Oral Irrigation

Question 1

What is the objective of supragingival oral irrigation?

Answer 1

Diminish inflammation by disrupting biofilms above the gingival margins

Question 2

What is the goal of subgingival irrigation?

Answer 2

Reduce number of bacteria in the periodontal pocket space

Question 3

What is a water flosser? What else is it known as?

Answer 3

Device that delivers pulsed irrigation of water or other solution subgingivally and supragingivally

-Water irrigator
-Home irrigator
-Dental water jet

Question 4

What is the mechanism of action of a water flosser?

Answer 4

Delivers pulsating fluid that incorporates a compression and decompression phase

Question 5

What is hydrokinetic activity?

Answer 5

2 zones of fluid movement created by the compression and decompression phase

Question 6

What are the 2 zones of fluid movement?

Answer 6

Impact zone- initial fluid contact w/ an area in the mouth
Flushing zone- depth of fluid penetration w/ a subgingival sulcus or perio pocket

Question 7

What is the depth of penetration of a toothbrush?

Answer 7

1-2mm

Question 8

What is the depth of penetration of rinsing?

Answer 8

2mm

Question 9

What is the depth of penetration of flossing?

Answer 9

3mm

Question 10

Biofilm removalWhat is the depth of penetration of water flossing?

Answer 10

6mm

Question 11

What are the benefits of home irrigation?

Answer 11

-Biofilm removal
-Bleeding reduction
-Gingival inflammation reduction
-Periodontal pathogen reduction
-Reduction in inflammatory and destructive host response

Question 12

What is the difference between manual brushing and flossing and using an irrigator with manual brushing?

Answer 12

29% increase in biofilm removal when adding a water flosser

Question 13

What types of patients would we recommend using a water flosser?

Answer 13

Ortho
Dental implants
Bridgework
Dexterity issues
Diabetic patients
Those who don’t floss

Question 14

Who should we be cautious about recommending a water flosser to? Why?

Answer 14

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

Question 15

What types of solutions can be used in irrigators? Which is best?

Answer 15

Water
Chlorhexadine (diluted)
Mouthrinses/Essential oils (undiluted)

Water is best as it is most cost effective , readily available and has no side effects

Question 16

What is the max strength of chlorhexadine in the US?

Answer 16

0.12%

Question 17

What are the different types of irrigation tips that are available?

Answer 17

Standard irrigation tip
Subgingival irrigation tip (rubber tipped)
Orthodontic and fillament tipped (tapered brush to get around wires/brackets/implants)

Question 18

How should the standard irrigation tip be placed in the mouth? How should it be moved?

Answer 18

90 degree angle at the neck of the tooth

Move the tip along the arch so that it traces the gingival margin

Question 19

How should the subgingival irrigation tip be placed in the mouth?

Answer 19

Set on lowest pressure
Slide tip beneath the gingival margin at a 45 degree angle

Question 20

How should the ortho tip be placed in the mouth?

Answer 20

At a 90 degree angle

Question 21

What is professional irrigation?

Answer 21

The in-office flushing of pockets performed by a dental professional

Disrupts and dilutes plaque biofilm within the periodontal pockets

Question 22

What tools may be used for professional irrigation?

Answer 22

Blunt-tipped cannula attached to a handheld syringe
Ultrasonic unit
Specialized air driven handpiece attached to dental unit

Question 23

What are some professional irrigation solutions?

Answer 23

Water
Chlorhexadine
Diluted Betadine and water
Diluted stannous fluoride
Tetracycline
Listerine

Question 24

Characteristics of chlorhexadine

Answer 24

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

Question 25

What does bacteriostatic mean?

Answer 25

Means the agent prevents the growth of bacteria

Question 26

How effective is professional irrigiation?

Answer 26

In-office irrigation w/ antimicrobial agents is said to have limited to no beneficial effects over instrumentation alone

Has no substantivity

Question 27

Why does professional irrigation have no substantivity?

Answer 27

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