Dental Plaque Removal Study (PAU2)

• Modified Gingival Index, Gingival Bleeding index, Plaque Index, and clinical attachment level). [ Time Frame: Baseline and Week 2 ] [ Designated as safety issue: No ]
  To evaluate the impact of a fluid cleaning principle (MTB+Waterpik Waterflosser) relative to MTB+Floss and MTB alone on clinical outcomes: Modified Gingival Index, Gingival Bleeding index, Plaque Index, and clinical attachment level.
• Number of Adverse Events and Intraoral Exams [ Time Frame: Baseline and week 2 ] [ Designated as safety issue: Yes ]
  Safety endpoints based on adverse event reports and intraoral exam (soft tissue evaluation)findings.

The purpose of this research study is to investigate water flow in dental devices and to understand the function of water flow behind oral hygiene improvements. Understanding this mechanism may help with the design of future products.

The overall clinical response (plaque, gingivitis, bleeding) in participants with varying stages of gingival health as well as the causative or indicative hallmarks of selected biological responses underpinning the overt clinical manifestations described above will be evaluated. The chief biological response that will be investigated is how a reduction in the concentration of bacterial lipopolysaccharide endotoxins (LPS) in interproximal plaque may influence improvements in the clinical response (e.g., through mitigation of bleeding) when compared to a change in the plaque biomass within which a large component of the endotoxins reside. The hypothesis is that improvements in clinical bleeding may result more from the removal or reduction of toxic bacterial products that serve as the direct impetus of the inflammatory response rather than from sheer bulk removal of interproximal plaque. From a methods development perspective, this study will also assess the feasibility of measuring endotoxin load from clinical samples. Ultimately it is anticipated that a comprehensive evaluation of clinical benefits conferred by continuous fluid streaming will emerge upon analysis of the relationships between clinical and biological data sets, particularly where causal relationships may exist between both parameters.

• Gingivitis
• Gum Disease

• Device: Manual Toothbrush only
  ADA (American Dental Association) Reference Manual Toothbrush (MTB)
• Device: MTB + Waterpik Ultra Water Flosser 'High'
  MTB + Waterpik Ultra Water Flosser 'High'
• Device: MTB + Floss (MTB+Floss)
  MTB + Floss (MTB+Floss)

• Control
  ADA (American Dental Association) Reference Manual Toothbrush (MTB)
  Intervention: Device: Manual Toothbrush only
• Test
  MTB + Floss
  Intervention: Device: MTB + Floss (MTB+Floss)
• Experimental: MTB + Waterpik Ultra Water Flosser High
  MTB + Waterpik Ultra Water Flosser High
  Intervention: Device: MTB + Waterpik Ultra Water Flosser 'High'

Inclusion Criteria:

• are in good general health
• are 18 - 75 years old;
• have and will abstain from all oral care in the 12 hours prior to each scheduled appointment, but no more than 18 hours prior.
• have and will abstain from consumption of apples and other sticky fruits in the 12 hours prior to each appointment.
• agree to abstain from eating, drinking, chewing gum, and the use of breath mints, etc in the one hour preceding saliva collection at Visits 2 and 3
• have a minimum of 20 natural teeth (excluding 3rd molars);
• have 2 qualifying Interproximal Unit test sites in each posterior quadrant from 3 approximating teeth (see Section 5.1.1, Interproximal Unit (IU)Test Site Selection, for definition);
• present with one of the following three categories:
• BGI-gingivitis: all PD<3mm, BOP>10%;
• BGI-periodontitis (P2): 1+ site with PD>3mm, BOP>10% but <50%
• BGI-periodontitis (P3): 1+ site with PD>3mm, BOP>50%
• have provided written informed consent and are willing to participate and be available at all times required for participation
• are willing and able to fully understand and comply with the written and verbal study instructions provided in English
• agree to return all study materials at the final visit

Exclusion Criteria:

• have systemic diseases, Down's syndrome, or known AIDS/HIV;
• have Diabetes
• are a smoker
• are pregnant or nursing by participant report;
• have a cardiac pacemaker or AICD
• are undergoing or require extensive dental or orthodontic treatment;
• have had oral or gum surgery in the previous 2 months;
• require antibiotic treatment for dental appointments;
• have used antibiotics within 4 weeks of enrollment
• are currently using prescription-dose anti-inflammatory medications or anticoagulants (including aspirin)
• have heavy deposits of calculus, either supragingival and/or subgingival;
• have extensive crown or bridge work and/or rampant decay;
• currently use bleaching trays;
• have any oral or extraoral piercing on lips or in mouth with ornament or accessory;
• have a professional prophylaxis within 4 weeks of study;
• have participated in a prior study ≤ 20 days;
• participated in Philips study DRC-0742;
• are employed by an oral healthcare products company or dental research institution (i.e., dental school: administrative staff, assistants, hygienists, and research students).
• are a dentist, dental student or dental professional