Sir, I must concur with P. T. Blenkinsopp's letter (BDJ 2005; 198: 385) regarding the ready availability and promotion of dental irrigators in the UK. At the BDA Conference in 2004, Dr Philip Preshaw's Talking Points in Dentistry lecture on 'Full mouth disinfection' recommended subgingival irrigation with chlorhexidine immediately after full and thorough scaling. He suggested the cleaning should be completed in the minimum time from start to finish when two or more appointments were required for periodontal treatment, the recommended chlorhexidine irrigation being used to minimise the recolonisation of any remaining pathogenic microbial flora to the freshly scaled crevices and pockets. Continued use of irrigation at home would complete the treatment to a more satisfactory level. Unfortunately, chlorhexidine has well known disadvantages when used for any length of time.

While irrigation does reduce the debris and loose bacterial content of the interdental spaces and crevices, adding mouthwash does little to reduce the pathogenic microbial biofilms. US firm Aloe Vera of America, Inc commissioned bacteriological studies for their newly developed stabilised aloe vera in the 1970s and 1980s Their patented stabilisation process kept the bio-activity the same as that of the freshly cut aloe leaves. This process prevented the destructive oxidation of the beneficial properties of the inner gel. Their investigations showed that Streptoccus mutans and its biofilm, when immersed in high concentrations of the stabilised aloe vera, literally came away from the hard tissue surface of the tooth, and subsequent regrowth was suppressed. With the biofilm gone, plaque and calculus did not develop. The company found that a number of other periodontal pathogens were similarly affected. Irrigation was the vehicle of choice in delivering the stabilised aloe vera into the crevice and pocket areas. Also noted were the anti-inflammatory and desensitisation benefits of the plant material to the adjacent tissues. Suitable irrigators such as the Water Pik should be promoted and be more widely available, as they are another excellent aid in the treatment and management of periodontal disease. Suitable additives to the irrigation fluid can actively prevent or minimise the destructive actions of pathogenic microbial flora in the oral environment. The message is wipe and wash, or tape and irrigate.