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(c) Regular cleansing of the pockets and interproximal spaces by the patient is the essential part of the local treatment. Firstly, the spaces between the teeth must be freed of food débris by means of "floss silk, " and the gums should then be well squeezed between the thumb and the first finger, with a downward pressure on the upper teeth and an upward pressure on the lower teeth. The next step is to " irrigate the pockets. " If the irrigation can be easily carried out no special fluid is necessary and a free flushing with sterilized water would be effective. The most efficient method is to flush the pocket with peroxide of hydrogen (vols. xv), using a hypodermic syringe. The needle of the syringe is passed well into the pocket and gentle pressure exerted. The use of force is to be deprecated as it is essential that any granulation tissue that may be present should not be broken down. But as a hypodermic syringe cannot be readily manipulated by the very large majority of patients it is generally necessary to try an easier, if less efficient, means of irrigation. I find the best plan is to have the pockets wiped out with a wisp of cotton-wool dipped in hydrogen peroxide, the cotton-wool being wound round a fine broach. It is necessary to give patients very precise instructions . The broach should be of the type ordinarily used for root canal dressings. The method of winding the wool on the broach should be demonstrated. I would suggest the following plan: Spread a wisp of cotton- wool along the palmar surface of the terminal phalanx of the first finger of the left hand; place the broach on the centre of the wool; fold the cotton-wool over the broach; bring the thumb on to the broach and then run the thumb with the broach up the palmar aspect of the first finger; the fragment of wool over the point should then be turned down so as to prevent the point sticking through.
Such detailed instructions may seem hardly necessary, but experience has taught me that the success of this method of treatment depends in a large measure on the skill of the patient in twisting the wool on to the broach. The patient should be shown exactly where and how to apply the peroxide, and instructed to pay special attention to the irrigation of the spaces between the posterior teeth. The hydrogen peroxide to be used should be poured into a small receptacle, and any left unused should be thrown away and not returned to the bottle. The pockets should be cleansed at least once a day, the best time being shortly before retiring for the night.
If the patient will only carry out this method of cleansing the spaces thoroughly and regularly, a marked improvement may be confidently anticipated.
Hydrogen Peroxide
Hydrogen Peroxide
