Irrigating the whole mouth need not take longer than
five minutes. The plaque below the gums is not sticky
like the plaque above the gums. The purpose of the
irrigator is to distribute an antimicrobial agent
deep to the bottom of the pocket, not to pressure
clean the mouth.
For most people irrigating is easier than flossing.
It requires less dexterity, you dont need small
fingers and you don't have to open your mouth as wide.
WaterPik® Professional model, Hydro Floss®,
ViaJet® and other oral irrigators offer attachments
for subgingival irrigation. Some offer a smaller tub
that holds around 10 ounces (300 cc) of liquid, which
is enough to thoroughly distribute solution to all
areas of the mouth without wasting the anti-microbial.
New to the market are a portable electric irrigator
from Panasonic® and a convenient squeeze-bottle
pocket irrigator from OraTec® (oratec.net).
Therapeutics for Oral Irrigation
The ideal irrigating solution combines antimicrobials,
connective tissue rebuilders and tissue conditioners
to create an unfriendly environment for a wide variety
of microorganisms. It does not just suppress their
activity, but it enhances the host's resistance. The
ingredients should be natural, non-toxic and supported
by valid claims and research. The products
page provides information about natural products that
are commercially available for therapeutic, maintenance
or preventative purposes.
Solutions other than commercially available natural
antimicrobials can also be useful in combating PI.
Each has positive and negative features. The following
recipes are based on using 10 ounces (300 cc) of warm
potable water with the ingredient described below.
If the oral irrigator you choose is different in size,
calculate the difference.
1. Plain water can reduce microflora; use it, if
nothing else is available.183
2. Two teaspoons of baking soda (sodium bicarbonate)
is a salt that is four times more bactericidal than
regular table salt. Because undissolved crystals are
bad for the machine, it is best to mix the powder
in a glass container and then add the solution to
the irrigator tub. Thoroughly rinse the irrigator
after use. Unless considerable amounts of the mixture
are swallowed, no significant amount of sodium is
absorbed through the oral mucosa, making it safe for
those on salt restricted diets.
3. One teaspoon of table salt (sodium chloride) can
dehydrate microorganisms. Unfortunately it can also
dehydrate the teeth, causing sensitivity for a short
period. Caution: only use an irrigator marked safe
for salt. Because undissolved crystals are bad
for the machine, it is best to mix the powder in a
glass container and then add the solution to the irrigator
tub. Always thoroughly rinse the irrigator after use.
Unless considerable amounts of the mixture are swallowed,
the amount of sodium chloride absorbed through the
oral mucosa is insignificant.
4. Three capfuls of 3% hydrogen peroxide diluted
in ten ounces (300 cc) of water is a potent antimicrobial.
It is the substance that our defensive cells release
to kill invaders. However, peroxide is destructive
to the connective tissue that supports the teeth.
It can be used occasionally, but should not be used
on a regular basis.
5. One-half teaspoon of bleach (sodium hypchlorite)
is an effective killer of bugs; however, it is a chemical
and is toxic. Bleach is caustic, tastes terrible and
is poisonous if swallowed.
6. Three and one-half ounces of vinegar acidifies
the mouth, creating an unfriendly environment for
bugs. However, due to its low pH, it can dissolve
teeth if used on a regular basis.
7. Ten percent povidone iodine diluted 50/50 with
warm water is quite an effective antimicrobial; however,
it tastes terrible, and stains teeth and anything
else it touches.
8. TheraSol® is a powerful antimicrobial using
two synergistic proprietary active agents, amphoteric
quaternary surfactants. This product does not stain
the teeth and has a pleasant taste.
9. Peridex® and Periogard® (0.2% chlorexidine,
CHX) is probably the best-known antimicrobial in the
dental profession because it has been researched for
thirty years. Although it is an effective antimicrobial,
it has considerable side effects. If used on a regular
basis, it produces dark brown stains on the teeth
and increases calculus in about 40% of users. Also,
it cannot be used in bleeding pockets because it binds
with blood, preventing the solution from penetrating
the pocket. CHX is available with a prescription only
from pharmacies as a 5% concentrate. Use 1 ounce of
concentrate per 25 ounces of warm water to make a
The above irrigating solutions generally have considerable
downside problems: brown tooth staining, undesirable
taste, poisonous in increased amounts, and difficulty
and complications of proper mixing and measuring.
Whether the limitations are one or several, most people
give up too early in the treatment process to have
any success. I generally recommend the commercially
available natural products I discuss in the next chapter
over any of the above solutions.