Periodontal pocket irrigation as adjunctive treatment

The emphasis in periodontal treatment generally has shifted in recent years from periodontal surgery towards periodontal medicine. Because the major periodontal disease group is the chronic inflammatory group, and the major direct cause of chronic inflammation is dental plaque, much of the new research is directed at more ergonomic and economic means of plaque control that have the efficacy of traditional methods. As a result, the field of plaque chemotherapy is expanding concurrent with the modes of application of anti-plaque chemical agents to their interdental and subgingival sites of intended action. Since the rediscovery of subgingival irrigation some 15 years ago, the technique has been shown to provide an efficient means of subgingival application of anti-plaque agents, and it has also been used to apply anti-inflammatory compounds. It was never intended to stand alone. It was and is meant to be used as an adjunct to professional debridement, but one that simplifies home-care oral hygiene for the patient. This, indeed, is part of the aim of all chemical anti-plaque adjunctive therapy. It requires the use of appropriate anti-plaque agents in sufficient concentration and with sufficient periodicity to be clinically effective. It is only ineffective if dose or periodicity is inadequate, or if mechanical plaque control is unrealistically good--that is, unlikely to be maintained long term by the majority of patients. Subgingival irrigation enables the patient for the first time to deal with bursts of periodontitis activity when professional help is not readily available. Although irrigation per se may dilute plaque toxins, it is still clinically inadequate without a suitable chemical adjunct. Subgingival irrigation with a suitable antimicrobial agent currently constitutes an effective adjunct to the simplified oral hygiene regimen that does not require unrealistic levels of interdental or subgingival home-care cleaning by the patient.