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Lazarus Long Profile picture
@LazarusLong13
Oct 22, 2025 • 19 tweets • 8 min read • Read on X
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If you are Covid Aware you have probably been avoiding the dentist. Well, the dental studies have come to you.

This edition? #CovidAwareSoReducingDentalVisits - Water flossing (WF) edition.

Or, as I like to think of it, the Gum Salon.

Thread.
Flossing is necessary for those super tight contact points as you see in the above thread, and is great to remove plaque down 1 mm deep in the gum line (gently).

InterDental Brushes are fantastic and go down 2-3 mm into the gum line to remove plaque.

And WFs in general, are, well, amazing!!

They basically go back and forth with InterDental Brushes on which is better as far as being the top of the food chain for overall cleaning of the space between your teeth.

But.

If you have gum recession, you may have this Image
going on. The water flosser would never be inserted that deep, but it still shows that like floss, it could be a problem with straight versus the curve-out that bristles can do.

But, there is one thing that water flossing does that is magic. Image
A Pik Pocket Tip (for the WaterPik brand. You basically put the setting as low as possible, and put the tip in the groove - or even down in the pocket if it will let you (always gently).

Have that water flush out those pockets? Sheer bliss.

Video
A couple of studies:

Better than floss:
pmc.ncbi.nlm.nih.gov/articles/PMC10…

Better than IDB:
onlinelibrary.wiley.com/doi/full/10.11…

IDBs better than WF:
pmc.ncbi.nlm.nih.gov/articles/PMC59… Image
Below you can see the subgingival tip (Pik Pocket tip, coming into play, and cleaning up.

onlinelibrary.wiley.com/doi/10.1002/cr…Image
I have used this water flosser - but it died on me. Twice.
amazon.com/dp/B0BG52SJ5N?…

I just upgraded to this one:
walmart.com/ip/Waterpik-Ul…

Sub $50 and I am very happy.
With the Pik Pocket Tip, you you can potentially reach up to about 90% of the depth of a ~6 mm pocket, and perhaps ~60-70% or more of deeper pockets (>7 mm).

These tips for periodontal pockets called subgingival, pocket, or perio tips.

This is an amazing tool.
If you insert it 3 mm into the pocket? You can clean any size pocket.

This next part is very, very important.

"Periodontal disease causing bacteria cause an increase in cytokine levels, which leads to bone resorption."

Got that?

rdhmag.com/pathology/publ…Image
"Daily oral irrigation leads to a reduction in pro-inflammatory cytokines that leads to a slight, but significant, improvement in mild to moderate periodontal disease"

You will be getting rid of cytokines. How cool is that!?
"Most of the active periodontal disease process occurs subgingivally...". Under the gum line.

Here are the tips. Just the jet and the perio tip are the ones I am using. Image
In this sample, it's possible this person occasionally had bleeding gums.
Here are all the things associated with gingivitis.

It includes Alzheimer's. Periodontitis – progression from untreated gingivitis Dental caries (cavities) – due to plaque accumulation and bacterial activity Halitosis (bad breath) – linked to bacterial overgrowth Cardiovascular disease – atherosclerosis, heart attack risk (association, not direct causation) Stroke – increased risk in some observational studies Diabetes mellitus – bidirectional relationship (gingivitis can worsen glycemic control; diabetes increases risk) Adverse pregnancy outcomes – preterm birth, low birth weight (association) Respiratory infections – pneumonia, COPD exacerbations (oral bact...
And now you know the WHY, here is the HOW-to.

The flossing thread is over, but there's a reasonable chance you have not read the thread that will change your life.

Stephan's Curve.

Once I understood what was going on, it immediately became easy to make a few changes, and begin healing.

. Very important details on the water flosser.

Specifically, the Waterpik has a dial numbered 1-10. 1= 10 psi, 2 = 20 psi, etc.

Eventually, you should be using it at 6 or 7 with the regular jet tip. The perio tip should be at 1-2.

The Waterpik is optimized at 1400
pulses per minute. That is EVERY setting is at 1400 ppm. Which is good, as 1200-1400 ppm is the sweet spot in terms of removing the bacteria.

By setting it to 6 or 7, you are setting it at 60/ 70 -perfect for inflamed gum tissues.

/+

rdhmag.com/patient-care/h…Attached gingiva can withstand pressure up to 160 psi for 30 seconds without irreversible damage, leading to the recommendation that 90 psi is acceptable for undamaged tissue and 50-70 psi for inflamed or ulcerated tissue.4 Bacteria removal is accomplished by the water flosser’s pulsating action.1 The incidence of bacteremia produced with water flossing is like that of other self-care exercises, such as toothbrushing and flossing.5
Important - IF you have healthy gums, studies support setting it to 9/ 10 and safely removing plaque.

In fact, once you have healthy gums, and you can tolerate it, go up higher.

In this one - setting it on 80 psi, or level 8, was CORRELATED with

mdpi.com/1660-4601/20/4…"Average irrigation pressures were positively correlated with the reduction in percentage of BOP% at the baseline–12 weeks period (rho = 0.330, p = 0.027)."

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More from @LazarusLong13

Lazarus Long Profile picture
May 22
The "epidemiology" of Ebola tells us that it's not airborne. You've heard this over and over.

What drives it? The questions on the contact tracing form.

Quick 🧵. Image
COVID - the WHO and CDC said it wasn't airborne via aerosols, right?

The CDC said it was spread person to person via close contact - within about 6 feet.



And you remember it took FOREVER to get changed.

The contact tracing form was web.archive.org/web/2020032817…Image
Image
arranged around close contact. These are the questions driving the stats of how many and how are infected.



So, the CDC will only hear back what it's asking. This was the epidemiology of COVID - until it wasn't. web.archive.org/web/2020052514…Image
Read 16 tweets
Lazarus Long Profile picture
May 20
Speaking of silly, can we agree that the WHO has Ebola experts?

Let's talk about PPE, and a bias towards "less PPE is better." Image
The WHO EBOLA IPC guidance:


Foreshadow on PPE

"...due to the desirability of an off-
the-face design, and not for protection from aerosols, respirators may be used instead of medical masks"who.int/publications/i…
If you can stay 3 feet away while screening? No medical mask needed. Image
Image
Read 12 tweets
Lazarus Long Profile picture
May 10
Great article by @EmilyJoshu here.

Emily, there's another article in this that's even more shocking.

The aerosols from milking have long been discussed by many of us on X.

People like myself, @sri_srikrishna, @AbraarKaran have long advocated for comfortable aerosol
protective gear like PAPRs. But, have been ignored by the USDA who, of course, thought it was only contaminated milking gear like the claw.

But there is one more source of aerosols besides cow breath.

The wastewater. When you spray anything you generate huge amounts of Image
aerosols. And that farm wastewater, filled with milk dumped from being full of H5N1, gets reclaimed and reused.

Those milk and wastewater lagoons are on most dairy farms (my grandfather owned a dairy farm).

And there's something you should know.

Image
Read 15 tweets
Lazarus Long Profile picture
May 7
Humanity's hubris vs the precautionary principle.

The virus, ANDV, will do what it will do. Pandemic? History tells us "NO." But history is in the past.

Let me show you what the studies tell us - and why I am livid that the WHO is insisting that surgical masks are ok.

🧵
Incubation time, or how long until symptoms show up?

The high risk time frame is 14–32 days. Not to put too fine a point on that, but that can mean a full month later

pmc.ncbi.nlm.nih.gov/articles/PMC32…

There have been some out to 8 weeks, but let's ignore those

gov.uk/guidance/andes… Image
Clinical features The most important complication of ANDV infection is HCPS, which is associated with a high mortality rate. Milder illness without significant cardio-respiratory compromise may also be seen. Illness usually develops 2 to 4 weeks following exposure, but incubation periods as early as 4 days and up to 8 weeks have been described.
But, what receptor does the ANDV attach to?

PCDH1 (protocadherin-1) is primarily expressed in the airway epithelium of the respiratory system, especially in the bronchial and nasal epithelial cells, and in pulmonary endothelial cells.

So, that means in the URT and the LRT.
Read 41 tweets
Lazarus Long Profile picture
May 6
@mvankerkhove - a follow-up question on today's press conference.

In this bit, you were thanked for being very clear.

But, you said that the medical personnel taking care of those sick would be wearing PPE.

N95s are not PPE. They are Respiratory Protective Equipment. /1
Surgical masks are PPE.

So, is the WHO advising them to wear surgical masks or N95s/FFP2/KF94/KN95 (respirators)?

Second followup, @mvankerkhove, you referred to "really close contacts"

Close contacts are defined by the WHO as within 3 feet.
Cases 1 & 2 were close contacts.

How did the other cases get it? I realize you cannot possibly have an answer...but you are labeling this as "really close contact" for those cases - as well.

Staterooms are typical 2 person rooms.

It doesn't add up. Image
Image
Read 12 tweets
Lazarus Long Profile picture
Mar 26
I've become a bit of a Dental Nerd after just getting savaged by avoiding the dentist due to COVID.

But, now, I have a Dental Nasal PAPR, know all about Stephan's Curve, use a waterpik, Oral-B iO Series 10, chew 8 pieces of xylitol gum - and the dentist just said that.....
He has never seen anyone reverse course so perfectly before.

"Immaculate."

And bonus...I ran into a fellow masker in his lobby!!

She had never heard of Readimask, so I was super happy to share the Good Word with her.

Sharing the Good Word - not COVID!
Good point.

Read 4 tweets

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