June, 2023 

By Dr. Victor M. Sternberg

The majority of dental disease, whether it be dental decay or periodontal disease, is caused by bacteria that accumulates between the teeth. Even effective brushing does not reach these areas. 

Dental floss and tooth picks are often recommended. In my experience over many years, the most appropriate, and I stress appropriate, effective use of water irrigation is the single most effective way to reduce the recurrence of decay and periodontal disease. 

The power of the water and its ability to reach nooks and crannies between your teeth makes it far more effective than any other manual method. 

However, some principles have to be understood and efficated to effectively use this technique. 

1) It is important to understand that the bacteria sticks to the teeth via a plaque or sticky substance that forms on your teeth after they have been cleaned, within 12 hours. The purpose of oral hygiene in general is to remove this film twice a day to prevent a critical mass of bacteria to accumulate. That mass of bacteria can initiate tooth decay and inflammation or periodontal disease. The effective use of the irrigator every 12 hours can remove that film of bacteria and prevent it from reaching critical mass which can cause disease.

2) The water irrigator only works if it is held still for a count of 10 between each space, both from the inside and the outside. 

3) Each water irrigator has a setting of 1-10. Your goal is to reach 10, but for many that will be uncomfortable if the gums are not extremely healthy. You can begin on a low number and gradually go up until you reach the maximum force of the water. The greater the force of the water the more effective the water irrigator becomes. 

4) The water should be on the warm side because cold water under pressure will often be uncomfortable since the teeth can be sensitive, as many of you have seen following any recession or periodontal treatment. 

5) Drive-by water irrigating does not work. I have observed that I need two bowls, one for the upper teeth and one for the lower teeth in order to spend a count of ten between each space both inside and out. 

6) I've taken to filling my water irrigator up and putting it in the sink, letting water drip into the receptacle as I irrigate. This allows me to never run out of water and not rush the procedure. It takes me approximately four minutes to do my upper and lower teeth effectively using this technique. Leaving it in the sink has no adverse affects; the machine is hermetically sealed. I have discussed this with the company. I have personally done this technique for many years with no harm to the irrigator or myself. 

7) There are occasions when I am pressed for time and I will only water irrigate my teeth and not brush. This seems counterintuitive but just realize that most of the food particles and the most dangerous plaque forms between your teeth, something a brush will not remove. 

8) It is very important that you re-order your sequence of your oral hygiene. I always, and I stress always, use the water irrigator first before I brush my teeth.

9) Finally, it is more difficult to use the irrigator on the inside surface of your upper and lower teeth. This area is often missed by patients. Again, in the beginning you can use it at a lower force so you can master the technique of holding it on the inside and counting to 10 on every single tooth. Once you've mastered this your mouth will feel clean and refreshed, and most, if not all the plaque will be gone. 

If you have any questions about this technique please contact my office. We will be happy to help in any way that's necessary. 

Yours truly, 

Victor M. Sternberg, D.M.D.

By Westchester Center for Periodontal & Implant Excellence

May 31, 2023