Good Morning

Department of periodontology and oral implantology

Presented by :

Keshav Mehta

Roll no : 36

BDS 4th Year

Resource faculty :

DR. Dhirendra Giri

Head Of Department

Contents

Introduction

Objectives

Oral irrigator

Dental water jet mechanism of action

Technique for irrigation

Indication

Conclusion

Supragingival and subgingival irrigation

Oral Irrigation

Its targeted application of a pulsated or steady stream of water for removing debris.

Also known as hydrotherapy/ lavage

-Can be a valuable adjunct to helping to maintain oral cleanliness and health

-Oral irrigating devices force a steady or pulsating stream of water over the gingival

tissue and teeth with the goal of removing unattached debris, loosely attached biofilm

and reducing the concentration of bacteria, periodontal pathogens, and cellular end

products that may be present.

Introduction

Objectives

supragingival irrigation

to diminish gingival inflammation by disturbing biofilms coronal the gingival

margin.

subgingival irrigation

goal is to reduce the number of bacteria in the periodontal pocket space.

Disruption and dilution of the bacteria and their products from within periodontal

pockets.

Delivered By

Power driven device

Generates an intermittent or

pulsating jet of fluid.

An adjustable dial for regulation of

pressure is provided along with a

held interchangeable tip that

rotates 360 degree for application

at the gingival margin.

Non-power driven device

It’s attached to a household water supply

and delivered through a hand held

interchangeable tip that can be used for

application at the gingival margin.

ORAL IRRIGATION

Supragingival Irrigation

Oral irrigators for daily home use by patients work by directing a high-pressure,

steady or pulsating stream of water through a nozzle to the tooth surfaces

Most commonly, a device with a built-in pump generates the pressure but other

devices attach to the water faucet.

Oral irrigators clean nonadherent bacteria and debris from the oral cavity more

effectively than toothbrushes and mouthrinses.

Supragingival irrigation is irrigation with a jet tip placed above the gingival margin

resulting in penetration of a solution into the subgingival sulcus to approximately

50%.

Supragingival irrigation used in combination with toothbrushing and other

interdental cleaning aids is acceptable and can result in improved clinical health.

Subgingival Irrigation

Irrigation with the soft, site-specific tip is called subgingival irrigation.

This refers to the placement of the tip, which is placed slightly below the gingival

margin.

The subgingival tip is used for the localized irrigation of a specific site such as a

deep pocket, furcation, implant, or crown and bridge.

Subgingival irrigation performed both in the dental office or by the patient at

home, particularly employing antimicrobial agents, has been shown to provide

some site-specific therapy.

Subgingival irrigation at home is not the oral hygiene procedure of choice for

patients requiring antibiotic prophylaxis before dental treatment, particularly if

extensive inflammation is present.

Subgingival irrigation performed with an oral irrigator using chlorhexidine

diluted to one-third strength, performed regularly at home after scaling, root

planing, and in-office irrigation therapy, has produced significant gingival

improvement compared with controls.

Oral irrigator

An oral irrigator (also called a dental water jet) is a home care

device that uses a stream of pulsating water to remove plaque and food

debris between teeth and below the gumline and improve gingival

health.

The first oral irrigator was developed in 1962 by a dentist and an

engineer, both from Fort Collins, CO.

It has been tested and shown effective on people in periodontal

maintenance, and those with gingivitis, diabetes, orthodontic

appliances, crowns, and implants.

A study at the University of Southern California found that a 3 second

treatment of pulsating water (1,200 per minute) at medium pressure (70

psi) removed 99.9% of plaque biofilm from treated areas.

It can also be used to remove 'tonsil stones' in tonsilloliths patients.

There is some evidence that an oral irrigator is useful in preventing and

treating canker sores.

Prevention involves pulsing the soft tissues of the mouth (gums,

cheeks, etc.).

Dental water jet mechanism of action

Delivers pulsating fluid that incorporates a compression and

decompression phase.This creates two zones of fluid movement

called hydrokinetic activity.

► Impact zone

Initial fluid contact with an area of the mouth

► Flushing zone

Depth of fluid penetration within a subgingival sulcus or .

. periodontal pocket

fluid penetration depth

Toothbrush : 1-2mm

Rinsing : 2 mm

Floss : 3 mm

Dental water jet : 6mm

Toothpick/wooden wedge, interdental brush: Depends on the size of the

. embrasure

Benefits of home oral irrigation

Remove biofilm

Reduces bleeding

Reduces gingivitis

Reduces periodontal pathogens

Reduces inflammatory mediators

Indications for recommendation of oral irrigation

Individuals:

on periodontal maintenance.

who are noncompliant with dental floss.

with special needs

Ex: dental implants, diabetes, ortho appliances, prosthetic,

bridgework and crowns.

Solutions can be used with the DWJ (Dental water Jet)

The most effective one is the one that is acceptable to the patient.

* Water is highly effective and readily available

* Chlorhexidine- In home should be diluted with water and its better for IP and

subgingival penetration that rinsed. The dilution can help minimize stainining.

Irrigant solutions

1) Chx

2) Providone Iodine (1:9 water)- bacteriostatic activity

3) Water

4) Stannous fluoride (1:1)

5) Tetracycline 6) Listerine

Technique for use of irrigation tip standard jet tip

Supragingival irrigation

The common home-use irrigator tip is a plastic nozzle with a 90-degree bend at the tip attached to

a pump providing pulsating beads of water at speeds regulated by a dial.

Patients should be instructed to aim the pulsating jet across the proximal papilla, hold it there for

10 to 15 seconds, then trace along the gingival margin to the next proximal space and repeat the

procedure.

The irrigator should be used from both the buccal surface and lingual surface.

Patients with gingival inflammation usually start at lower pressure and then can increase the

pressure comfortably to about medium as tissue health improves.

In subgingival irrigation

Currently, two types of irrigator tips are useful for subgingival irrigation.

the cannula type tip recommended for office use, and the other is a soft rubber tip

for patient use at home.

The subgingival irrigation tip should be gently inserted into pockets or furcation

areas, 3mm if possible, and each pocket shoud be flushed for a few seconds.

Orthodontic irrigation, tip is placed 90 degree angle at neck of tooth near gingival

margin, direct tip towards brackets. Use light contact.

Subgingival antimicrobial irrigants

1. Chlorhexidine: PerioGard (11.6% alcohol), Peridex, and Oris at 0.12%

2. Perio Med at 0.63% Stannous F

3. Listerine Antiseptic: Essential Oils (26.9% alcohol)

4. Sodium Hypchlorite

5. Povidone Iodine (Betadine, 10% for 5 minutes)

In- office oral irrigation

3 methods

1) Blund tipped irrigating cannula that is attached to a handheld syringe .

2) Ultrasonic unit equipped with a reservoir .

3) Specialized air driven handpiece that connects to the dental unit airline (perio pik

handpiece)

Conclusion

Home irrigation is safe and effective for a wide variety of patients, including those

in periodontal maintenance; those with calculus buildup, gingivitis, orthodontic

appliances, maxillary fixation, crown and bridge, implants, and diabetes; and

those who are noncompliant with floss.

Clinical outcomes include the reduction of plaque, calculus, gingivitis, bleeding

on probing, probing depth, periodontal pathogens, and inflammatory mediators.

References