manual
toothbrush and often cost the same. May be a good
gateway product

• Affordability: With multiple products in a wide range of
prices, there is a power brush to fit anyone’s budget

Brushing Recommendations

Some individuals may think that once they use a power
brush, they no longer have to make any effort when
brushing. Therefore, it is important to continue empha­sizing how often and long to brush. Studies have shown
that good biofilm removal takes time, and those who
brush longer tend to remove more biofilm.

8,9

It is important to explain to first time users that power
brushes have a unique or different sound and sensation
than manual brushes. It may take some time to get
adjusted to a new product. Additionally, some products
may enhance the foaming action of the toothpaste and
this may initially be overwhelming. See Figure 1. Advise
individuals not to use an excessive amount of toothpaste
and not to turn the unit on until they have placed the
brush head in their mouth.

3

Figure 1