1. Good Morning

2. Department of periodontology and oral implantology
Presented by :
Keshav Mehta
Roll no : 36
BDS 4th 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. 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.

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.
► Impact 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
 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

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

16. 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.

17. 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

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. 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)

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)

25. 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.

26. References