PICO Process: Oral Irrigation
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Professional subgingival oral irrigation is the in-office flushing of pockets performed by the dental hygienist or dentist using one of three systems: a blunt-tipped irrigating cannula that is attached to a handheld syringe, an ultrasonic unit equipped with a reservoir, and a specialized air-driven handpiece that connects to the dental unit airline. The goal of subgingival irrigation is the disruption and dilution of the bacteria and their products from within periodontal pockets (Nield-Gehrig & Willmann, 2011.) Professional subgingival irrigation has been controversial in its therapeutic effects for the patient with periodontal disease. To see whether these procedures in fact help these patients or not, is determined by evidence-based decision making. Below is the PICO mnemonic to conduct research to whether these irrigation procedures benefit the patient.
Patient or problem: What are the most important characteristics for the potential patient?
To perform professional subgingival irrigation the patient must present with periodontitis with periodontal pockets that are 5mm or greater.
Intervention, cause or prognosis: What main intervention am I considering for my patient with deep periodontal pockets?
I would consider using a blunt-tipped irrigating cannula that is attached to a handheld syringe for flushing the periodontal pockets. I would use an antimicrobial, such as chlorhexidine, for the disruption of bacteria inside the pockets.
Comparison: Is subgingival irrigation beneficial to the patient with periodontitis as an adjunct to nonsurgical periodontal
instrumentation?
Many studies have been done to show that irrigation has only limited or no beneficial effects over nonsurgical periodontal instrumentation alone. One study in particular compared these two procedures and demonstrated that irrigation with antimicrobials had only limited effects on the subgingival bacteria (Wennstrom, 1987).
Outcome:
What are the benefits that I can accomplish with my periodontitis patient?
Other studies have found a minimal improvement in certain patients, but the majority had no significant difference between irrigation versus nonsurgical periodontal instrumentation regarding probing depths or inflammatory status (Nield-Gehrig, 2011).
Personal Reflection: I chose this topic because I am administering antimicrobial agents with a cannula and syringe for my patients with deep periodontal pockets. It is very important to know everything there is to know about the procedures I am performing in clinic as well as outside of school in private practice. In the future I will need to use my evidence-based decision making on whether to perform these procedures on my patients. I will have to use good judgment on what patient could actually benefit from professional subgingival irrigation.
Additional Information:
http://www.rdhmag.com/articles/print/volume-23/issue-10/feature/oral-irrigation.html
References:
Nield-Gehrig, J. S., & Willmann, D. E. (2011). Foundations of periodontics for the dental hygienist: Professional oral
irrigation. (3rd ed., pp. 458-459). Philadelphia, PA: Lippincott Williams & Wilkins.
Wennström, J. L., Dahlén, G., Gröndahl, K., & Heiji, L. (1987). Periodic subgingival antimicrobial irrigation of periodontal pockets: II. Microbiological and radiographical observations. Journal Of Clinical Periodontology, 14(10), 573-580. doi:10.1111/1600-051X.ep13483467
Patient or problem: What are the most important characteristics for the potential patient?
To perform professional subgingival irrigation the patient must present with periodontitis with periodontal pockets that are 5mm or greater.
Intervention, cause or prognosis: What main intervention am I considering for my patient with deep periodontal pockets?
I would consider using a blunt-tipped irrigating cannula that is attached to a handheld syringe for flushing the periodontal pockets. I would use an antimicrobial, such as chlorhexidine, for the disruption of bacteria inside the pockets.
Comparison: Is subgingival irrigation beneficial to the patient with periodontitis as an adjunct to nonsurgical periodontal
instrumentation?
Many studies have been done to show that irrigation has only limited or no beneficial effects over nonsurgical periodontal instrumentation alone. One study in particular compared these two procedures and demonstrated that irrigation with antimicrobials had only limited effects on the subgingival bacteria (Wennstrom, 1987).
Outcome:
What are the benefits that I can accomplish with my periodontitis patient?
Other studies have found a minimal improvement in certain patients, but the majority had no significant difference between irrigation versus nonsurgical periodontal instrumentation regarding probing depths or inflammatory status (Nield-Gehrig, 2011).
Personal Reflection: I chose this topic because I am administering antimicrobial agents with a cannula and syringe for my patients with deep periodontal pockets. It is very important to know everything there is to know about the procedures I am performing in clinic as well as outside of school in private practice. In the future I will need to use my evidence-based decision making on whether to perform these procedures on my patients. I will have to use good judgment on what patient could actually benefit from professional subgingival irrigation.
Additional Information:
http://www.rdhmag.com/articles/print/volume-23/issue-10/feature/oral-irrigation.html
References:
Nield-Gehrig, J. S., & Willmann, D. E. (2011). Foundations of periodontics for the dental hygienist: Professional oral
irrigation. (3rd ed., pp. 458-459). Philadelphia, PA: Lippincott Williams & Wilkins.
Wennström, J. L., Dahlén, G., Gröndahl, K., & Heiji, L. (1987). Periodic subgingival antimicrobial irrigation of periodontal pockets: II. Microbiological and radiographical observations. Journal Of Clinical Periodontology, 14(10), 573-580. doi:10.1111/1600-051X.ep13483467