In-office irrigation

You are correct that in-office irrigation hasn't been shown to provide any additional benefit over scaling and root planing alone. When the procedure first became popular, it was thought that delivering medicaments subgingivally might help improve certain clinical parameters, like bleeding on probing and pocket depths. However, no matter what medicaments were tested, research hasn't been shown this to be true. Think of it this way: when a patient receives in-office irrigation, the solution is washed away from the pocket almost immediately. It provides a very transient effect. Unlike slow-release antimicrobial products such as Arestin, the effect on the microflora with in-office irrigation is not long-lasting. However, if you want to use this procedure after your mechanical debridement therapy to rinse debris from pockets and provide a cleaner mouth-feel for patients, that is a cosmetic (not therapeutic) application. Charging patients for this procedure is at the discretion of your dentists employer, but patients should know that it is not helping to alleviate any type of periodontal condition. I hope that helps! PS. On the other hand, patient applied irrigation at home has been shown to be effective, either with medicaments or water. It makes sense since patients are doing this on a daily basis versus a single in-office application.