Oral Irrigation Flashcards
What is the objective of supragingival oral irrigation?
Diminish inflammation by disrupting biofilms above the gingival margins
What is the goal of subgingival irrigation?
Reduce number of bacteria in the periodontal pocket space
What is a water flosser? What else is it known as?
Device that delivers pulsed irrigation of water or other solution subgingivally and supragingivally
-Water irrigator
-Home irrigator
-Dental water jet
What is the mechanism of action of a water flosser?
Delivers pulsating fluid that incorporates a compression and decompression phase
What is hydrokinetic activity?
2 zones of fluid movement created by the compression and decompression phase
What are the 2 zones of fluid movement?
Impact zone- initial fluid contact w/ an area in the mouth
Flushing zone- depth of fluid penetration w/ a subgingival sulcus or perio pocket
What is the depth of penetration of a toothbrush?
1-2mm
What is the depth of penetration of rinsing?
2mm
What is the depth of penetration of flossing?
3mm
Biofilm removalWhat is the depth of penetration of water flossing?
6mm
What are the benefits of home irrigation?
-Biofilm removal
-Bleeding reduction
-Gingival inflammation reduction
-Periodontal pathogen reduction
-Reduction in inflammatory and destructive host response
What is the difference between manual brushing and flossing and using an irrigator with manual brushing?
29% increase in biofilm removal when adding a water flosser
What types of patients would we recommend using a water flosser?
Ortho
Dental implants
Bridgework
Dexterity issues
Diabetic patients
Those who don’t floss
Who should we be cautious about recommending a water flosser to? Why?
Patients with heart conditions or who are at risk for infective endocarditis
Water flossing can cause bacteria to enter the bloodstream much like other oral healthcare devices. Consult physician
What types of solutions can be used in irrigators? Which is best?
Water
Chlorhexadine (diluted)
Mouthrinses/Essential oils (undiluted)
Water is best as it is most cost effective , readily available and has no side effects
What is the max strength of chlorhexadine in the US?
0.12%
What are the different types of irrigation tips that are available?
Standard irrigation tip
Subgingival irrigation tip (rubber tipped)
Orthodontic and fillament tipped (tapered brush to get around wires/brackets/implants)
How should the standard irrigation tip be placed in the mouth? How should it be moved?
90 degree angle at the neck of the tooth
Move the tip along the arch so that it traces the gingival margin
How should the subgingival irrigation tip be placed in the mouth?
Set on lowest pressure
Slide tip beneath the gingival margin at a 45 degree angle
How should the ortho tip be placed in the mouth?
At a 90 degree angle
What is professional irrigation?
The in-office flushing of pockets performed by a dental professional
Disrupts and dilutes plaque biofilm within the periodontal pockets
What tools may be used for professional irrigation?
Blunt-tipped cannula attached to a handheld syringe
Ultrasonic unit
Specialized air driven handpiece attached to dental unit
What are some professional irrigation solutions?
Water
Chlorhexadine
Diluted Betadine and water
Diluted stannous fluoride
Tetracycline
Listerine
Characteristics of chlorhexadine
Broad antibacterial activity
Binds to hard and soft tissues
Attaches to and damages the bacterial cell membranes
Binds to pellicle and prevents biofilm buildup (bacteriostatic)
Continues working for 8-12 hours
What does bacteriostatic mean?
Means the agent prevents the growth of bacteria
How effective is professional irrigiation?
In-office irrigation w/ antimicrobial agents is said to have limited to no beneficial effects over instrumentation alone
Has no substantivity
Why does professional irrigation have no substantivity?
Long lasting effects of antimicrobials are mitigated by the constant flow of gingival crevicular fluid
Substance would have to be retained in the pocket for a length of time
Regular at-home use more effective
