Plaque and Gingivitis Reductions

Early studies documented the effect a pulsating irrigator with a standard jet tip has on PI, calculus index (CI), and GI.43,44 In 1969, Lobene demonstrated a 50% reduction in CI and GI in clients who used a manual toothbrush and a pulsating oral irrigator compared to brushing only. Interestingly, the PI was unchanged.43 In 1971, Hoover and Robinson found that over the course of 90 days, clients who incorporated home irrigation into a routine of manual brushing and interdental stimulation with a rubber tip had significantly less calculus, plaque, and gingivitis 44 than those who did not.

More recent studies, also with a standard jet tip, concur with these results. A six-month study by Chaves compared daily 0.04% chlorhexidine (CHX) irrigation, daily water irrigation, and twice daily 0.12% CHX rinsing to a manual toothbrushing control. They found that both CHX irrigation and CHX rinsing reduced plaque by 30–35% while water irrigation had minimal effect. In spite of this, CHX irrigation, CHX rinsing, and water irrigation both showed sim-ilar significant GI reductions. Additionally, significant changes in the subgingival microflora were produced in the irrigation groups.45 Flemmig et al. conducted a six-month study with groups and methodology similar to Chaves and found concurring results.46 Newman et al. evaluated the microbiota of the clients in the study by Flemmig et al., and found that while all groups reduced the number of colony forming units (CFU) and proportion of black pigmented Bacteroides, only the 0.06% CHX daily irrigation reduced them significantly.47

In studies of shorter duration, Brownstein et al. found a 40% reduction in bleeding following 0.06% CHX irrigation compared to 26% for CHX rinsing,48 and Ciancio and co-workers compared irrigation with either an antimicrobial or placebo rinse and found both resulted in a 54–62% decrease in GI and 12% decrease in GCF.49