Electron microscopic study of the effect of water jet lavage devices on dental plaque

Oral Irrigation Devices: A Scoping Review

OBJECTIVES

Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps.

METHODS

The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting.

RESULTS

Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices.

CONCLUSIONS

Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.

Comparative evaluation of adjunctive oral irrigation in diabetics

AIM

The purpose of this study was to assess the response of diabetics to scaling and root planing treatment and subgingival oral irrigation as adjunctive therapy.

METHOD

A total of 52 type 1 and 2 diabetics (mean age 51.3+/-14) with adult periodontitis were randomized to two groups. Treatment included ultrasonic scaling and scaling and root planing in both groups (control and test) plus subgingival water irrigation 2x daily for the test group. Assessments were made prior to and at 6 and 12 weeks after treatment. Parameters measured were modified gingival index (MGI), probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), and bleeding on probing (BOP). Systemic measurement of Reactive Oxygen Species (ROS) generation, cytokines (TNF-alpha, IL-1beta, IL-10, and PGE2), and glycated hemoglobin (HbA1C).

RESULTS

After treatment, analysis of data showed that both groups had clinical and systemic improvement. The test group had a statistically significant reduction for MGI, PI, and BOP compared to controls (p<0.03) at 12 weeks and for ROS generation at 12 weeks (p<0.012). Unlike controls, systemic analysis of cytokines showed a statistically significant reduction from baseline for IL-1beta at 6 weeks and PGE2 at 6 and 12 weeks (p<0.05) within test group.

CONCLUSION

These results suggest that scaling and root planing and adjunctive therapy may be of value in establishing a healthy periodontium in diabetics.

Effects of ultrasonic and sonic scalers on dental plaque microflora in vitro and in vivo

The effects of ultrasonic and sonic scalers on the subgingival microflora were investigated in vitro and in vivo. In the in vitro investigation, 27 plaque samples collected from periodontal pockets were submitted to ultrasonic and sonic vibrations for 10, 30 and 60 s. Bacterial suspensions were examined by darkfield microscopy to detect qualitative changes and cultured to evaluate the total number of cultivable bacteria. Microscopic counts following both instrumentations showed a decrease in the proportions of spirochetes and motile rods and an increase in the % of coccoids and rods. The changes were directly related to the time-period of instrumentation. Comparison between both types of instrumentation showed significant differences and more pronounced changes were observed with the ultrasonic than the sonic scaler. Spirochetes and motile rods were reduced to approximately 0.1% after ultrasonic treatment versus 24.7% after sonic instrumentation. Cultural observations showed a marked increase in total number of colony-forming units following both treatments. The clinical investigation included 66 periodontal pockets which were instrumented subgingivally for 10 and 30 s with ultrasonic or sonic scalers. Qualitative changes were similar to those observed in vitro, i.e., reduction in spirochete and motile rod counts as well as the other morphotypes with an increase in coccoid cells. Total counts of bacteria were reduced following debridement. No difference in the microscopic or cultural data was found between ultrasonic and sonic instrumentation.

Reviewing nonsurgical periodontal therapy

Selection of the appropriate case and clinical competency in treatment modalities results in success in nonsurgical periodontal therapy. The patient with early periodontitis with significant local factors in the form of professionally accessible plaque and calculus is the most receptive to nonsurgical periodontal treatment. The clinician must make decisions centering around the important question, "Can the patient, or moreover, can the therapist delivering the debridement, gain access to the microbial subgingival plaque on a frequent basis below the host defense threshold of the respective patient?" If the answer is "yes," nonsurgical periodontal therapy will be rewarding. If the answer is "no," other modalities such as periodontal surgery must be instituted.

Effect of sanguinaria extract on established plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator

Sanguinaria extract (sanguinaria) solutions were evaluated in 44 subjects in a 2-week, no oral hygiene study as a 300 micrograms/ml manual rinse, and the results compared to supragingival irrigation with 22.5 micrograms/ml sanguinaria concentration and supragingival irrigation with water. Both the manual use of sanguinaria and supragingival irrigation of dilute sanguinaria produced significantly less plaque growth than supragingival irrigation with deionized water. In terms of % changes from baseline, manual rinsing and supragingival irrigation with sanguinaria limited plaque growth to 17.7% and 24.2%, respectively, while irrigation with water had a 51.5% growth. For gingivitis, control supragingival irrigation with sanguinarine and with water were statistically different from manual rinsing with sanguinaria. Compared to baseline, the groups irrigating with sanguinaria and with water had gingivitis reductions of 68.7% and 73.3%, respectively, while manual rinsing with sanguinaria had a 29.6% reduction. The results suggest that dilute solutions of sanguinaria delivered via rinsing or supragingival irrigation are effective in controlling plaque as an additional benefit to the use of supragingival irrigation to control gingivitis. Supragingival irrigation with sanguinaria as part of a home care routine for patients with plaque and gingivitis is suggested.

Modes of application of anti-plaque chemicals

Because interdental and subgingival sites are relatively inaccessible to mouthrinsing, they necessitate alternative methods of application of anti-plaque chemicals. These include routine oral hygiene aids, surfactants to enhance uptake and retention of antimicrobials, gels and periodontal dressings. The principal modes of application that have received attention recently, apart from the systemic route, are syringe and pulsated jet irrigation and slow release compounds. Slow release devices currently receiving attention may be classified as membrane diffusion, solution of drug in polymer and solid drug dispersed in polymer matrix. The most widespread dental instance of a slow release device appears to be the use of varnishes and resins to carry fluoride. Recent attempts at devising improved methods of antimicrobial application include the testing of materials for their biodegradability or for their potential to adhere to mucosal surfaces. It is concluded that the potential exists for antimicrobials applied directly to the site of intended action to contribute significantly to dental health, particularly when employed as components of practical oral hygiene regimes.

Developing an effective oral hygiene program for the orthodontic patient: review, rationale, and recommendations

This article demonstrates the importance of good oral hygiene during and after orthodontic treatment. The attitude of all parties involved toward oral hygiene contributes to the dentition's future. Several means of assisting the patient to maintain good oral hygiene are discussed. It has been emphasized throughout the article that correcting malocclusions is important, but if the result of this effort is lost in a few years because of periodontal disease or caries the patient has not been helped. However, if the patient learns to practice effective plaque control, he may keep his teeth for a lifetime.