The Best Waterpik / Water Flosser for Braces 2023

Who should use a water flosser?

Overall, water flossers are not the most effective method for plaque removal. But they still show benefits for gum health.

They are a good option for someone who has tried and failed to use interdental brushes.

Water flossers are a good option for:

• Someone with limited hand and finger mobility.
• Someone with braces, to help clean around the brackets.
• Someone with dental work such as bridges and crowns, who struggle with cleaning in that area.
• Anyone who wants to use them in addition to either floss or interdental brushes.

Water flossing vs string flossing with braces

There is agreement that having braces slightly increases your risk of things like tooth decay and gum disease. That is because the brackets stuck to your teeth retain more bacteria, compared to if they weren’t there.

Some dentists fall back on the recommendation of string floss for cleaning between the teeth when you have braces. 

There are very few studies that directly compare floss and water flossers for brace wearers. Those that do, such as Jolkovsky or that by Pithon et al have mixed results. They seem to agree that both floss and water flossers both remove more bacteria than tooth brushing alone. 

But they can’t agree that one is much better than the other.

String flossing is very technique sensitive. In non-brace wearers it is normally found to be the least effective technique for cleaning between the teeth. (See our page comparing different cleaning techniques for the full round up). Wearing braces makes using floss an even bigger challenge. 

The wires get in the way of pulling floss down between the teeth. A flossing tool can help you use string floss. For example, a floss threader allows you to get the floss above the wire and between the teeth. A platypus tool is used like a flossette – it holds the floss tight and the thinner plastic arms mean you can slide it under the wire no problem.

Using a water flosser can be easier.

Also, the physical contact of string floss can be more beneficial than water. But when cleaning around a brace, using string floss can be very time consuming and awkward.

Water flossers enable you to clean all around the bracket as well as between the teeth. They dislodge food particles. And it is believed that the water flow acts to massage the gums and reduce bleeding from the gums.

Overall, interdental brushes are the most effective option for cleaning.

But when it comes to floss vs water flossers, there is no definitive right or wrong answer — it’s about finding a cleaning method that works for you. 

There is certainly a place for water flossers.  Ideally though, you want to be combining the use of a water flosser with interdental brushes.

Why would I need a water flosser with a brace?

The design of a dental brace means you have more surface area for bacteria and food to stick to.  Food particles get caught in brackets and wires.

Getting food particles and dental plaque trapped around your braces can increase your risk of dental disease.

If brushing and flossing was important before wearing braces, it is even more so when you have them.

The increased surface area, and nooks and crannies of the fittings, give more opportunity for plaque to build up on the teeth. It also makes the plaque more difficult to remove.

Failing to clean around these can result in:

• Staining of the teeth
• Decalcification (white spots) on the tooth surface
• tooth decay
• Gingivitis (gum disease)
• Bad breath

The early stages of gum disease, gingivitis starts with swelling and redness to the gums. At the early stages they are tender and bleed when touched.  

This is caused by bacteria at the gum level not being cleaned away well enough and releasing products which irritate the gums.

If left untreated, more advanced gum disease (periodontitis) can develop. In the most severe cases this causes bone loss, loose teeth, and can result in teeth falling out.

Good plaque removal is vital.

To remove plaque, you should brush around all parts of your brace and all of the surfaces of your teeth.

There is a mixed consensus about when to brush. Ideally, you should brush each time you have eaten. 

Generally, the advice is to brush straight away. This is especially true if you are wearing removable braces as it means you can put them in as soon as possible. 

Sometimes, the advice is to leave it about 30 minutes after every meal or snack, before you brush. This would be the recommendation if you have eaten or drunk something particularly acidic. This includes fruits and fizzy drinks. 

A manual brush works well if used correctly.  

But our advice is to invest in an electric toothbrush. A study by the American Journal of Orthodontics and Dentofacial Orthopaedics found that electric toothbrushes promote better cleaning habits. If you find toothbrushing difficult, switching to an electric toothbrush has an even better effect.

We have compiled a list of the best electric toothbrushes for braces.

Even the best toothbrushes and brushing technique won’t remove all the plaque around a brace.  You need to use other flossing tools in addition to brushing.

The wires and brackets restrict the movement of floss in between the teeth and up into the gum line.  This makes flossing with braces awkward.

You do not need a water flosser as a brace wearer, but you do need to clean interdentally. Water flossers make it more convenient to clean these surfaces and reach the gumline. 

The water and the pressure at which it hits the teeth gets into the smallest of gaps.  It also disrupts the bacteria chains that cause gum disease.

The evidence doesn’t support water flossers removing plaque. But yet, it still has a positive effect on the gums.

Not all water flossers come with them, but an orthodontic tip can be very useful. It combines a traditional jet tip with bristles to wash and sweep away the debris.  The manual action of the bristles gives an extra dimension to the clean. They can help dislodge and disrupt debris and bacteria.

What is the evidence for and against water flossers?

Water flossers are one of the less common forms of interdental cleaning.

They are safe, with little ability to cause damage to the gums or your brace.

Most evidence shows that water flossers do not fully remove plaque. Despite this, they can still have a positive effect on the gums.

Waterpik has listed a large amount of clinical research on its website. Some people could perceive this as biased. But it is worth noting that it is independently scrutinized to be published in peer-reviewed journals. This means that you can discount any obvious problems with their data. However, do consider that they are unlikely to promote data that doesn’t support their hypotheses (read: advertising claims). Many of the articles are not available in full online, only the Waterpik summary or the paper abstracts.

Highlights from their research are (the link will lead you to the journal article, not the Waterpik page):

• Using a water flosser in addition to toothbrushing reduces bleeding gums and plaque levels. Lyle et al. compared bleeding scores and plaque levels in two groups: those using only an electric toothbrush; those using an electric toothbrush + water flosser. They found that the group who used the water flosser had decreased levels of bleeding gums. The plaque levels were also lower in those using the water flossers. Although these results were of less statistical significance.
• Waterpiks reduce gingival inflammation more than flossing does. Barnes et al. 2005 study found a Waterpik to be more effective than string floss in reducing gingival bleeding. This study compared manual toothbrush + floss to manual toothbrush + water flosser and sonic toothbrush + water flosser. They miss out a key comparison group: sonic toothbrush + flossing. This makes the evidence somewhat skewed in favour of the water flosser. Much of the benefit of switching to a powered brush is presented as being the water flosser, but there is no way to compare.
• Water flossers are effective and safe for implants. Kotsakis et al. showed that water flossers are as effective as interdental brushes and more effective than chlorhexidine mouthwash. They reduce the amount of bacteria on implants, without damaging the implant surface. 
• Water flossers are more effective than string floss in adolescent patients with orthodontic appliances. Sharma et al showed that a powered water flosser with a specialized orthodontic jet tip is more effective at reducing plaque and bleeding in adolescents who have orthodontic appliances, compared to string floss. Although this study did exclude interdental brushes and electric toothbrushes so you can’t compare to those more effective methods of cleaning, it does show water flossers to be a good alternative to string floss. 

Independent reviews and papers support most of these claims. 

Independent reviews by Ng and Lim as well as Worthington et al showed that water flossers do not reduce plaque levels. This is also shown in Waterpik’s own study in 2011. 

Water flossers might not reduce levels of plaque, but it is thought they do disrupt forming plaque from above and below the gum level. The theory is that this changes the structure of the plaque layer. If the plaque structure is altered, it may cause less inflammation in the gums. But at present, this is only a theory.

Despite ineffective plaque removal, water flossers do reduce inflammation of the gums. They reduce bleeding from the gums, an indicator for active gum disease.

The water flossers also flush out food debris.The 2015 review by Sälzer et al also supports water flossers for improving gingival health versus no interdental cleaning aid. The European Federation of Periodontology (EFP) also recommends water flossers for interdental cleaning in their evidence based guidelines.

Cordless vs corded (countertop) water flossers

If you have space (approx 6 x 6 inches) for one in your bathroom, we recommend going for a countertop water flosser over a cordless water flosser. 

We’ve found countertop models slightly more comfortable to use. They also have larger water reservoirs, meaning they have longer cleaning times and need to be refilled less often. They often come with extra features, such as extra pressure settings or a built-in timer.

There is no evidence to suggest one is better than the other. There are scientific studies that confirm the effectiveness of both. In our own hands-on testing, we have found them to be as effective as each other.

That being said, a cordless water flosser is still a perfectly good option if you don’t have space for a countertop model, or if you travel a lot.

Countertop units need a power outlet.  They need to be plugged in for them to work. You are therefore more restricted on where you place them.  

Cordless units are wire-free. This makes them more portable and convenient, particularly if you don’t have a socket in your bathroom.

Some cordless options are waterproof too, meaning you can use them in the shower, reducing the mess you make in and around the sink.

Examples of how much space countertop flossers take up

One of the drawbacks to countertop water flossers is that they are larger.

Each model is different, but you generally need an area 6 x 6 inches or 15 x 15cm on your countertop to accommodate the footprint of the water flosser.

You then want to have about 10-12 inches (25-30cm) space above this free for the unit to stand upright.

Each corded unit has a power cable that is around 3-4ft (90-120cm) in length.  The hose from the handle tends to be of a similar length too.

A maximum distance from the power socket and the sink is approximately 2 meters. Any more than this and you will likely struggle.

If you are short of countertop space, one option is to store the flosser elsewhere and get it out as and when you need it.  Many people place it in a bathroom cabinet.  This overcomes the space issue, but regular use can become more challenging as it takes more effort and time to get it setup, and there isn’t the visual reminder from it sitting in plain sight.

Here is a table comparing the sizes of some of the most popular water flossers.

How important are pressure settings?

Having different pressure settings is very useful.

You might not need to switch between them all the time, but having the choice is valuable.

Whilst countertop water flossers can have as many as 10 settings, 2 or 3 is common for cordless models.

You want at least a low and a high setting. As the names imply, the pressure varies between these.  Low is more gentle and high more intense.

Pressure is measured in Pounds Per Square Inch (PSI) or Bar. Typically the pressure ranges from 10 to 100PSI, although some models reach as much as 160PSI. 

Low pressure tends to be around 30-45PSI and high 60-80PSI, subject to model. 

The extra power can blast away more debris. But, sheer force is not essential and may feel uncomfortable to some people.  Lower pressure with the correct technique is equally as effective. 

There is no evidence to support using higher power over a lower power.

A low setting is ideal for inflamed, sensitive and bleeding gums. 

If you have healthy teeth and gums, the higher setting can be used.

What makes a good water flosser for braces?

From handling and testing lots of water flossers, we’ve come to regard some features as essential, and others as nice to have but not a dealbreaker if they are missing.

We deem the essential features of a good portable flosser to be:

45 seconds or more flossing time

Flossers with a water tank of around 200ml will achieve this. 45 seconds is enough time to get a thorough clean without having to refill. It can make the flosser slightly heavier but it is a worthwhile trade off.

2 or more pressure modes

If you have sensitive gums it is useful to be able to adjust the pressure.

Water control button on the handle (countertop)

A button or switch on the flosser handle allows for much greater control of the water flow. This makes it easy to stop, start and pause the jet of water. No need to use the on/off switch on the countertop unit itself.

Rotating nozzle (or handle for countertop)

Having a 360 degree rotating nozzle makes it easier to reach all parts of the mouth.

Comfortable grip (cordless)

From our testing, a large area for the palm and fingers to grip onto is better than a slim handle. It’s also helpful if the grip is made from materials that prevent slippage, particularly when wet.

Hose storage (countertop)

Having a convenient place to tuck away the hose when not in use avoids trailing cables around the bathroom.

Features that are nice to have, but not critical

There are lots of extra features that can be built into a flosser.  These are in our opinion not essential. They are nice to have if they are included:

600ml+ water tank (countertop)

Having a large tank allows for multiple uses from a single fill, or extended flossing times for those who need more time when cleaning.

2+ week battery life (cordless)

A battery life stated as being at least 2 weeks allows for a good amount of use between charges.

Battery status/charge light (cordless)

A battery status or charge light gives you a clear indication of how much power actually remains. You know when it will need recharging and there is less chance the flosser will cut out on you mid session.

Backed by clinical evidence

Scientific studies that have tested the product and confirm what it can achieve.

Approved by dental bodies and organizations

Independent assessment of the product and any clinical data that exists. Examples include the Oral Health Foundations “Approved” status and the American Dental Association’s Seal of Acceptance.

Compact footprint

A compact footprint reduces the amount of space the water flosser takes up in your bathroom.

Power cable storage (countertop)

If the flosser comes with a mechanism for keeping excess cables tidy it is a bonus. It helps to keep the bathroom tidy and makes it easier to stow the flosser away if necessary.

Mode/pressure setting notification lights (cordless)

Visible indicators to show the selected mode.

Variety of flossing tips

Interchangeable tips make the water flosser more adaptable to different use case scenarios. For example, some tips are designed to safely reach into periodontal pockets. These allow for deeper cleaning beneath the gum-line.

Nozzle storage 

Some flossers come with a place to stow any additional/replacement nozzles, which helps to keep the bathroom tidy. A removable lid cum storage compartment also works well.

Travel pouch/case (cordless)

It’s a bonus if the flosser comes with a protective cover to prevent damage, leaks or accidental activation when in transit, but it’s not a deal-breaker if it isn’t included.

USB charging (cordless)

USB charging offers a more convenient option as the cable tends to be smaller with no bulky power brick. It’s particularly useful for regular travellers.

2 Year warranty

Ideally the flosser will come with a warranty of 2 or more years so that you have the peace of mind that should the product fail it will be repaired or replaced. Typically products do come with a 2 year warranty, but there are some that only come with 1 year.

Pros & cons of water flossers

Pros

• Convenience
  • Fill the tank and switch it on. 
  • It is less hassle than pulling out a length of floss and wrapping it around the fingers. Not to mention then feeding it between the teeth.
  • Rotating nozzles make it easy to reach awkward spots in the mouth.
  • The long nozzle makes it easy to reach the back teeth.
• Takes less time
  • You can complete a thorough floss of the teeth with a water flosser quicker than you can with string floss.
• Reduce inflammation and bleeding of the gums
  • The water reaches spaces that a toothbrush or traditional floss can’t. Notably, under the gumline. This means bacteria and debris that cause inflammation and bleeding are removed.
• They disrupt more plaque
  • Traditional string floss requires a very specific technique to be effective.
  • Water flossers are easier to use to disrupt the plaque layer.
• They are more gentle on the gums
  • Incorrect flossing technique can be painful or damaging to the gums.  
  • The pressurised water feels softer and gentle on the gums. It will stimulate blood flow.
  • Variable pressure settings allow you to find the right pressure for you.
• Suitable for braces, implants and bridges
  • The water flow allows for a quick and effective clean around dental appliances.
• They are easier for people with limited mobility (dexterity)
  • The nozzles allow for much easier positioning and reach into the mouth.
  • There are fewer fingers and thumbs and awkward movements.
• Different nozzles
  • A variety of nozzles allow for a more personalised oral care routine.
  • Individual circumstances, such as periodontal disease can be more effectively treated at home.

Cons

• Environmental impact
  • No studies into the environmental impact of water flossers exist yet. 
  • In 2020 a study compared electric toothbrushes to manual alternatives. Electric brushes came out worse in many areas.
  • The weight and electrical components likely make water flossers less environmentally-friendly. This is in comparison to other flossing options.
  • The heavy use of water also has a large impact on the environment. 
• Size
  • Even the most compact water flosser isn’t as travel friendly as a reel of traditional floss.
• Noise
  • The water flosser makes quite a bit of noise when in use.
• Price
  • A water flosser is more expensive than string floss or floss sticks.
• Interdental brushes are more effective
  • Despite the ease of use, interdental brushes produce better results.
  • Plaque isn’t removed as effectively.
• Water tank size/pressure settings
  • Each flossing session is limited to the size of the water tank and the pressure setting selected. You may have to refill the tank multiple times to complete the clean.
• Sink access
  • You need to be lent over a sink, even with a cordless, due to the amount of water that needs to be expelled during use.
• Batteries/power
  • Water flossers will require recharging or replacement batteries.

How do the different nozzles / tips work?

The type of nozzle jet tips that fit a water flosser are interchangeable.

This means they can be changed as and when you like.

The most common nozzle is the ‘jet tip’.  This is suitable for the vast majority of users.

It is designed for everyday use.

It offers a deep clean between teeth and along the gumline.

Most water flossers come with this type of tip included and available as a spare/replacement.

Some brands, notably Waterpik, offer a wider variety of nozzles.

As a brace wearer, it is the orthodontic or brace nozzle that is of particular interest.

You don’t have to use it.  But, you will find it more convenient for cleaning the brace.

On the tip of the nozzle is a tapered brush.  The bristles help disrupt and remove plaque from the braces.

Combined with the pressurised water the bacteria and debris are flushed out from around the wires and brackets.

The various nozzles on offer from some brands include:

• Orthodontic tip
  • The tip has a tapered brush on the end to help remove plaque from braces and orthodontics.  It also helps flush out bacteria and food debris from around teeth and under the gums.
• Plaque Seeker tip
  • Designed to clean in and around harder to reach areas.  Most notably dental restorations. 3 thin bristle tufts gently access stubborn plaque around dental implants, crowns, bridges and veneers.
• Pik Pocket tip
  • Designed to deliver water deep into periodontal pockets.  Ideal for those diagnosed with more advanced gum disease.
• Tongue cleaner
  • The nozzle has a spoon-like shape. This traps and removes plaque from the tongue, in an effort to prevent bad breath.
• Toothbrush tip
  • You can brush your teeth as you floss.
  • It acts like a manual toothbrush (the bristles do not move like an electric toothbrush).
• Implant denture tip
  • Designed to reach hard to access areas. Ideal to clean around dental appliances such as fixed implant bridges and dentures.

The additional nozzles are specifically designed to offer benefits to particular users.

The names and features of the tips can vary from one brand to another.

The range of nozzles and the availability tends to be best with larger brands.

Our research suggests Waterpik offers the best range.

In fact, out of the box, Waterpik models often come with some of these different tip types.

Your orthodontist can recommend which tip is best. You will likely be advised orthodontic and/or jet tip.

The orthodontic tip will need to be replaced on average every 3 months.

Jet tips should usually be replaced every 6 months.  

It is possible to clean jet tips with distilled vinegar. This can extend the usable life from them and reduce the need to replace them.

Please note. Although nozzles are interchangeable, one brand might not be interchangeable with another. For example, Waterpik nozzles will not work with Sonicare.

Things to know about travelling with a water flosser

Wearing a brace results in increased brushing and flossing. Inevitably this can mean that you will need to do this on the go.

It is quite rare to travel or take a countertop water flosser on the go with you.

You are going to want to opt for a cordless water flosser. These are specifically designed to be more portable.

Different water flossers require different power supplies.

Many will come with a power cable suitable for the 2 pin outlet in your bathroom.

Few come with replaceable batteries.  But those that do can be a real winner for some. If you do need a water flosser with replaceable batteries, we recommend the Waterpik WF-03 Cordless Freedom.

More products now come with USB cables. These are more convenient, offering more flexibility when recharging.

If you intend to travel internationally, be aware of the different power requirements.  As a quick reference guide:

• Printed on base/plug – 100-240V
  • Where can it be used? Globally
  • Do I need a voltage convertor? No
  • Do I need a plug adapter? Subject to country
• Printed on base/plug – 220-240V
  • Where can it be used? In countries with 200-240V (e.g. most European countries, NOT US/Canada)
  • Do I need a voltage convertor? Yes if the voltage of the country you are travelling to is less than 220V
  • Do I need a plug adapter? Subject to country
• Printed on base/plug– 110 Volts 60 Cycles
  • Where can it be used? In countries with 110 volts (e.g. US/Canada)
  • Do I need a voltage convertor? Yes if the voltage of the country you are travelling to is higher than 110V
  • Do I need a plug adapter? Subject to country

It is worth considering protection for your water flosser when travelling.  Some, but not all, come with cases included. It is rare for a countertop unit to have a case available.  

More often than not, the cases provided are basic cloth pouch cases.  They offer limited protection.  What they do allow is for the flosser and all the accessories to be kept neatly together. They can help stop any excess water leaking out into a bag.

Some will also come with a separate case for the nozzles.

Do bear in mind no cordless water flosser we have tested comes with any way to deactivate the buttons. It is possible that, in a cloth case, a button might be accidentally pressed and the device activated.

How to use a water flosser with braces

Using a water flosser is a fairly straightforward process, but there is a technique, and it will take a little practice.

As a fixed brace wearer you will need to adapt the technique slightly, compared to those who don’t wear braces.  You need to give specific attention to the brackets.

Do not be surprised if on your first few uses you spray water outside the mouth or dribble in an uncontrolled way.

Each manufacturer will give their recommended steps for their particular flosser. 

The key steps are as follows:

1. Fill the water tank (reservoir) with warm water.
   1. Make sure the door to the reservoir is securely closed to prevent leaks.
2. Select the most appropriate (orthodontic) nozzle/tip and attach it (if not already fitted).
3. Lean over a sink and place the nozzle into the mouth. Close your mouth to create a bit of a seal around it.
   1. Purse the lips to allow the waste water to escape from the mouth.
   2. Make sure the water flosser tip is at 90 degrees to the tooth/gum surface. 
   3. Try to place the nozzle just a few mm away from the gumline.
4. Turn the water flosser on.
   1. Set the pressure to the lowest options available. Adjust later if desired.
   2. Press/switch the power on the water flosser on.
      1. A power button on the main unit and another water control button on the flosser handle (subject to model).
5. Move the water flosser around the edges of the bracket on the tooth.  Move down to and along the gumline. Pause briefly between the teeth. Repeat on the next tooth.
   1. Start with the back teeth and clean all the interdental spaces in both the upper and lower arch of teeth.
   2. Allow excess water to fall out of the mouth into the sink below.
6. When complete, turn the water flosser off.
   1. Empty any remaining water in the tank and allow it to dry out (optional on a countertop model)
   2. Eject the nozzle.

Other key tips for good oral hygiene with braces

Create a regular habit. Doing so will have the biggest impact, over and above the specific water flosser you choose.

• Clean between the teeth and around the braces before each brushing session
• Use the correct flossing technique

Ensure that alongside your flossing you:

• Brush your teeth after every meal with a fluoride toothpaste (or at least twice a day)
• Brush for at least 2 minutes each time
• Use the correct brushing technique. Angle the brush at 45 degrees towards the gum line, and also around the brackets.
• Spit after brushing, don’t rinse with mouthwash or water
• Clean between the teeth and around the braces before each brushing session, with floss, water flosser, or interdental brushes

How does the warranty work?

This can vary from one manufacturer to another and from one country to another.

But, most come with a 2 year (24 month) warranty as standard.

Some brands are a little more customer centric. The best offer 3 year warranties

This will cover any faults that are not a result of user damage.

An example might be the pump failing to push water through.

If the product fails, you will need to contact the customer service department.

Many companies will require that it be returned for repair. This is usually within the country in which it was purchased.

How does dental association approval work?

Around the globe, there are many dental bodies and organizations

In fact, each country will usually have a leading panel of experts. They usually guide oral health within that country. 

These organizations are similarly aligned in their goals and approaches.

The public in particular look to them for advice on what products they should and should not be using.

The American Dental Association (USA) and the Oral Health Foundation (UK) are 2 examples.

Each has programmes that verify the safety and effectiveness of consumer products.

Consumer oral health care products are independently evaluated. This is to ensure they are safe and that the claims made are proven and not exaggerated.  Reliable scientific evidence is usually required. 

The programmes are designed to give consumers peace of mind and reassurance.

Each programme is run independently.  A manufacturer must apply and submit the relevant data to each organization. Only once this process has been completed will a product be awarded the ‘approved’ status of the relevant body.

The ADA issues a ‘Seal of Acceptance’. The Oral Health Foundation labels products as ‘Approved’.

Although they are separate programmes, most operate by similar policies.  A product awarded the ADA seal would likely be approved by the Oral Health Foundation. 

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