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Oral health: A window to your overall health

Your oral health is more important than you might realize. Learn how the health of your mouth, teeth and gums can affect your general health.

By Mayo Clinic Staff

Did you know that your oral health offers clues about your overall health — or that problems in your mouth can affect the rest of your body? Protect yourself by learning more about the connection between your oral health and overall health.

What’s the connection between oral health and overall health?

Like other areas of the body, your mouth teems with bacteria — mostly harmless. But your mouth is the entry point to your digestive and respiratory tracts, and some of these bacteria can cause disease.

Normally the body’s natural defenses and good oral health care, such as daily brushing and flossing, keep bacteria under control. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease.

Also, certain medications — such as decongestants, antihistamines, painkillers, diuretics, and antidepressants — can reduce saliva flow. Saliva washes away food and neutralizes acids produced by bacteria in the mouth, helping to protect you from microbes that multiply and lead to disease.

PREC-oral-irrigator-showimage
PREC Oral Irrigator function show image

Studies suggest that oral bacteria and the inflammation associated with a severe form of gum disease (periodontitis) might play a role in some diseases. And certain diseases, such as diabetes and HIV/AIDS, can lower the body’s resistance to infection, making oral health problems more severe.

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What does an oral irrigator do?

PREC Oral irrigators for healthy teeth and gums

Adding an oral irrigator to your routine can be invaluable in the fight against gum disease. Specifically, oral water irrigators have been proven to:

  • Reduce the overall amount of bacteria that increases your risk of developing gum disease.
  • Remove 99% more plaque than brushing alone, especially when used in conjunction with brushing and flossing.
  • Help control gingivitis—particularly in those who don’t floss on a regular basis.
  • Reduce the incidence of gum bleeding.
  • Improve bad breath.

Although oral irrigation was designed to replace flossing, dentists recommend that flossing remain a part of one’s daily oral care routine, as it is more effective at removing plaque than dental irrigation.

Oral irrigation to the rescue: when flossing isn’t an option

Oral irrigation is often recommended for people who are unable to tolerate flossing. Sensitive gums, orthodontic appliances, diabetes, dental implants, and non-compliance are all reasons why oral irrigation is an effective alternative to flossing. For people with sensitive gums, flossing can prove to be highly irritating; oral irrigators are an excellent alternative and should be used on a regular basis. 

People with orthodontic appliances are also good candidates for using an oral irrigation system because of the difficulty they tend to have flossing around metal wires. Studies have found that people with braces and other orthodontic devices who use an oral irrigator with a specialized tip after brushing, remove three times the amount of plaque as those who use a floss threader, and five times as much plaque as those who only brush.

Because diabetes increases the risk of periodontal disease — especially if glucose levels are uncontrolled or improperly controlled — diabetics can benefit greatly from using an oral irrigator. Even when glucose levels are stable, diabetics tend to be predisposed to experiencing more gum bleeding and inflammation than non-diabetics who have the same level of plaque build-up.

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THE BENEFICIAL EFFECTS OF ORAL IRRIGATORS

The oral irrigator is scientifically proven to reduce several clinical parameters, including biofilm, dental plaque, calculus, bleeding, gingivitis, periodontal pathogens, probing depth, and inflammatory mediators. 

INTRODUCTION 

The oral irrigator was invented by dentist Dr. Gerald Moyer and engineer, John Mattingly in the late 1950s in the United States, and was introduced to dental professionals at a convention in Texas in 1962. It is a device that releases a pulsating stream of water, either alone or combined with an antiseptic, which causes a compression and decompression phase that is ideal for removing food debris and biofilm and for massaging gums without damaging them

The pressure is crucial for these devices, which must be between 50 and 90 psi to be effective. These devices provide a pulsation rate of approximately 1200 per minute, which creates two zones of hydrokinetic activity: the supragingival zone, where the stream first hits, and the flushing zone which is the subgingival area where the solution penetrates for irrigation. 

Because they are convenient, oral irrigators boast good patient compliance and are easily used as part of a normal daily oral hygiene routine. The irrigator tip should be aimed toward the tooth surface, and left for a few seconds on each surface. This process be repeated for all teeth, and the same route should always be followed, making sure not to miss any teeth. Different types of solutions can be used, but the most recommended is water alone, as it is the most economical and widely available, does not cause side effects and is backed by scientific studies. 

Another solution that has been studied is water combined with chlorhexidine. Some studies have found better interproximal and subgingival penetration with the use of mouthiness compared to the use of water alone. 

The efficacy and safety of irrigators have been shown in multiple studies which have evaluated soft tissues after use with an oral irrigator, verifying that no damage was produced, and positive effects on the keratinized gingiva and on the capillary vascularization were observed. 

REDUCTION OF CLINICAL PARAMETERS 

The oral irrigator has been scientifically proven to reduce several clinical parameters, including biofilm, dental plaque, calculus, bleeding, gingivitis, periodontal pathogens, probing depth and inflammatory mediators. 

Mechanical biofilm removal is one of the most effective methods for its control. The flushing effect of the irrigator can cause quantitative and qualitative changes in biofilm or dental plaque by diluting and detaching it. In an in vitro and in vivo study on biofilms, a near 99.9% reduction of this biofilm was observed through scanning electron microscopy after 3-second application on the surface being treated. 

In another patient study, the use of toothbrushing plus irrigation was compared to toothbrushing plus dental flossing, and greater plaque reduction was observed in the patients who used irrigation. 

Furthermore, and thanks to the special replacement tips available, access to subgingival biofilm is greater even when patients have periodontal pockets. Similarly, calculus reduction is significant with the use of these devices. 

Oral irrigators have also proven to significantly reduce gingivitis and bleeding on probing. A 4-week study conducted by the University of Nebraska (United States) on 105 subjects showed how the use of an oral irrigator together with manual or electric toothbrushing improved bleeding and gingivitis indices – practically twice as effective – compared to brushing and flossing. 

Likewise, another recent study showed that the combination of manual brushing and oral irrigation is twice as effective at reducing bleeding on probing compared to brushing and flossing. 

With regard to inflammation, the oral irrigator has shown not only to reduce biofilm, but also to change the structure of the biofilm making it less pathogenic for the host. This was also observed in another study, which revealed a significant reduction in cytokines and proinflammatory mediators including IL-1ß and PGE2, which would explain this mechanism and would support the use of irrigators by people who have difficulty controlling biofilm. 

Irrigators have also proven to reduce levels of subgingival pathogenic bacteria by 6 millimeters, regardless of the solution used, an effect that can be enhanced by the use of special replacement tips for application to difficult-to-reach areas. 

PEOPLE WITH SPECIAL NEEDS 

Oral irrigators have been studied in different special clinical situations. One study found that when used with periodontal tips, the oral irrigator improved parameters relating to biofilm, bleeding and gingivitis in patients with diabetes, besides reducing the expression of destructive inflammation mediators IL-1ß and PGE2. 

Another recent study has proven the safety and efficacy of the oral irrigator together with a special replacement tip in patients with implants. Brushing plus irrigation was compared to brushing plus flossing, and very significant differences were observed in relation to bleeding reduction in favor of the patients who used irrigators. 

The oral irrigator has also proven to be greatly useful in periodontitis patients who are undergoing periodontal maintenance therapy and as a supplement to routine oral hygiene measures, by reducing gingival inflammation, bleeding on probing and probing depth. 

Lastly, a significant improvement in bleeding and inflammation indices has also been seen in orthodontic patients who used an oral irrigator compared to those who used brushing alone, and even a significant improvement compared to brushing along with flossing. The different studies mentioned in this article are based on studies conducted with oral irrigators. 

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What is Oral Irrigation?

Oral irrigators were first developed in 1962 as an alternative to dental flossing.  Also known as a “dental water jet”, “water pick”, or “dental irrigator”, an oral irrigator uses a stream of pressurized, pulsating water to clean between teeth and below the gum line. As a result, harmful deep periodontal pocket bacteria that could not otherwise be reached through brushing or flossing, is flushed out and removed.

Oral irrigators for healthy teeth and gums

Adding an oral irrigator to your routine can be invaluable in the fight against gum disease. Specifically, oral water irrigators have been proven to1:

  • Reduce the overall amount of bacteria that increases your risk for developing gum disease.
  • Remove 99% more plaque than brushing alone, especially when used in conjunction with brushing and flossing.
  • Help control gingivitis—particularly in those who don’t floss on a regular basis.
  • Reduce the incidence of gum bleeding.
  • Improve bad breath.

Although oral irrigation was designed to replace flossing, dentists recommend that flossing remain a part of one’s daily oral care routine, as it is more effective at removing plaque than dental irrigation2.

Oral irrigation to the rescue: when flossing isn’t an option

Oral irrigation is often recommended for people who are unable to tolerate flossing. Sensitive gums, orthodontic appliances, diabetes, dental implants, and non-compliance are all reasons why oral irrigation is an effective alternative to flossing. For people with sensitive gums, flossing can prove to be highly irritating; oral irrigators are an excellent alternative, and should be used on a regular basis. People with orthodontic appliances are also good candidates for using an oral irrigation system because of the difficulty they tend to have flossing around metal wires. Studies have found that people with braces and other orthodontic devices who use an oral irrigator with a specialized tip after brushing, remove three times the amount of plaque as those who use a floss threader, and five times as much plaque as those who only brush3.

Because diabetes increases the risk of periodontal disease — especially if glucose levels are uncontrolled or improperly controlled — diabetics can benefit greatly from using an oral irrigator. Even when glucose levels are stable, diabetics tend to be predisposed to experiencing more gum bleeding and inflammation than non-diabetics who have the same level of plaque build-up4.

People undergoing dental implants need to be especially careful about oral cleanliness and can benefit from the use of oral irrigators as well. Implant failure is a risk if plaque build-up increases to the extent that it inflames the surrounding gum tissue. Oral irrigation helps to reduce the overall amount of plaque, occurrence of gingivitis, and the incidence of gum bleeding5.

For those who are averse to flossing or who find it hard to floss regularly, investing in a dental irrigator is a good option. While oral irrigation is not as effective as flossing, it is beneficial if regular flossing has proven difficult. Using an alcohol-free oral rinse that contains essential oils instead of water can yield even better results.

Dental Herb Company’s Under the Gums Irrigant® is a professional strength antimicrobial herbal concentrate designed for dilution and use with an oral irrigator. It has been shown to reduce the number of oral bacteria, and help reduce the incidence of bleeding gums while improving the condition of the tissue surrounding the teeth.  Under the Gums, Irrigant® is formulated with pure essential oils and extracts of organically grown herbs that are capable of penetrating the mucous membrane with greater potency and longer-lasting effectiveness, while conditioning and rebuilding gum tissue. Extracts of Echinacea, Gotu kola, and essential oils of peppermint, red thyme, cinnamon bark, eucalyptus, and lavender, work together to help maintain healthy teeth and gums. Using the professional strength Under the Gums Irrigant® after brushing and flossing is an excellent way to maintain oral health naturally. Under the Gums, Irrigant® is available in a 4.1-ounce glass bottle, which if used once daily is approximately a two-month supply.