Practice Implications

The clinical benefits of home irrigation are clear for clients with gingivitis or for those in periodontal maintenance. It is an effective means of reducing gingivitis and bleeding on probing and has the potential to reduce putative pathogens.43,-55,62

The ability to significantly reduce probing depth has also been demonstrated but in most cases those reductions may be too small to be clinically relevant.50,51,53,54,62 For individuals with implants, Felo et al. showed that irrigation is both safe and effective.55

The evidence for whether or not irrigation can remove plaque is mixed, with the best results found when an antimicrobial agent was employed.43-46,48-55 However, regardless of whether or not plaque removal was enhanced by irrigation, there were still significant reduc-tions in bleeding and pathogens.43-55,62 The mechanism by which irrigation accomplishes this is still unresolved although several researchers have provided important clues. Eakle et al. and Braun and Ciancio have demonstrated the ability of irrigation to penetrate the periodontal pocket thus targeting loosely attached plaque.59,60 Importantly, Cobb et al. found that water irrigation of untreated, chronic periodontal pockets resulted in a significant qualitative change on subgingival plaque bacteria up to 6 mm.61

A recent study by Cutler et al. sheds new light on how irrigation improves the gingival health of clients with periodontitis. In addition to finding reductions in established clinical parameters such as PI, GI, BOP, and PD, home irrigation had a significant effect on GCF cytokine.62 Specifically, IL-1ß and PGE2, known mediators of inflammation that regulate the duration and severity of periodontal disease showed significant decreases after the implementation of daily home water irrigation.63-66 Additionally, IL-10, an anti-inflammatory cytokine, showed increased levels.60,64 Thus, this study indicates that home irrigation with water has the potential to selectively modulate inflammatory mediators thus reducing disease activity. 62 Since inflammatory mediators such as IL-1ß and PGE2 are acknowledged as two players in the break down of bone in the periodontal disease, it seems likely that home irrigation with water could become a mandatory home care procedure for clients with or at risk for periodontal diseases.