Ion Exchange vs. RO for Shower Water

Ion Exchange vs. RO for Shower Water

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If calcium and magnesium hardness is the problem you want to solve, ion exchange is the more direct treatment mechanism to investigate for shower water. Reverse osmosis, or RO, uses a membrane to reduce dissolved substances, but a proposed RO installation must also demonstrate that it can supply your shower’s required flow, pressure, and duration. A drinking-water RO specification alone doesn’t establish shower suitability.

That distinction matters when you’re looking at mineral buildup, soap scum, hair that feels coated, or skin that feels uncomfortable after bathing. These observations can justify checking your water, but they don’t identify a cause or tell you which equipment to buy.

Our recommendation is to separate the decision into three questions: What needs to change in the water? Which fixtures need treatment? Can the proposed system deliver and maintain that change under your actual shower conditions? Answering them in that order makes the comparison much clearer.

What is the difference between ion exchange and reverse osmosis for shower water?

Ion exchange changes which ions are present in the water; RO separates water through a membrane. For a conventional household softener, the target is calcium and magnesium hardness. RO has a broader separation purpose, with performance that depends on the complete system and the substances being evaluated.

An ion is an atom or molecule with an electrical charge. Calcium and magnesium occur in water as positively charged ions. A conventional softener exchanges them for sodium or potassium ions using resin, a treatment material that holds and exchanges selected ions. This is why “softening” has a more specific meaning than “filtering.”

Hardness, dissolved solids, and filtration describe different things

Hardness generally describes dissolved calcium and magnesium. Total dissolved solids, usually shortened to TDS, includes a wider collection of dissolved materials, including salts containing sodium, potassium, calcium, magnesium, and other constituents. The Alaska DGGS explanation of dissolved solids helps establish that broader definition.

Three terms to keep separate when comparing treatment claims
Term What it tells you How to use it in this decision
Hardness Information about calcium and magnesium hardness Establish whether softening addresses your measured concern
TDS Information about the broader dissolved-material content Use alongside substance-specific information; it doesn’t identify hardness by itself
Filtration A treatment category whose function depends on the media and system Ask exactly which substance the equipment reduces and under what conditions

The practical consequence is that a TDS reading alone cannot verify successful softening. Replacing hardness ions with other ions is a different objective from broadly reducing dissolved solids. That conclusion follows from the hardness definition, the TDS definition, and the exchange mechanism; it isn’t a claim about a particular product’s before-and-after readings.

Likewise, a device described as a shower filter needs a specific claim attached to it. Ask whether the claimed function is chlorine reduction, sediment removal, hardness reduction, or something else. The word filter is too broad to settle the comparison.

Confirm hardness before treating it

The USGS guidance on hardness and soap scum classifies water as follows. These are descriptive bands, not safety limits or mandatory treatment thresholds. USGS also explains that calcium reacts with soap to form soap scum and cautions against using regional maps to determine an individual property’s hardness.

USGS general hardness classifications
Classification Hardness, expressed as mg/L as CaCO₃
Soft 0–60
Moderately hard 61–120
Hard 121–180
Very hard More than 180

“As CaCO₃” means the result is expressed as a calcium carbonate equivalent, a common basis for reporting hardness. Keep that unit with the number when requesting a recommendation.

Start with current utility information or a suitable water test. If your report gives a range, share the range rather than choosing its lowest value. Record where the sample was collected and whether existing treatment was operating.

For a practical follow-up, our guide to checking shower-softener claims with hardness testing explains how to approach matched inlet and outlet comparisons.

Ion exchange and calcium magnesium water hardness.
Hardness testing and dissolved-solids measurements answer different treatment questions.

Shower delivery is a system requirement

A shower needs treated water throughout the bathing period, at a usable flow and pressure. We recommend treating delivery as a separate purchase requirement from water-quality reduction: a system proposal should demonstrate both.

Flow is the volume delivered over time. Pressure describes the force available to move water through the installation. Capacity can refer to something different again, such as how much hardness a softener can handle before regeneration. Ask the seller to identify which quantity each specification describes.

As a reference for scale, EPA WaterSense showerhead flow and performance guidance says labeled showerheads use no more than 2.0 US gallons per minute and meet independent performance criteria. That is a voluntary U.S. showerhead-program reference, not a universal shower requirement or proof that a treatment unit can supply that flow.

Turn your shower routine into a delivery estimate

Use this simple estimate to prepare for a sizing discussion. Enter your shower’s measured or documented flow, usual running time, and number of consecutive showers:

Calculate:

Water delivered per shower = flow × running time

Water delivered for consecutive showers = flow × running time × number of showers

Keep the volume units consistent. If you use liters per minute, the result is liters; if you use US gallons per minute, it is US gallons.

Enter three positive values to calculate delivered volume. Results use liters when flow is in liters per minute, or US gallons when flow is in US gallons per minute.

The result has three useful interpretations:

  • All inputs are known: Send the calculated volume, flow, and simultaneous-use information to the installer for verification.
  • Flow is unknown: Obtain a fixture specification or suitable measurement before treating the estimate as a sizing input.
  • RO storage is proposed: Ask the designer to explain usable stored volume, production during use, refill time between showers, and delivery after storage is drawn down.

For variable shower lengths, calculate a shorter and longer routine. Treat them as planning scenarios rather than promises about daily consumption.

This arithmetic estimates water delivered at the fixture. It does not calculate membrane production, softener capacity, pressure loss, wastewater, or a safe equipment size. Those require system-specific information. If treatment serves only part of the mixed-water supply, the installer must establish the relevant treatment volume and final water quality.

The entry for other fixtures is a note for your installer; it does not add their demand to this calculation. Likewise, the calculation assumes each consecutive shower has the flow and duration entered. If household members use different routines, calculate those routines separately and share the separate results. Keep the original flow and time beside each total so a designer can see how the estimate was produced.

For example, a hypothetical flow of 6 liters per minute, a 10-minute shower, and two consecutive showers gives 60 liters per shower and 120 liters across both showers. This is an arithmetic example, not a recommended flow, shower duration, storage volume, or equipment capacity.

Compare operating conditions with operating conditions

Ask for pressure information while water is flowing, as well as any required inlet-pressure range. Request the proposed system’s pressure drop at the intended service flow. A maximum pressure rating and a flow rating answer different questions.

The same care applies to RO production figures. A daily production rating needs its test conditions and an explanation of how water reaches the shower during the period of use. Storage, pumps, and membrane production should appear in one delivery plan rather than as disconnected specifications.

Write down your least convenient normal scenario: consecutive showers, another bathroom in use, or another fixture running. Ask the seller to explain that scenario explicitly. This makes “suitable for a household” a question that can be reviewed.

What does ion exchange do to hard water?

Conventional ion exchange reduces calcium and magnesium hardness by exchanging those ions for sodium or potassium ions. It is therefore a logical technology to evaluate when household testing confirms that hardness is the treatment target.

The NSF explanation of softening and treatment standards describes this mechanism under NSF/ANSI 44. It also identifies NSF/ANSI 58 for RO and NSF/ANSI 177 for shower filtration; its shower-filter explanation concerns free available chlorine reduction. These standards have distinct scopes.

The exchange cycle includes regeneration

A conventional softener’s resin has a finite working capacity. Regeneration restores its exchange function using sodium or potassium chloride. The University of Minnesota residential softening guidance discusses sizing, regeneration controls, salt maintenance, and the salty discharge associated with regeneration.

The buyer’s task is to establish how that cycle works in the actual model. Ask whether regeneration is automatic or manual, how the need is determined, what work you perform, and what happens to the water supply during the process.

Don’t accept “recharge regularly” as the whole ownership explanation. Request the procedure, required materials, rinse instructions, service interruption, and discharge arrangements. Your inlet hardness and expected use should be part of that discussion.

Flow and working capacity need separate verification

A system may have an advertised service flow and a separate hardness capacity. Require both to be explained under stated conditions. For a shower-level unit, ask what outlet hardness is expected at your inlet hardness, water temperature, and intended flow, including near the end of its service cycle.

This avoids a common comparison error: judging softening from a fresh-cartridge demonstration while making a purchase for repeated household use. We recommend requesting evidence that describes the useful operating cycle, along with a clear trigger for regeneration or replacement.

Our article on evaluating mineral-removal claims in shower softeners provides more context for those questions.

Choose your first investigation path

Use the following decision route to identify what deserves further investigation. Choose your main concern, whether you have relevant water information, and the intended treatment scope. Follow the first applicable route:

  1. Your water information is missing or doesn’t identify the concern. Start with utility information or suitable testing. Keep treatment selection provisional.
  2. Calcium and magnesium hardness is confirmed and is your main concern. Investigate ion-exchange softening. For one shower, request shower-specific operating data; for several fixtures or the whole home, request a household plumbing and demand assessment.
  3. A defined dissolved substance or broader dissolved-solids objective is established. Investigate RO or another treatment documented for that exact objective. Require a complete shower-delivery design if shower treatment is intended.
  4. The concern is a disinfectant such as free chlorine, rather than hardness. Investigate a filtration claim matched to that disinfectant and intended operating conditions. If the disinfectant hasn’t been identified, establish that first.
  5. The concern is hair or skin feel alone, with no verified water-quality target. Record the observations and check the water before choosing equipment.
What is your main concern?
Does current water information establish that treatment target?
Where would you want treatment?
Choose a concern, water-information status, and treatment scope to identify the next investigation. The numbered routes above remain the complete guide.

If you have more than one confirmed concern, retain each applicable route and ask for a treatment plan that explains the role of each stage. Scope changes the installation assessment: one shower requires fixture-level verification; several fixtures or a whole home require simultaneous-demand and plumbing verification.

This route identifies a next investigation. It doesn’t diagnose a personal-care concern, select a model, establish water safety, or replace sizing.

The route gives missing water information priority because an unverified concern cannot establish a treatment requirement. Choosing “yes” means that your information identifies the concern; it does not mean the proposed equipment has been verified. You still need the exact reduction claim, operating conditions, and acceptance checks. For several confirmed concerns, repeat the selection for each concern and bring the combined questions to the designer.

Is reverse osmosis suitable for shower water?

RO can be considered for a shower only when its treatment purpose and complete delivery design justify the installation. You should not assume that an ordinary drinking-water unit can supply shower service simply because both applications use RO.

RO uses pressure to move water through a semipermeable membrane, a barrier that allows water through while restricting selected dissolved substances. It produces permeate, the treated stream, and reject water, the more concentrated stream leaving the process. EPA guidance on RO operation and maintenance explains this separation and describes point-of-use systems intended for drinking and cooking.

The shower-specific conclusion is an engineering inference: a proposal must separately establish sustained delivery, installation requirements, and the treatment claim under expected conditions. It would be equally careless to declare that RO can never supply showers or that any RO unit can.

Ask how the complete installation works

The University of Nevada guidance on RO installation describes pressure dependence, storage, drain connections, and maintenance for conventional under-sink equipment. Published in 2005, it offers background principles rather than specifications for a current shower or whole-home system.

Use those principles to request a complete layout. Where is the feed connected? What pretreatment is required? Is storage included? What provides delivery pressure? Where does reject water go? How is the treated supply connected to the shower’s hot and cold water arrangement?

Ask the designer to identify any temperature limitations and explain the proposed heating arrangement. Don’t assume equipment intended for a cold drinking-water connection is approved for hot shower water.

RO shower delivery needs flow and pressure checks.
Evaluate membrane production, storage, pressure, and the shower connection as one delivery plan.

Evaluate wastewater at the proposed system’s scale

EPA’s guidance describes reject water from point-of-use RO and distinguishes more efficient labeled equipment. Those drinking-water figures should not be transferred to an unnamed shower installation.

Request expected treated-water and reject-water volumes for the proposed design under your feed-water conditions. Ask whether the estimate includes flushing and other operating water. If a seller supplies a ratio, have them label the numerator and denominator: feed-to-product and reject-to-product are different comparisons.

The useful decision is whether the documented water use, drainage, space, and maintenance fit your household. A technology-wide “wastes less” claim cannot answer that.

Compare the complete systems on the same terms

Compare ion exchange and RO using the same household conditions, intended fixtures, and acceptance criteria. A technology label provides an initial direction; documented system performance determines whether a proposal meets your need.

Shower water treatment comparison: mechanisms and purchase questions
Decision criterion Conventional ion-exchange softening Reverse osmosis
Treatment purpose Reduces calcium and magnesium hardness through exchange Uses membrane separation to reduce dissolved substances
First evidence to request Inlet and outlet hardness under stated service conditions Reduction evidence for the defined substance or dissolved-solids objective
Shower delivery Verify service flow, pressure drop, temperature rating, and working capacity Verify production, storage if used, pumping, pressure, and sustained delivery
Maintenance Verify regeneration, salt or recharge materials, settings, and replacement needs Verify prefilters, membrane replacement, cleaning or sanitation, and service needs
Wastewater Account for regeneration and rinse discharge Account for reject water, flushing, and other operating discharge
Installation Verify fittings, support, access, drainage, and plumbing scope Verify the full feed, pretreatment, membrane, storage, delivery, and drain arrangement
Hair and skin claims Hardness reduction does not establish a clinical or cosmetic outcome Dissolved-substance reduction does not establish a clinical or cosmetic outcome
Certification Check the exact model, standard, and certified claim Check the exact model, standard, and certified claim

The mechanism and maintenance distinctions are supported by NSF, EPA, and University of Minnesota guidance. The remaining entries are verification questions, not universal specifications for either technology.

Read certification as a specific claim

Ask for the exact model listing and the claimed reduction. A certificate for one function should not be stretched to cover another.

NSF’s explanation of NSF/ANSI 177 concerns free available chlorine reduction in shower filtration. It does not establish calcium and magnesium removal, chloramine reduction, or a skin benefit. Likewise, a standard number is not a ranking that makes one technology “higher grade” than another.

Our comparison of shower filtration and ion-exchange softening can help you keep the treatment stages separate. For a media-specific explanation, see KDF media versus ion exchange for shower water.

Compare ownership without inventing savings

Request an itemized ownership estimate rather than relying on a low purchase price. Use the same comparison period and household-use assumptions for both proposals.

For softening, ask about regeneration materials, regeneration water, routine testing, replacement parts, and service. For RO, ask about filters, membranes, operating water, service, and any pumps or other powered equipment included in the design. EPA advises following manufacturer instructions for RO filter and membrane replacement; fouling can impair performance.

A useful comparison worksheet is:

Ownership estimate = equipment + installation + consumables + water and wastewater charges + applicable energy + testing and service

Leave an item marked “awaiting quote” when you don’t have a defensible figure. Don’t substitute a generic market average for a missing system specification.

For combined treatment, request separate maintenance instructions for each stage. Soft Water Care’s replacement cartridge for the ACF filtration stage is a store-local consumable destination; its description assigns hardness removal to the separate softener stage. Replacing a filtration cartridge should therefore be considered separately from maintaining the softening stage.

What can either approach establish about hair and skin?

A verified treatment result can establish a change in water quality. It cannot, by itself, establish why your hair feels rough or your skin feels uncomfortable, or guarantee that those sensations will improve.

We recommend setting two separate expectations before buying: a measurable water objective and a personal observation you want to track. For example, “reduce measured shower-water hardness” is a treatment objective. “Hair feels easier to rinse” is an observation. Keep both, but don’t treat them as interchangeable evidence.

Hair evidence needs careful interpretation

Published laboratory findings are mixed. In Srinivasan and colleagues’ hard-water hair experiment, detached hair from 15 volunteers underwent hard-water and distilled-water exposure over 30 days. The study reported no statistically significant difference in tensile strength or elasticity. This was a small laboratory experiment, without an installed shower-treatment comparison or a cosmetic outcome assessment.

A separate experiment, Luqman and colleagues’ hair-strength laboratory comparison, used detached hair from 70 men. It reported reduced strength after hard-water exposure compared with baseline, while deionized-water exposure did not significantly differ from baseline. The checked abstract does not supply exposure duration or strength units, and it did not test a household softener or RO shower installation.

These studies cannot establish that one shower technology improves hair feel more than the other. Nor should a detached-hair strength result become a promise about shedding, regrowth, or a store product.

If your concern is coated, dull, or difficult-to-rinse hair, record the complaint in your own words and establish whether hardness is present. Our guide to hard water and hair observations offers further context for reviewing water alongside your wash routine.

Skin comfort and eczema treatment are different questions

The strongest directly relevant household trial in the supplied evidence concerns established childhood eczema. In the Softened Water Eczema Trial, 336 children with moderate or severe eczema were randomized to usual care with or without a household ion-exchange softener. At 12 weeks, adding softening did not improve the blinded primary eczema-severity outcome compared with usual care alone. Thomas and colleagues’ household eczema softening trial.

What that result means for a purchase: a household softener should not be presented as an established treatment for childhood eczema on this evidence. The trial did not compare RO, and it does not settle every question about adult skin sensations or ordinary bathing preferences.

Some parent-reported secondary outcomes favored softening, but families knew their treatment allocation. That does not change the primary clinical result. Keep that distinction intact if a seller cites the trial.

For persistent or worsening skin or scalp symptoms, seek appropriate clinical advice. Keep treatment decisions connected to verified water needs rather than using equipment selection as a diagnosis.

Hair and skin clues need water quality checks too.
Personal observations, laboratory endpoints, and clinical outcomes should remain separate.

Keep an observation record before changing equipment

Use one record to make a later comparison more useful:

Check each item as you add it to your own record. These check marks are for this page visit; keep your measurements and observations in a separate record you can revisit.

Avoid changing every part of your routine at once if your goal is to understand what changed. A personal record can help you judge satisfaction, but it remains an observation rather than a controlled experiment or proof of cause.

Should you treat one shower, several fixtures, or the whole home?

Choose scope according to where you need a verified water change and what plumbing access you have. One shower is a different project from treating several bathrooms, the water heater supply, or the whole home.

Point-of-use treatment serves a particular outlet or use. Point-of-entry treatment treats water near its entry to the property, subject to the plumbing layout and any bypasses. EPA and university guidance distinguish fixture-level treatment from broader household arrangements.

When a shower-level investigation makes sense

A shower-level approach deserves consideration if the desired treatment is limited to one bathing location and the equipment can meet that fixture’s conditions. Ask how it attaches, what supports its weight, how you access it for maintenance, and whether its temperature and pressure ratings match the proposed location.

Also decide whether you are comfortable maintaining separate equipment if you later want treatment at another shower. Evaluate the work involved in the exact proposed arrangement rather than assuming that “small” means convenient.

Our article on planning a shower-level portable softener setup describes installation and external recharge considerations. Use the current equipment instructions to confirm fittings and procedures.

When broader treatment deserves assessment

If your concerns extend across several fixtures, request a broader plumbing assessment. Ask the installer to mark which hot and cold supplies would be treated and which would remain outside the treatment path.

Make the scope visible on a simple drawing. Include the proposed equipment location, treatment outlets, bypass, drainage, and service access. Then review simultaneous demand and maintenance access against that layout.

For an upstream installation, ask whether the treated path includes the water heater supply. For a shower-mounted device, clarify that its treatment scope begins at that device. These are installation questions to resolve in writing.

Scope also affects ownership. Ask who performs each maintenance task and what happens during an interruption. If the arrangement involves landlord permission or alterations to plumbing, settle those constraints before comparing models.

Compare one shower and whole home treatment scope.
The treated plumbing path determines which fixtures receive the intended water change.

What should you verify before choosing a system?

Before purchase, obtain written answers that connect the system to your water, shower demand, installation, and maintenance routine. Treat undocumented performance as a question to resolve.

Build a clear water-quality brief

Write a short statement that separates the concern from the evidence:

“We want to address ______ at ______ fixtures. Our water information shows ______, in ______ units, collected or reported on ______. Our shower flow is ______ and our usual consecutive-use pattern is ______. Please explain the proposed treatment result and delivery under those conditions.”

If the water information is missing, say so and ask what testing is needed. That gives a seller a useful starting point without inviting them to infer chemistry from a photograph or a symptom description.

For hardness treatment, request an expected outlet-hardness result and the operating conditions behind it. For RO, identify the particular reduction objective and the evidence supporting that claim. Keep broad descriptions such as “cleaner water” out of your acceptance criteria.

Request an operating specification you can review

Your written proposal should identify:

  • The exact model and treatment stages.
  • Intended installation location and treated fixtures.
  • Permitted inlet-water conditions.
  • Rated service flow and relevant pressure requirements.
  • Temperature limits for the proposed connection.
  • Working capacity or production conditions, as applicable.
  • Regeneration, replacement, cleaning, and service procedures.
  • Wastewater or discharge arrangements.
  • Any certified claims and the matching model listing.
  • What the system supplies during maintenance or depletion.

Ask the seller to distinguish tested values, design estimates, and household assumptions. All can be useful, but they should be labeled.

For a softener, “capacity” needs its hardness basis and regeneration conditions. For RO, “production” needs its operating conditions and relationship to usable shower delivery. Request the meaning of any specification whose units or conditions are missing.

Plan acceptance checks before installation

Agree on how the installer will demonstrate the promised result. We recommend recording the inlet condition, outlet result, flow, and operating state so that a later service question has a clear reference.

For softening, use hardness testing appropriate to the promised result. Decide where samples will be collected and how performance will be checked later in the service cycle. A fresh-treatment reading and a reading after repeated use answer different ownership questions.

For RO, ask which measurements demonstrate the stated treatment objective and which demonstrate delivery. TDS may form part of a documented operating check, but it should not substitute for evidence of a specific contaminant reduction or water safety.

A proposal is easier to compare when each promised result has a matching check. Put the treatment objective beside its measurement, and put delivery beside the intended shower-use scenario. If either check remains undefined, ask the installer to complete it before treating two quotations as equivalent. This keeps a clear distinction between purchasing a technology and accepting an installation that performs the agreed job.

Confirm discharge and maintenance arrangements locally

Conventional softener regeneration discharges salty water, and RO produces a reject stream. The practical arrangements and applicable requirements need to be checked for the installation location. General institutional guidance does not establish your local permissions.

Ask who is responsible for verifying the drain connection and any discharge restrictions. Request the answer before installation rather than leaving it as a task for the person delivering the equipment.

Check whether the maintenance routine fits your household

Read the actual procedure before judging convenience. If manual recharge is involved, consider how you will move the unit, obtain materials, perform the process, rinse it, and return it to service. If professional service is proposed, request its scope and cost.

For combined filtration and softening, list the separate tasks in one calendar. A single reminder labeled “change filter” may leave the softening stage unaddressed.

Soft Water Care’s shower-softener buying and maintenance guide connects testing, recharge, replacement, and troubleshooting topics. Use it to prepare questions, then confirm the exact model’s instructions.

Verify shower system fit and upkeep before buying.
Bring water information, delivery requirements, and maintenance questions into the same written proposal.

Choose the next step that matches your evidence

For verified calcium and magnesium hardness, start by evaluating an ion-exchange system that can document the required result at your shower conditions. For a defined dissolved-substance objective, investigate RO within a complete treatment and delivery design. If you have observations but no established water target, testing is the proportionate next step.

If a shower-specific softening approach fits your scope, you can review Soft Water Care’s shower system combining filtration and ion-exchange softening The store describes it as combining an activated carbon fiber filtration stage with a separate softening stage. Before choosing it, request current flow, pressure, temperature, hardness-capacity, regeneration, and installation documentation for your conditions.

A useful purchase decision has a short chain of reasoning: measured concern, suitable treatment mechanism, verified shower delivery, workable maintenance, and an agreed acceptance check. Keep that chain visible as you compare proposals. It gives you a practical basis for choosing equipment without requiring either technology to be a universal winner.

Frequently asked questions

Can ion exchange and RO be used together?

Yes, they can form different stages of a treatment design, provided each stage has a defined purpose. Ask the designer to explain why both are proposed, what each changes, and how the combined arrangement is maintained. The Hinkley pilot is an example of evaluating combined technologies in a specialized contamination setting, not a template for an ordinary shower installation.

Does a shower filter soften hard water?

A shower filter does not automatically establish hardness reduction. Check for a documented calcium and magnesium reduction claim under the intended operating conditions. NSF’s explanation of shower-filter certification concerns free available chlorine reduction, which is a different treatment function. A combined device may have separate filtration and softening stages.

Does softened water have to show a lower TDS reading?

No. Conventional softening exchanges calcium and magnesium for sodium or potassium; it is a different objective from broadly lowering dissolved solids. Verify softening with a suitable hardness test. Don’t use a TDS result alone to decide whether hardness removal succeeded.

Can a cold-water RO unit be connected directly to a hot shower?

Do not assume that it can. Require explicit temperature approval and a complete installation design for the exact equipment. Ask how the treated supply reaches the hot and cold sides of the shower, how delivery pressure is maintained, and how reject water is handled.

How soon will treatment improve my hair or skin?

There is no established universal timeline for those outcomes in the evidence used here. First confirm that the equipment produces its documented water-quality change. Then track your own observations without treating them as proof of medical benefit. The household eczema trial did not establish an added primary clinical benefit from softening, and it did not compare RO.

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