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Oral Irrigation for Chronic Periodontitis

While some oral health professionals are wary of recommending oral irrigation for the management of chronic periodontitis, evidence demonstrates it is an effective therapy in reducing inflammation.

Chronic periodontitis is the most common variation of periodontal disease. In addition, acute periodontal diseases—such as the periodontal abscess, acute necrotizing ulcerative gingivitis (ANUG), and acute necrotizing ulcerative periodontitis (ANUP)—are encountered, albeit less frequently.

Oral irrigation — when used as an adjunctive self-care strategy—is effective in helping patients manage chronic periodontitis. However, some oral health professionals approach such a recommendation with hesitation. A concern I often hear from other periodontists is that the degree of inflammation associated with a periodontal abscess, ANUG, or ANUP increases the fragility of the soft tissues, making oral irrigation risky. It is true that severe inflammation can make the soft tissues more fragile, and these soft tissues may be more susceptible to trauma from the pulses of water from a mechanical oral irrigator. As a result, recommending an oral irrigator as adjunctive therapy in treatment of these acute clinical conditions may not be beneficial.

By contrast, soft tissues associated with chronic periodontitis may be far less fragile. The concern regarding tissue trauma is reduced and oral irrigation should be considered. In fact, clinical research demonstrates that oral irrigation helps to reduce inflammation.1,2 Clinically, when oral irrigation is used, a reduction in edema, erythema, and bleeding on probing is observed. Evidence points to the pressure and pulses of water affecting the composition of the subgingival flora.1,2 It does not matter whether water or an antimicrobial fluid is implemented as the irrigant.

In chronic periodontitis, there are three types of subgingival bacteria: a root-surface adherent biofilm, a nonadherent or planktonic bacteria, and a pocket epithelium-adherent biofilm. The bacterial plaque or biofilm that adheres to the root surface supports the growth of the planktonic bacteria in the pocket space. Moreover, the planktonic bacteria encourages the growth of the pocket epithelium-adherent biofilm, which is also known as the invasive red complex. The red complex bacteria not only adhere to the pocket epithelium but also cause ulcerations of the pocket wall and, subsequently, invade the underlying connective tissue, infecting the host. The presence of bleeding on probing in a pocket is associated with the red complex.

Oral irrigation may not be able to completely remove root-adherent plaque but the pulses likely disrupt the planktonic microbiota in the pocket space. The disruption reduces support for the red complex bacteria, which are likely decreased in number, effecting a change in the subgingival bacterial composition. With less invasive bacteria to infect the patient, a decrease in inflammation and bleeding on probing may be observed. As oral irrigation disrupts and alters the subgingival microbial composition in chronic periodontitis, oral health professionals may want to consider recommending it as part of an effective oral hygiene regimen.

REFERENCES

  1. Abullais SS, Dani N, Hamiduddin, Priyanka N, Kudyar N, Gore A. Efficacy of irrigation with different antimicrobial agents on periodontal health in patients treated for chronic periodontitis: A randomized controlled clinical trial. Ayu. 2015;36:380–386.
  2. Cutler CW, Stanford TW, Abraham C, Cederberg RA, Boardman TJ, Ross C. Clinical benefits of oral irrigation for periodontitis are related to reduction of proinflammatory cytokine levels and plaque. J Clin Periodontol. 2000;27:134–143.

From Dimensions of Dental Hygiene. January 2018;16(1):12.

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