The use of water flosser in implant-supported fixed prosthesis: a narrative review and the opinion of Italian dental hygienists.

Introduction: The aim of the present study was to evaluate the opinion of Italian dental hygienists about the use of domiciliary water flosser for the oral hygiene of implant-supported fixed prostheses.

Evidence acquisition: A narrative review of the literature is presented, and a digital questionnaire was shared on Facebook professional groups to be anonymously filled by Italian dental hygienists. A descriptive analysis of the answers was conducted.

Evidence synthesis: Three hundred thirty-three dental hygienists participated of which 34% have worked for 0-5 years, 27.4% for 6-10 years, 26.81 27% for 10-20 years, and 11.14% for more than 20 years. Water flosser was recommended by the 49,7%. A small proportion of respondents, the 7.83%, thought that this intervention could cause emphysema/abscesses, while the 43.98% and the 36.75% believed respectively that it was either ineffective in the plaque removal or even it could push the biofilm under the gums. The 12.35% believed that the water flosser could cause gum recession, was difficult to use (20.48%) and it could damage the prosthodontic and implant components (1.2%). These information were acquired from textbooks (31.63%), web (25%), universities courses (57.23%), companies (25.6%), other courses (38.25%) and personal experience (6.33%). The 48.2% of the hygienists reported that they were often asked from their patients about water flosser, 47.3% rarely, 1.25% always and 3.3% never.

Conclusions: Although the scientific literature supports the use of water flosser in terms of efficacy and safety, Italian dental hygienists rarely recommend it for home oral hygiene of implant-supported prostheses mainly because they consider it ineffective or even dangerous.