Definition: the target application of a pulsated or steady stream of liquid into a sulcus or periodontal pocket for preventive or therapeutic purposes.

1. Rinsing
2. Oral irrigration
3. Subgingival irrigration

Pt friendly

easy to apply

Inexpensive to dose

Doesn't go too deep into the soft tissue

• Uneven distribution of agent (intraprox)
• Inadequate subging penetration

Reaches most LAP

Reduces concentration with higher volume

Lower concentration with minium side effect

Needs prof. instructions

Extra time required as part of HC

Incomplete eradication of subflora

Increased dose to assure efficacy

Site-specific

higher concentration which allow limited does to effect more swiftly with prolonged suppression of subflora at the apex of the tooth

Cost to pt

No research to show one time use benefits

Recommended for professional use only

The purpose of irrigation is to non-specifically reduce bacteria and their by-products [chemical mediators] that lead to the initiation or progression of periodontal diseases.

Targeted application of a pulsated or steady stream of water or other irrigant

Two streams of hydrokinetic activity are created:

Impact zone – initial contact

Flushing zone – deflected subgingivally

1. Highest concentration of lipopolysaccharides – LPS
2. Large number of polymorphonuclear leukocytes – PMN’s
3. High percentage of gram negative bacteria

Jet tip 0 -3

eakle 4 - 7

Pik Pocket tip <6mm

Braun            >7mm

When would you use water piks?

Give 7 reasons

1. Furcations

2. Deep pockets

3. Unresolved pocket depths

4. Problems with dexterity

5. ANUG

6. Orthodontics

7. Implants

8. Diabetics

9. Motivational

• It will remove bacteria missed by scaling and root planing.
• No harm, might help
• Financial gain
• Information from sales representatives

• Furcations
• Post S&RP
• Inaccessible areas
• In place of polishing

Research does not support a single episode of lavage by a professional  to increase the impact or duration of root planing.

1. Evidence-based therapy
2. Proven effective in reducing gingivitis
3. Effective adjunct to normal oral hygiene
4. Recommended for gingivitis, periodontal maintenance, orthodontics, prosthodontics, implants, and diabetic and halitosis patients
5. Adjunct to brushing and flossing to remove loosely adherent plaque – angle and depth of penetration
6. Reduces bleeding
7. Pulsating action flushes out biofilm
8. Gentle on tissues
9. Helpful to people with limited dexterity

40yrs

started being studied in 1962

Even without instruction, patients with gingivitis experienced no damage to hard or soft tissue when using water irrigation.

1. Gingival bleeding index (GI)
2. Bleeding upon probing (BOP)
3. Probing depth (PD)
4. Periodontal pathogens
5. Inflammatory mediators

Even though daily irrigation with water showed a minimal decrease in plaque, it significantly improved inflammation even in sites with good plaque control.

In a 6-month study, patients previously treated for periodontitis added daily water irrigation to brushing and flossing and reduced gingivitis and BPO significantly more than patients who only brushed and flossed.

Use of oral irrigators is contra-indicated during periods of active treatment of gingivitis or periodontitis because of ulcerated epithelium and increased bacteria present Greenstein, 1992

1. A true “natural” product
2. No side effects
3. Cost effective
4. Readily available
5. Efficacy demonstrated through clinical trials

1. Common in-office product
2. Solid research
3. Oxidizes anything on teeth
4. Builds calculus and stain

Supragingival

Marginal

Subgingival

• 90% penetration of >6mm pocket
• insert tip beneath the gingival margin at 45 degrees to the tooth
• lowest pressure setting
• trace margin for 1-3min per tooth

1. Usually not used for self-care
2. Reduce the number of microflora in the pocket to prevent periodontitis or to facilitate its reduction
3. Use of a cannula
4. Lowest pressure setting

1. Solution used, including water, should be at room temperature for maximum comfort
2. Always advise patients first beginning an irrigation routine to start out at the lowest setting and then increase as comfortable
3. Lean low over the sink
4. Do not turn on the unit until the tip is in the mouth
5. Close the lips slightly to avoid splashing but allow the water to flow freely from the mouth into the sink
6. Before removing the tip, pause the flow or turn the unit off
7. If any solution other than water has been used, fill half of the reservoir with water, remove the tip and flush the system

1. Bend cannula with cover to > 45 degree angle
2. Fulcrum
3. Insert to depth of sulcus and retract 1mm
4. Irrigate circumferentially walking around the tooth
5. Dispose cannula as a sharp

1. Jet tip
2. Pik Pocket^® subgingival irrigation tip
3. Tongue cleaner

1. Braun-B Oxyjet/3D Oral Care Center
2. Hydro Waterfloss Oral Irrigator
3. Colgate Via-jet Oral Irrigator
4. Conair Interplak Dental Water Jet
5. Panasonic Portable Oral Irrigator