Sir, I was pleased to read your articles in the GSK Oral Health Report of October 2004, which I thought were useful. You are well aware that periodontal problems have an increasing relevance in modern day society, and I continue to be frustrated by the lack of recommendation of inter-dental irrigation in the prevention of this problem. For many years Oral 'B' manufactured and sold a Water Pik which is an electrical pump with a tank of water and fine nozzle to flush out debris from the interdental spaces. Of relevance to GlaxoSmith Kline and other manufacturers of mouthwashes, the addition of a small amount of mouthwash to the tank of water improves the cleaning and will help to reduce the bacterial content of the interdental spaces. This type of appliance is freely available in the United States, but is difficult to find in the UK. The problem is made worse as periodontists may rightly say that irrigation does not remove plaque, but seem unwilling to accept that it removes much of the debris which causes plaque. Periodontists recommend the use of dental tape on a regular basis, which may well be efficacious but is difficult to use, and therefore not practised conscientiously by a large proportion of the population. The elderly particularly who are losing some of their manual dexterity, find this technique impossible. I understand that in the United States the use of water irrigation with an antiseptic mouthwash is now being promoted for the prevention of periodontal disease, and I am sure this would be a valuable asset in the United Kingdom if promoted properly.

The purpose of my letter is to draw your attention to this issue, and if properly promoted by the British Dental Association in conjunction with the manufacturers of mouthwash, a large benefit to the population in terms of their dental health would be achieved. I personally have used an irrigator for twenty years and would never be without it.