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. Since that time, the oral irrigators have been evaluated in more than 50 scientific studies.

The primary purpose of oral irrigation is to reduce harmful bacteria and therefore the risk and severity of periodontal disease. Studies have shown that daily oral irrigation has the potential to suppress periodontal pathogens located within the pocket. Oral irrigation has demonstrated a reduction in proinflammatory mediators.

Patients who may benefit from oral irrigation include those with orthodontic appliances, implants, crown and bridge, diabetes, periodontal maintenance, gingivitis and those whose traditional oral hygiene may be less than ideal.

There are several types of oral irrigators. The most common type for home use is a pulsed flow irrigator. There are also direct flow or steady stream irrigators, and the pulsed flow magnetized irrigator. The choice for tips is multiple. The most prevalent is the jet tip or standard tip, which is designed for supragingival placement. Each tip is designed for a special use, helping in one or another problem.

 Patients are instructed to direct the tip at a 90º angle to the long axis of the tooth, and about 3 mm away from the gingival margin. Then, follow the gingival margin and stop at each interproximal area for five or six seconds, irrigating both the lingual and buccal aspect of the teeth. For moderate to advanced periodontal disease, daily subgingival irrigation can be very beneficial in helping to achieve adequate home care.

It can be used just with water or you can add for example mouthwash.Some researchers have investigated the efficacy of irrigating with an antimicrobial. Several studies assessed the efficacy of supragingival irrigation with 0.06 percent chlorhexidine (1 part water to 1 part CHX) and demonstrated a significant reduction in gingivitis and bleeding. It is important to mention that water also significantly reduced gingivitis and bleeding and the differences between the groups if statistically significant may be clinically insignificant.

Fig.1: the oral irrigator efficiently removes all food debris that stick to the dental surface

Perhaps the biggest advantage of daily irrigation is that it helps patients to maintain a reduced bacterial count in the oral cavity. This in turn leads to fewer bleeding points, more shallow probing depths, and improved gingival health.

Fig.2: special care should be taken to only direct the irrigator at 90 degree angle

The key to success with oral irrigation seems to be consistency, as the bacteria must be continually "knocked down" to achieve maximum benefit. Still, irrigation is only one component of a comprehensive dental care program. Patients must also perform daily thorough toothbrushing, flossing, and any other adjuncts the dental professional deems appropriate. During dental office visits, thorough debridement is still paramount to achieving oral health.

Author: Dr. Ionut Vasilof, ABC Eurodent dentist, competence in Implantology

Sources: ww.rdhmag.com, www.smileartsny.com, www.tutti.ch, www.hammacher.com

Photos:  ww.rdhmag.com, www.smileartsny.com, www.tutti.ch, www.hammacher.com