ORAL IRRIGATORS

a.k.a Water Floss

Is it just me or is it always so complicated to make someone understand how to floss! Use your middle finger to wrap it around and use your thumbs and index finger to maneuver it…….trust me….the person will loose his patience before figuring it out !! So there came a simple solution for people who are ‘busy’ (or lazy!) to use floss…….ORAL IRRIGATION DEVICES, also known as Water Floss or even Dental Water jets.

 

Stating the obvious, oral irrigators should not be considered as an alternative to brushing. It is effective in cleaning away food debris that can become stuck between teeth and aids in the prevention and treatment of plaque and forms of gum disease such as gingivitis.

A BRIEF HISTORY

It was WaterPik who first introduced these systems in 1966 as a plaque and debris removal device. But unfortunately at that time the researchers were not able to fully show its plaque removal capabilities. It was not accepted as a valuable part of plaque control.

But contrary to the attitude of the professionals, the patients found the systems effective and continued to use them. Surprisingly these patients always showed better than average oral health.

The irrigation research now focuses more on plaque alteration than removal. Alterations in sub-gingival plaque have been observed, along with changes in immune responses. Without plaque removal, irrigation seems to affect bacteria within the plaque, thickness of the plaque and immune response

HOW DO THEY WORK?

In simple words it uses a high pressured stream of water to remove food/debris from around the teeth.

A gentle penetrated stream of water targets and flushes away food debris. The use of water is vital to cleanliness as is its use of a magnetized mechanism which attacks and picks up food particles to effectively clean and refresh your teeth.

Some oral irrigators have a magnetic component which changes the polarity of water reducing calculus depositions. Others are controlled by hand pumping rather than electricity. Full mouth irrigation devices are also being developed with the idea of reaching all areas effectively and saving time.

Oral irrigators aim to treat the following conditions:

1. Gum disease
2.  Periodontal issues
3.  Those with dental appliances like braces
4. Plaque and tartar
5. Bad breath
6. Tooth decay

 IRRIGATION VS RINSING

·        Best anti-plaque agent available right now is Chlorhexidine. But rinsing does not reach sub-gingival or interproximal areas.

·        Oral irrigation with water was more effective in controlling gingivitis than rinsing with chlorhexidine

·        Chlorhexidine should be saved for patients with non-responding areas. Water is the first choice for rest.

TYPES/MODELS AVAILABLE

Different brands have their own specifications, the most popular ones being those offered by Waterpik, the Hydro floss and Kitty Hydro Care. The different models available are:

§  Hand-held Oral Irrigator – 

o   Target hard to reach areas in the mouth.                                                               

o   Offers an exemplary level of flexibility.                                                                           

o   Have pulsations of 1200 though there are some that are more powerful.                                                                                                                                      

o   Beneficial to those with dental appliances like braces for ease of use.

§  Counter-top Oral Irrigators –

o   As effective in the cleaning of teeth as the hand-held appliance but is a larger unit.                                                                                                                     

o   Come with various detachable attachments.                                                             

o   Tend to take up more space.

§  Cordless Oral Irrigators – 

o   Do not need to be centered on any counter to work as they offer a great level of flexibility

o   They are rechargeable.

o   Makes it simple to clean your teeth and is an excellent substitute to dental floss.

o   Include water jet air that comfortably massages the gums and removes bacteria.

o   Comfortable and easy to hold as well as offering a great level of portability.

ADVANTAGES

We already have a fair idea of why these systems are beneficial. Here are a few more pointers:

 Ø Better patient compliance. Only 30% of patients perform adequate home care with brushes and some sort of interproximal aid. 35% of patients occasionally use dental floss and only 2-15% floss daily.

Ø Decreased tooth and gum sensitivity

Ø Removes food and bacteria stuck in between teeth and under the gums which lead to decay and periodontal disease.

Ø Better penetration compared to flossing/brushing/rinsing. Alterations of sub-gingival plaque have been measured both qualitatively and quantitatively as deep as 6 millimeters.

Ø Reductions in bleeding upon probing, pocket depths and inflammatory cytokines, interleukin 1 (IL-1) and prostaglandin (PG-E2) were observed

Ø Supra-gingival irrigation controls bacterial levels before they can influence sub-gingival areas, since reduction of supra-gingival plaque

Ø Patients who wear dental appliances such as braces or bridges will find an oral irrigator to be the perfect solution to maintaining oral health.

Ø Better oral hygiene can be achieved by individuals with special needs.

Ø Less frequent trips to the dentist, less money spent while you are there (can be seen as a disadvantage too!).

DISADVANTAGES

Ø As expected the systems would take out more from your pockets than your standard floss. Also the tips need to be changed frequently. 

Ø As unlikely as it may sound, these is a danger of electrocution if not used carefully in the bathrooms.

Ø Studies have shown no added benefit of irrigation following Sub-gingival Debridement and/or Root Planning

Ø As per the ADA there are chances of bacteria coming into your bloodstream with the use of oral irrigators.

Ø The oral irrigator should not be used if you have tooth absences, severe periodontitis, or a ‘predisposition’ to bacterial infections.

Ø High settings could push debris into the tissue, rather than pushing it out, as intended.

COST AND BRANDS IN MARKET

The cost varies from brand to brand and also the type of system one opts for. Also there is an additional cost for different tips that one chooses to buy. There are various brands in the market. Some of the known ones are:

    Waterpik

·        By far the most known brand

·        Offers a wide range of products

·        Anywhere from $15-80 (1000-4000)

·        http://www.waterpik.com/oral-health/why-waterpik.html 

    Oral B

·        Offers a variety of products

·        Approximately $95-100 (Rs.4500-5000) http://www.oralbprofessional.com/us/products/power/pow7900.asp

    Hydro Care

Approximately $30-40 (Rs.1500-2000)

    Kitty Hydro Floss

Approximately $90-100 (Rs.4500-5000)

    Panasonic

Approximately $50-60 (Rs.2500-3000)

Maintaining good oral hygiene is vital in promoting healthy teeth and gums; brushing is also an essential part in warding off unwanted oral health conditions. Oral irrigators can be included in your oral hygiene routine to effectively combat plaque and are simple to use.

INVISALIGN

                                          INVISALIGN

Invisalign…..something that we have heard about so much but always wondered what “exactly” is it and how it works? Right ?

 Well, to put it in simple terms, it is an aesthetic and removable orthodontic treatment option for patients. It is a procedure of attaining straighter teeth with a series of removable, virtually invisible aligners

Invisalign is gaining favor amongst patients and more and more people are opting for Invisalign especially for cosmetic reasons. I mean who likes a metallic smile.... right !??!

WHY INVISALIGN ?

Well the first question that will pop into anyone’s mind would be why Invisalign ?

Amongst others, the major advantage is patient compatibility.

Here are a few more advantages that invisalign offers:

ØThe aligners are completely transparent therefore virtually more difficult to detect than traditional braces (hence, more popular amongst adults)

Ø As they are removable there are no restrictions on eating...so u can eat everything without the risk of damaging brackets and wires. So you can enjoy your favorite bubble gum now !!

Ø  The aligners can be removed to eat, drink, to clean their teeth and to get regular dental checkups.

Ø Computerized treatment planning is compulsory as part of the Invisalign protocol.  This allows the prospective patient to review the projected smile design, learn how long the treatment is going to take, compare different plans and make a more educated choice.

Ø Invisalign treatments have been claimed** to be quicker than traditional appliances.

Ø From a dentists view point, invisalign avoid many side effects of traditional fixed appliances. Unlike all other types of orthodontic treatment, it prevents the ill-effect on gums and supporting soft tissues and will not cause the roots of the teeth to shorten (root resorption). Demineralization or tooth decay occurs in up to 50%of patients because the brackets cannot be removed for eating and cleaning, which is unlikely to happen in case of invisalign.

Ø New aligners are given every 2weeks. As a result the aligners give less force per week and so are less painful for the patient than fixed appliances that are tightened every six weeks and apply greater forces. Hence fewer calls at night by patients complaining of pain !!

** the claim that Invisalign is faster than traditional braces has been challenged by the Invisalign review which points out that there are other brace appliance systems that take half the time (incorporating surgery or temporary implants that insert into the patient’s bone to accelerate the procedure).

INVISALIGN : There’s one for everyone…..

Invialign offers various products for the dentist to choose from. Dentists can choose which product they would like to use depending upon the severity of malocclusion and needs of the patient:

Ø INVISALIGN FULL : Provides the full spectrum of treatment options, gives maximum flexibility and maximum range of treatment for severe malocclusion cases.

Ø INVISALIGN EXPRESS : A shorter duration treatment for alignment of teeth as a precursor to pre-restorative work and treating minor crowding or spacing cases.

Ø INVISALIGN TEEN : All the features of invisalign full plus additional features that address the unique orthodontic needs of non-adult comprehensive patients.

Ø INVISALIGN ASSIST : An invisalign treatment that comes with compliance indicators, progress tracking tools and detailed pre-planned appointment schedules.

HOW TO SELECT CASES??

Most cases can be treated using Invisalign. Depending on the severity of malocclusion the cases can be divided into Simple, Moderate or Severe Cases.

Simple Case:

•  Crowding with lingually tipped teeth
•  Spacing with flared anterior teeth.
•  Rotations of less than 40 degrees
•  Extrusion, if required, not more than 2.5mm for individual teeth
•  Overjet correction - 4mm or less
•  Midline correction - not more than 1mm per arch

ANY CASE not falling within these parameters is then divided into Moderate or Severe case. These cases require a longer duration for treatment and hence increased cost of treatment.

Simple cases can be treated using Invisalign Assist or Invisalign Express whereas for Severe to Moderate cases, Invisalign Full with a broader treatment spectrum has to be used.

THE TREATMENT PROTOCOL:

Here’s a step by step process to make you more familiar with how the treatment process works –

 1)  Talk to an Invisalign Provider: You (or your dentist) should be an experienced Invisalign Preferred Provider. This is an important medical and financial decision for you - that's why choosing the right doctor and the right treatment plan is crucial. Make sure you, have received the proper Invisalign training so that you can truly evaluate the patients’ needs and determine how Invisalign can help them. During the consultation, discuss your case in detail to determine if they are a good candidate for Invisalign. Ask your patients to take the Self Assessment ahead of time to see if he\she may be a good candidate 

2)    How to Start: Orthodontist or the general dentist takes impressions x-rays       or photographs and sends them to align technology. The impression is put through CT scan from which computer creates a 3-Dmodel.Custom software simulates the movement of teeth in stages. The orthodontist reviews the simulation online using align technology’s “CLINCHECK” and approves or modifies the treatment.

3)    Custom Aligners Fabricated: Once approved a plastic resin aligner is manufactured for each stage of computer simulation and sent to the dentist. These aligners are made of a smooth, comfortable BPA-free plastic that won't irritate your cheeks and gums like traditional metal braces often do.   Attachments, also called buttons, are bonded to teeth that need to be rotated or moved more than other teeth. Patients can expect as many as fourteen attachments. They are tooth colored and made of glass like substance. Elastic wear (rubber bands) are also used to move the teeth forward or back ,relative to the jaw, thus accomplishing anterior or posterior corrections. Interproximal reduction is used at the contacts to allow for a better fit.

4)    Occasional Check-ups: Approximately every two weeks, new set of aligners are provided advancing the patient to the next stage of treatment. To monitor the progress occasional checkups, usually only every six weeks or so, are conducted by the dentist.

5)    Length of Time Until that Spectacular Smile is Reveled: While every case is unique, treatment typically takes approximately a year for adults. The length of treatment is comparable to that of braces for teens, but since the teeth won't be covered by wires and brackets, you'll be able to see improvement much sooner ! For best results and a timely outcome, you should wear your aligners for 20 to 22 hours per day, throughout your entire treatment.

6)    Cost Of Treatment: the average treatment cost for the patient is between     $3500 - $8000 or 1.5 lakhs - 4lakhs

DISAVANTAGES:

Every treatment has its pros and cons and so does invisalign. While most of you would already be frowning at the treatment cost the other few disadvantages are:

Ø Does not rely on cephalometric radiographs and does not take into account patient’s facial profile.

Ø Largely dependent on a patient habits and their cooperation. Success is based on a patient’s commitment to wear the aligners for a minimum of 20-22hours a day, only removing them when they are eating, drinking or brushing their teeth.

Ø As mentioned, they are more expensive than traditional wire and bracket systems.

Ø Because the aligners can be removed there is always a chance of losing them.

Ø Certain teeth are problematic for Invisalign aligners to rotate.

Ø May cause slight lisp at the beginning of treatment. This usually disappears as the patient becomes used to the treatment.

Ø Made of polyurethane that may cause allergic and toxic sensitivity reactions.

Ø If patient compliance is not good the next set of aligners will not fit and a new set of aligners will be necessary adding to the cost.

There are other options out there to straighten up ones teeth but Invisalign offers a greater level of comfort, confidence and convenience with minimal interference on how one lives and a positive impact on how one appears and feels about oneself.

Written and Edited by Dr. Aditi and Dr. Mahit Bhatt