Content Dam Diq Online Articles 2016 08 Ultrasonic Water

Hygiene Message in a Bottle Mailbag: Optimal water pressure for subgingival, supramarginal irrigation

Aug. 8, 2016
Colleen Olson, RDH, BBA, replies to a question about the optimal water pressure for subgingival irrigation and supramarginal irrigation.

The "Hygiene Message in a Bottle Mailbag" is a monthly feature of the e-newsletter, Pearls for Your Practice: The Product Navigator. Each month, Colleen Olson, RDH, BBA, the editorial director for the Hygiene Product Navigator,will answer reader-submitted questions to help you navigate your dental hygiene product decisions (and more!). This month, she replies to a question about the optimal water pressure for subgingival irrigation and supramarginal irrigation.

QUESTION: Patty, BS, RDH, wrote: What is the optimal water pressure (psi) for subgingival irrigation? And what psi is recommended for supramarginal irrigation?

Great question, Patty! I'm not sure if you are referring to subgingival and supramarginal irrigation with an ultrasonic scaler, such as a Cavitron, or with a water flosser, such as a Waterpik, so I'll address your question in both ways.

In looking into a couple of Cavitron models, it seems that the water pressure for irrigation using ultrasonic scalers ranges from 20–60 psi, depending on the model and settings. Likewise, a search on the Waterpik website revealed that, depending on the model, Waterpik water flossers offer settings ranging from 10–100 psi. The Waterpik Pik Pocket tip, for subgingival irrigation of periodontal pockets at home, is described as being "designed for low-pressure delivery of therapeutic rinses." I was unable to find specific information on what exactly "low-pressure" means, but I would presume it is at the lower end of the 10–100 psi range of Waterpik product settings.

According to a position paper from the American Academy of Periodontology, "Supragingival irrigation forces of 80–90 psi generally can be tolerated without untoward effects. Scanning electron micrographs of human gingival biopsies confirmed that a 60-psi irrigation force induced no epithelial microulceration or alteration of cell morphology."1 By these numbers, the ultrasonic and water flosser irrigation pressures mentioned above fall within the acceptable ranges.

Based on this information, both Cavitron ultrasonic scalers and Waterpik water flossers are safe to use. The patient's comfort level should play a large role in determining the appropriate water pressure to use during irrigation with either device.


1. Greenstein G. Research, Science, and Therapy Committee of the American Academy of Periodontology. Position paper: the role of supra- and subgingival irrigation in the treatment of periodontal diseases. J Periodontol. 2005;76:2015–2027.

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Editor's Note: Do you have a question for Colleen? Is there a product you'd like to see her review? Or would you like to submit your own hygiene product "Pearl"? Send an email to [email protected]. You might just see it in the Hygiene Product Navigator! If you're not a Product Navigator subscriber, click here to sign up.

Colleen M. Olson, RDH,BBA, is an editorial director for the e-newsletter, Pearls for Your Practice: The Product Navigator. She earned a bachelor's degree in business administration from Texas A&M University in 2008 and worked in sales for five years. She graduated from the Blinn College Dental Hygiene program in 2013. She is currently a full-time hygienist in private practice in San Antonio, Texas. Colleen enjoys spending time outdoors with her husband, Zach, and their dogs, a Great Dane named Shiner and a shepherd mix named Duddley.

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