Is it really necessary? My research doesn't show any peer-reviewed control studies showing that there is a benefit, yet alone any reasonable necessity. Squirting some chlorhexadrine on the gums after a perio maintenance just seems like a typical money-grab by unethical practices who aren't satisfied with the fees garnered by the perio maint. alone. Any opinions?

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On 6/18/2018 10:27 AM, lentronix@no-spam-gmail.com wrote:

Is it really necessary? My research doesn't show any peer-reviewed control studies showing that there is a benefit, yet alone any reasonable necessity. Squirting some chlorhexadrine on the gums after a perio maintenance just seems
like a typical money-grab by unethical practices who aren't satisfied with the
fees garnered by the perio maint. alone. Any opinions?

While there is research on some intra-pocket medications, I cannot say
I've seen good research on irrigation with chlorhexidine. There ARE commercially-available delivery systems for chlorhexidine that will keep
it there longer (look up PerioChip), it's doubtful that a single
irrigation really adds much to the perio maintenance.
Some periodontists prescribe chlorhexidine rinses, but while they have
been shown to reduce superficial inflammation, it has not been
established that they significantly help periodontitis patients with significant pocketing. They also cause a lot of staining and change
taste perception. There is also emerging evidence that they can change
the gastrointestinal microbiome, with potential risks we don't fully understand.
As far as PerioChip, the periodontists I know are underwhelmed. They
seem to prefer intrapocket tetracyclines like Atridox. But these are
generally used in the context of patients who have areas who MAY need
surgery, and this might eliminate the need in some areas.
The short answer is that for most patients I think the irrigation is of questionable value in the context of periodontal maintenance.

Steve

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On Mon, 18 Jun 2018 13:56:10 -0400, Steven Bornfeld <dentaltwinmung@earthlink.net> wrote:

On 6/18/2018 10:27 AM, lentronix@no-spam-gmail.com wrote:

Is it really necessary? My research doesn't show any peer-reviewed control >> studies showing that there is a benefit, yet alone any reasonable necessity. >> Squirting some chlorhexadrine on the gums after a perio maintenance just seems
like a typical money-grab by unethical practices who aren't satisfied with the
fees garnered by the perio maint. alone. Any opinions?

While there is research on some intra-pocket medications, I cannot say
I've seen good research on irrigation with chlorhexidine. There ARE >commercially-available delivery systems for chlorhexidine that will keep
it there longer (look up PerioChip), it's doubtful that a single
irrigation really adds much to the perio maintenance.
Some periodontists prescribe chlorhexidine rinses, but while they have
been shown to reduce superficial inflammation, it has not been
established that they significantly help periodontitis patients with >significant pocketing. They also cause a lot of staining and change
taste perception. There is also emerging evidence that they can change
the gastrointestinal microbiome, with potential risks we don't fully >understand.
As far as PerioChip, the periodontists I know are underwhelmed. They
seem to prefer intrapocket tetracyclines like Atridox. But these are >generally used in the context of patients who have areas who MAY need >surgery, and this might eliminate the need in some areas.
The short answer is that for most patients I think the irrigation is of >questionable value in the context of periodontal maintenance.

Steve

Thanks for the confirmation. It especially holds true for me, since I barely even have perio disease, if I have it at all. ( A few years ago, while having some trouble transitioning to insulin therapy, I suddenly had some minor pockets. Apparently, I just as suddenly had some bone loss, so voila! I had perio disease, and required the attendant extra cleaning protocols. I went along
with it, since 1) insurance paid most of the cost, and 2) I figured I'd get some
higher quality cleanings as opposed to the prophys I had been getting. Three months later (and for these past 2 years) I have had no pockets greater than a 3, and this despite only doing the perio maint. every six months.. The hygienist
agrees that my home care is great, and that I probably just had a temporary problem related to my sugar when those pockets appeared, but because there is some minor bone loss he still has to call it perio disease. (I'm 62 now, so my story is that it's just me getting older.....))

In any event , the irrigation is again being pushed on me as a requirement of the office (it always was, but I had gotten a special dispensation from their previous manager), so it looks like I'll be moving on to a new practice.

/end rant...

Thanks again.

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On 6/18/2018 5:31 PM, lentronix@no-spam-gmail.com wrote:

Thanks for the confirmation. It especially holds true for me, since I barely even have perio disease, if I have it at all. ( A few years ago, while having some trouble transitioning to insulin therapy, I suddenly had some minor pockets. Apparently, I just as suddenly had some bone loss, so voila! I had perio disease, and required the attendant extra cleaning protocols. I went along
with it, since 1) insurance paid most of the cost, and 2) I figured I'd get some
higher quality cleanings as opposed to the prophys I had been getting. Three months later (and for these past 2 years) I have had no pockets greater than a
3, and this despite only doing the perio maint. every six months.. The hygienist
agrees that my home care is great, and that I probably just had a temporary problem related to my sugar when those pockets appeared, but because there is some minor bone loss he still has to call it perio disease. (I'm 62 now, so my
story is that it's just me getting older.....))

In any event , the irrigation is again being pushed on me as a requirement of the office (it always was, but I had gotten a special dispensation from their previous manager), so it looks like I'll be moving on to a new practice.

/end rant...

Thanks again.

They may be being extra vigilant because diabetes is a risk factor for
perio disease. Certainly some minor pocketing in a patient over 60 has
to be viewed differently than the same pocketing in someone who's 25.
In any case, not all general dentists will stay on top of perio issues,
so make sure that whatever office you end up does check for pocketing.

Steve

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