The Driving Force of Water Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

Since 1966 with the introduction of the Waterpik®, oral irrigation has been considered secondary to traditional flossing. Through the years, oral irrigation with water has proven more effective in reducing inflammation and bleeding than rinsing with chlorhexidine.

In fact, home oral irrigation is effective in controlling gingival inflammation, with reductions in gingivitis scores, bleeding scores, pocket depths and pro-inflammatory substances. Without removing plaque, oral irrigation seems to effect bacteria within the plaque, the thickness of the plaque and the immune response. So, if you aren’t recommending oral irrigation to your patients, or using it yourself, it’s time to start.

An oral irrigation product you might try is the ShowerFloss®, a unique product invented by Clyde Stewart, a retired General Motors engineer, to make cleaning between his teeth easier. Inspiration came to him as he stood in the shower, trying to get the water flow to clean his teeth. “There has to be a way to harness the water power of the shower,” Clyde mused. His engineering training took over and he designed and tested various ideas for an oral irrigator attached to the shower, finally settling on a design that simply diverted some of the water to a tube with an irrigating tip attached. Voilà, the ShowerFloss was born. He submitted and received the patents and began production in 1986.

Five years later, sitting at a continuing education seminar, Janice Madigan learned about the ShowerFloss and was intrigued by it. She took one home and found that the ShowerFloss provided an effective alternative to flossing for those who couldn’t or wouldn’t floss with traditional string floss. Janice then formed a company to distribute the ShowerFloss and perhaps in the future, other innovative hygiene products.

HT: Why did you start Hygiene Innovations?

JPM: Hygiene Innovations was started to provide consumers with an easy-to-use, low-cost oral irrigator to help them achieve good oral hygiene every day. I saw incredible results with the ShowerFloss at three-month recalls. Patients who refused to do any interproximal home care always came in with bleeding and pocketing that just didn’t clear up. I would give them a ShowerFloss and was amazed at the results. The bleeding was gone and the tissue was healthy again. It helped that the ShowerFloss was simple to use and not messy. The geriatric as well as male patients especially liked it because it was a new gadget.

It all started 12 years ago when I was working with my best friend, Pam, in the dental office she owned with her husband––she as a hygienist and he as a dentist. We developed a business plan for the company and each of us brought different skills to the table, and we were therefore able to take on different roles building the company.

HT: It’s hard to start a new business in the dental field. How did you go about getting customers?

JPM: It’s really been word of mouth, Trisha. We sent out fliers in the beginning, spent a lot of time talking, answering questions and taking brochures to dental offices in the area. We planted a lot of seeds, but didn’t hear back from most of our leads. When we did, there were more questions and not many orders. We did better around the holidays, November and December, selling them as gifts. We had a big break at a local home and garden show where we exhibited. Our exhibit was right next to a plumber with a shower display. He installed a ShowerFloss in his exhibit and Pam and her son got in the shower to show how it worked. No, they didn’t get wet, but just getting in the shower with the ShowerFloss attached was funny and entertaining. It was an adventure that the local TV news crew caught on tape. The TV talk show host highlighted unique products from the home show and included the ShowerFloss film on his program that night. Being on a popular TV show definitely helped our local sales.

HT: You’ve mentioned your partner Pam, but I only see your name now associated with Hygiene Innovations. What happened?

JPM: As a hygienist Trisha, you’ve done your share of head and neck cancer screening exams, as I have. Pam found a blackish/brown mole with irregular borders, smaller than a pea on the side of her face, just under the bow of her glasses, so it wasn’t even noticeable. You and I tell patients to get things checked early, but Pam let this go, thinking is was nothing. She was busy with her two children, husband, the dental practice, and our business. At that time, she was very busy organizing a dental mission trip to South America for her husband; gathering donations and getting the details arranged. Finally, she did have a biopsy, still thinking it was nothing. It wasn’t. It was a melanoma, stage V, despite being quite a small lesion still. Things moved rapidly from that point; she underwent surgery and chemotherapy. I helped wherever I could, driving her to chemotherapy appointments, taking care of her children, cooking for the family, and just spending time with her. My own son was just two years old at the time, so helping Pam and her family folded right into my life. The cancer spread to her bones and she soon needed a cane to walk and eventually a body cast. Chemotherapy was also taking a toll on her. With these dramatic changes in her health, Pam suggested I buy her half of the business. I remember her saying, “I can’t do the business anymore. I can’t even hold down lunch!” Pam always made me laugh, no matter how difficult the situation. She fought hard, but the cancer won out in the end and she died 18 months after the diagnosis. It was such a tragedy and I felt so helpless watching my best friend die.

HT: Janice, I am so sorry! It’s a tribute to Pam that you’ve continued with the business and built upon the vision of helping consumers you both had so many years ago. I’m impressed that you manage to run a household, work four days in clinical practice, and run Hygiene Innovations. Do you have electronic systems in place to keep it running?

JPM: That would be a good idea, but I haven’t yet moved into the 21st century of electronics and computers, as my friends are quick to remind me. Orders are taken over the phone and by mail, and I keep track of accounts with an alphabetized card system. You know, the kind we used to use for recall systems years ago. Many of my customers are dental offices that re-order, so I am able to follow up with this system and not miss an order. It works for me and my husband can help out. I am moving, with a bit of kicking and screaming, into the computer age. I now have a Web site where orders are accepted electronically, in addition to phone and mail orders. My 10-year-old son, Shane, already has the computer skills to take over the electronic aspects of the business, if I don’t watch out!

HT: During your three-decade career in dentistry, you completed the Periodontal Expanded Functions Program at Northern Arizona University in Flagstaff, Arizona and earned a Master’s Degree in Healthcare Systems from the University of Denver. Based on your education, you must be keenly aware of research and the evidence-based approach to healthcare. How do you answer questions about the difference between the direct flow of the ShowerFloss and the pulsed flow of the Waterpik and other powered oral irrigators?

JPM: You’re right Trisha, I do appreciate the importance of scientific evidence and I look to the research for answers. I also take into consideration what I see working for my patients and what my patients are willing to do. The research is important and compliance is essential. Waterpik is the leader in the field of oral irrigation and has done the lion’s share of the research, for which I am very grateful. Small companies like Hygiene Innovations and ShowerFloss don’t have the resources to tackle an expensive clinical research project. If my stats are correct, it can cost $10,000 per subject to complete a clinical study. For a study involving a minimum of 30 subjects, it would cost $300,000! That’s why so many small companies are unable to fund research. Until ShowerFloss can afford clinical research, our claims will focus on patient compliance, clinical observations and case reports. The reason this product was invented was to provide an alternative to dental floss, for those who can’t or won’t floss daily.

About the “pulsed” versus “direct stream” discussion, I’m not aware of any evidence comparing the two approaches head-to-head by measuring interproximal tissue health. Laboratory studies published in the 1970s do show the effectiveness of the pulsed flow over mucosal tissue, but nothing has been reported that would suggest that finding is true when irrigating under the gums and between the teeth. Research does show the effectiveness of the Waterpik for reducing bleeding and probing depths. I realize these findings can’t simply be applied to ShowerFloss since the technologies are different. The research findings are important and bring the value of oral irrigation to consumers who don’t like flossing. Irrigation is a good alternative for those who can’t or won’t floss. From my clinical experience, water irrigation works, both pulsed and direct flow. This is where each hygienist can do his/her own clinical research, measuring and documenting the clinical effects of oral irrigation, either pulsed or direct flow.

In the end, it’s all about compliance. The best product in the world is of no value if it isn’t used and dental floss is a good example. My goal is oral health, using whatever it takes to achieve that goal. I want to provide the best possible care for my patients and I want all consumers to have the products that will help them achieve and maintain good oral health.

HT: Oral irrigation is a good alternative for those who can’t or won’t floss, and now should be considered a regular part of oral hygiene for everyone.

Thank you Janice, for your dedication to oral health through your company, Hygiene Innovations. The ShowerFloss certainly provides an alternative to string floss and your commitment to sharing this technology with patients is a testament to your dedication to oral health.