This document discusses oral irrigation for periodontal disease treatment and prevention. It describes two types of irrigation: supragingival irrigation, which targets areas above the gumline, and subgingival irrigation, which is used to penetrate below the gumline. Professionally delivered subgingival irrigation aims to eradicate bacteria left after scaling but has limitations due to incomplete pocket debridement and agent washout. Home irrigation is effective for reducing plaque, gingivitis and pathogens when used as an adjunct to professional treatment and maintenance. Both types of irrigation work best when the agent can sufficiently penetrate, maintain effective concentration, and be used for an adequate duration within the periodontal pockets.

1. Supragingival and Subgingival
Irrigation

2. ORAL IRRIGATION DEVICES
• Supragingival irrigation
• Subgingival irrigation
Oral irrigation has been shown to
 Disrupt and detoxify subgingival plaque
 Can be useful in delivering antimicrobial
agents into periodontal pockets

4. • This is used as an adjuct to scaling and root
planing and also to improve oral health.
• Used in TWO distinct ways, in Therapy phase
and in Maintenance phase
1. Professionally delivered irrigation
2. Home or self-applied irrigation

5. Professionally delivered irrigation
(chairside)
• Mechanical debridement of deep pockets is
incomplete and does not completely remove
residual subgingival biofilm and also calculus.
• With antimicrobial irrigation, bacteria left behind
could be eradicated and better results after
scaling and root planing is obtained.
• 3 factors for efficacy,
• 1. Penetration
• 2. Concentration
• 3. Duration

6. • Penetration – Agent must be able to penetrate to the
base of pocket to reach periodontal infection.
• Concentration – Agent must be of sufficient
concentration to be bacteriostatic or bactericidal.
• Duration – Agent must maintain concentration for
sufficient duration to be effective against biofilm.
• To penetrate the pocket a blunt cannula using hand
syringe or mechanized device placed 1-3 mm into the
pocket and penetration ranges from 70-95%.
• 2 types- side port and end port cannulas are used,
side port has lowest ejection pressure and also
presence of calculus impair penetration to deep
pockets

7. Rubber tip used by patient for
subgingival irrigation
Cannula tip used by dentist for
subgingival irrigation

8. • Concentrations of agents used may not be
effective on cells in biofilm.
• Effectiveness was reduced or inactivated when in
contact with blood components in pocket,
flushing action of GCF because of outward flow
and wash out of agents and half life of agents
used subgingivally is 13mts.
• Agents used are
• CHX, tetracycline, stannous fluoride and
povidone-iodine.

9. Home (self-applied) irrigation
• Dentist and his patient engineer developed in
1960s.
• Trials failed due to limited ability to reduce
plaque, but evidence shown reduction in
gingivitis, bleeding on probing and periodontal
pathogens.
• Latest studies that home irrigation stimulates host
modulation effect

11. • Mechanism of action – direct application of a
pulsed or steady stream of water or other
solution.
• Pulsation provides for a compression and
decompression phase which clears bacteria from
pocket.
• Oral irrigator with 1200 pulsations per minute on
a medium to high pressure setting (50-90psi).
• This creates 2 zones of hydrokinetic activity-
Impact Zone, where solution contacts the area
and Flushing Zone, where solution reaches to
subgingival sulcus and outcome is subgingival
penetration

12. • 2 tips
• - Standard jet tip
• - Soft, site specific subgingival tip
• Other tips are available but does not show
subsequent results.
• Irrigation with standard tip is called supragingival
irrigation- point of delivery is at or coronal to
gingival margin resulting in penetration of
solution to subgingival sulcus by 50%.
• Used for full mouth irrigation

13. • Irrigation with Soft, site specific tip is called
Subgingival Irrigation – placement of tip is
beneath gingival margin.
• Used for localized irrigation of specific site – deep
pocket, furcation, implant or crown and bridge.

14. Safety
• Concerns about safety – soft tissue damage,
penetration of bacteria into the pocket but no
scientific evidence has been proved.
• Consider patients overall medical and health
status.
• Consultation with patients Physician to assess
risk and clinical judgement.

15. Clinical Outcomes
• Reduction in plaque, calculus, gingivitis,
bleeding on probing and probing depth
reduction, reduction in periodontal pathogens
and inflammatory mediators.
• Can be used as periodontal maintenance, pts
with orthodontic appliances, maxillary fixation,
crown and bridge, implants and diabetes.
• Compliance is one of the major consideration.

16. CHX dilutions shown effective in
clinical trials
• Conc. Water CHX
0.02% 5 parts 1 part
0.04% 2 parts 1 part
0.06% 1 part 1 part
based on CHX of 0.12%

17. • Oral irrigation covers 2 treatment modalities for
the prevention of periodontal disease.
• Professional irrigation – limited value.
• Self applied irrigation is accepted by majority of
patients.