8th February, 2011

Oral Irrigation
What is oral irrigation? It is an adjunctive procedure that can disrupt plaque in subgingival areas. The target area of irrigation is unattached or loosely attached microorganisms at the subgingival level, regardless of where the tip of the device is placed. The purposes of using oral irrigation are: reducing the potential of developing gingivitis or decreases existing gingivitis and directly reducing pocket microbiota in an attempt to control or prevent the initiation of periodontitis. Supragingival irrigation dilutes and flushes away bacteria coronal to the gingival, which helps to prevent or treat gingivitis and also reduces subgingival bacteria. Subgingival irrigation attempts to directly reduce the pocket microbiota in an effort to prevent initiation of periodontitis or to help its reduction. Home oral irrigation and in-office oral irrigation are the types of the oral irrigation. Home use of subgingival irrigation allows patients to participate in maintaining bacterial reduction after scaling procedures. In-office oral irrigation can be used following routine scaling and root planning to flush away calculus and plaque fragments

and to introduce an antimicrobial agent to impede reestablishment of plaque. There are many chemical agents have been used as irrigants, such as water, chlorhexidine, povidone-iodine, essential oils, hydrogen peroxide, fluoride and tetracycline. For the indication, oral irrigation is an ideal adjunct when supragingival mechanical aids such as toothbrushes, floss, and interproximal brushes and devices are not sufficient to keep the bacterial load below the threshold of disease. It is also ideal for delivering antimicrobial agents deeper into pockets. Patients with physical challenges, orthodontic appliances, or prosthodontic replacements such as implants and crowns or those who need an adjunctive method to reduce repopulation of bacteria between periodontal maintenance appointments are also ideal candidates for supplemental oral irrigation. Moreover, patients with plaque-induced gingivitis can benefit most from oral irrigation because the disease is in its early stage. Patient with slight and moderate chronic periodontitis also may benefit from oral irrigation. However, patient with severe chronic periodontitis and refractory periodontitis require more aggressive treatment. In addition, oral irrigation should not be used when a periodontal abscess or ulcerations are present. Once the problem has been resolved, it then may

be appropriate to recommend irrigation therapy. The limitation of irrigation is that it does not remove adherent dental plaque, calculus, or stains. Management as a dental hygienist of using irrigation are: subgingival calculus must be removed before irrigation because it interferes with penetration of the agent. After scaling and/ or root planning, inform patient that irrigation will be processed. OHI to improve patients oral hygiene such as physical and chemical plaque control and may recommend patient to have a home oral irrigation if necessary. Finally, in patients with good oral hygiene, daily brushing and flossing remain the most efficient methods for controlling gingivitis. Reference: Book: D617.664.C73 & D617.6891.C7