Oral irrigation

1. Good Morning

2. Department of periodontology and oral implantology Presented by : Keshav Mehta Roll no : 36 BDS 4 th Year Resource faculty : DR. Dhirendra Giri Head Of Department

3. Contents Introduction Objectives Oral irrigator Dental water jet mechanism of action Technique for irrigation Indication Conclusion Supragingival and subgingival irrigation

4. 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

5. O bjectives 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.

6. 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.

7. 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 .

8. 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 .

9. 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.

10. 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.

11. 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.

12. 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.).

13. 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. ► I mpact zone Initial fluid contact with an area of the mouth ► Flushing zone Depth of fluid penetration within a subgingival sulcus or . . periodontal pocket

14. fluid penetration depth T oothbrush   :   1-2mm R insing   :           2 mm Floss   :               3 mm D ental water jet : 6mm Toothpick/wooden wedge, interdental brush: Depends on the size of the . embrasure

15. Benefits of home oral irrigation   Remove biofilm Reduces bleeding Reduces gingivitis Reduces periodontal pathogens  Reduces inflammatory mediators

16. I ndications for recommendation of oral irrigation   I ndividuals : on periodontal maintenance. who are noncompliant with dental floss. with special needs Ex: dental implants, diabetes, ortho appliances, prosthetic, bridgework and crowns.

17. S olutions 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

18. 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.

19. 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.

20. S ubgingival 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)

21. 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 )

22. 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.

23. References