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 don’t 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 Devices

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 .2% solution.

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.