Handheld Vs. Electric Toothbrush? Waterpik Vs Floss?

Handheld Vs. Electric Toothbrush? Waterpik Vs Floss?

November 3, 2018

According to Science Illustrated, the bristle tooth brush was invented in China in 1498. Back then boar hairs were attached to handles made of bamboo or bone. Boar hair bristles were used until 1938 when they were replaced by the nylon bristles introduced by the company Dupont de Nemours.

To date, the toothbrush is still the most common and effective way to clean “accessible” tooth surfaces.Is an electric toothbrush better than a manual one?

Yet, this leaves us questioning what about the “inaccessible” tooth surfaces? …Introducing floss!

In 1819 an American dentist, Levi Spear Parmly was among the first to describe the use of a thread (waxed silk thread to be precise) to clean where no brush is able to clean; below the gumline. This eventually led to the production of modern day dental floss. Floss is still the most common method of cleaning between the teeth.


Hand held brushes: These are still the gold standard. Hand held brushes are as effective as the person holding onto and guiding the brush! See: How To Pick A ToothBrush

Electric brushes: There are generally 2 types of electric brushes depending on the motion of the bristles. One uses sonic vibrations to agitate the bristles whereas the other utilizes some variation of a rotary brushing motion. Both types are effective and again the greatest influence over how effective they are in preventing dental disease is the person whose hand is holding onto and guiding the device. One perk of using an electric toothbrush is their auto-timers that help you to make sure you’re brushing your teeth long enough. It is recommended that when we brush our teeth, we do so for a duration of 2 minutes. It can be hard to stand in front of our bathroom sinks and guess how long it has been since we started scrubbing. 2 minutes is more often a lot longer than it seems! Electric brushes ensure that we brush for the appropriate amount of time. Additionally, they may be beneficial to the elderly and those who have limited dexterity of their hands from arthritic or other conditions.

Dental Water Jets:

Also called the water pik, although “Water Pik” is a proprietary name and manufacturer of dental water Jet devices. These devices use a tiny stream of water under pressure to “blast away” dental debris and plaque. Most dentists’ feel that these devices are not quite as effective as brush and floss because the water pressures generated aren’t quite high enough to remove the sticky “dental pellicle” that bacteria use to attach themselves to teeth. Unfortunately, the pressures required to remove the dental pellicle would cause damage to the gums themselves.

Many of the water jet devices available today have a water reservoir to which medicaments can be added. Other than fluorides, there has been little support in the scientific literature to the use of medications in the water jet devices in so far as their ability to reduce dental disease over and above the use of water alone. Again, the single most influential factor affecting the effectiveness of the water jet devices in preventing dental disease is probably the hands holding onto and guiding the device.

Floss, floss wand, floss piks etc.:

Floss is still the most common and one of the most effective means of cleaning between the teeth. Although it requires practice to get good at it and a level of dedication that not everyone can muster. The floss wands and associated devices that allow you to floss without having to wrap the floss around your fingers are all designed to accomplish the same thing – getting at that sticky plaque from between the teeth. They all work well and their effectiveness is only limited by the hands holding onto and guiding them.

…Starting to notice a pattern here?


Toothpicks have been used for millennia to dislodge debris from around and between teeth. Although they can remove debris and plaque they are probably the least effective of all of the above. To be effective they require a thorough knowledge of the anatomy of the dentition of each and every tooth. To use them as a tool in preventing dental disease (which is what our goal is with all of these tools!) the time and dedication required of daily tooth picking is far more than most people are willing to invest. Those who claim to be proficient at cleaning their teeth with tooth picks would be surprised to find that they are only cleaning a small fraction of their tooth surfaces.

Interdental brushes:

Also called “Proxibrushes,” these tiny brushes look like miniature versions of the brushes used to clean baby bottles. The actual proxy brush is very tiny and comes either in one whole piece or with a refillable handle with attachment heads. The interdental brushes are probably the best overall tool for cleaning between the teeth. This is especially for people who have suffered from gum disease because they inevitably have larger spaces between the teeth. If you’ve never suffered from gum disease proxibrushes are still a great tool but you have to scope out the smallest diameter brush tips. Even then you may have trouble getting between the tight gaps of certain teeth. Where these little gems really shine is where gum disease has left larger spaces between teeth. The rule of thumb is to use the largest diameter proxibrush that will fit between the teeth so that the bristles are forced to compact as the brush is pushed through the space between the teeth. The bristles constant return to their fully expanded form will cause them to penetrate into all the nooks and crannies between the teeth and even into the hard to reach gum pockets.


While all of these tools are important for cleaning your teeth, the single most influential factor affecting the effectiveness of any oral home care device is the hands holding onto and guiding the device. That’s you! Regular dental hygiene practices are imperative to keeping clean teeth and a healthy mouth. This means brushing twice a day and – even though it takes more time – flossing each day. In addition to your brushing, Proxibrushes and Water Jets are good tools to use too as long as you are keeping up with a routine of dedicating some time each morning and night to your oral care!

By Dr Adrian Pawlowski, DDS MSD, is a periodontist practicing in the Bell Town Area of Downtown Seattle.

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