- NOTES ON ASPIRATION
STRATEGY - USING IRRIGATION OR ENDODONTIC NEEDLE AND
SYRINGE
FUNCTION - Irrigation needles serve two main
purposes. The most important one is to flush out
debris. The second purpose is to deliver "magical
elixars" as I like to call them, because their
actual effects are typically more imaginary than
real. Reason is the gums are constantly flushing
themselves out with gum juice, inter-whatever fluid,
which is similar to blood plasma. So any
imaginations that some short-term irrigation is
going to have some special effect is misinformed or
delusional.
Which is not to say they will have no effect at
all. Just not much. So what can be done to
overcome this issue? First is the fact that the
periodontal pocket is going to contain some
volume. So maybe the gums don't flush themselves
out so fast, eh? True rabbit. Second is the
possibility to irrigate over a period of time. Let
us say to put the flow into the gums for say 20
minutes or longer to increase the exposure time.
Yes. Also if you are getting any successful
flushing, especially from a deep periodontal
abscess, then it is likely you will continue the
process for awhile. Hence yielding your exposure
time.
= = =
HOW I RIDE - 02-28-14 - Right now I am into the
fat 16 guage Luer-lock open-ended irrigation
needle, combined with the 3cc syringe. Mostly I
use it to drive thick hyaluronic acid into the
deep pockets. Also to drive the 3Mix Triple
Antibiotic Paste down low. Reason is the thicker
gel-like fluid disperses slower. Plus my
subgingivals are mostly running fairly clean after
numerous debridement after debridement.
I probably have the 18 guage too. And am still a
big fan of the 20 guage open-ended needles for
moderately thick hyaluronic acid. Plus still like
the 23 guage needles for general fluid driving,
like povidone iodine.
I used to be a fan of the 5cc syringes. But
largely prefer the 3cc syringes now because can
draw better vacuum and drive more pressure. On
account of the smaller radius plunger. Also I am
not so much into the aspiration anymore. Reason
being that I would get these small fluid draws and
get all exited I was liberating infection. Then it
turned out all I got was the tip of the iceberg
and it was completely filthy down below.
Disenchanting me from aspiration. Though obviously
it has its merits. Especially if there is some
deep pool of crud that you can bust into with the
needle. In fact right now (02-28-14) I suspect a
deep abscess on my maxillary sinus. And one good
strategy is to target it with the needle.
= = =
SPECIAL NOTE - Can also use DuoDerm as a
hydrocolloid gel bandage, which is thick enough to
lay in place. DuoDerm can help autolyctic
debridement. So it is good stuff.
PRIMARY SUPPLIER - Vista Dental - catalogue
- Idea is to just act cool and not claim to be
anybody who you aren't. It is perfectly legal to
purchase irrigation needles. Also keep in mind
that some dental suppliers only sell to dentists.
So they have their controlled stuff mixed in with
their uncontrolled stuff and you won't even be
able to purchase a tongue depresser from them.
= = =
PRIMARY SYRINGES - Obviously
all syringes should have a "Luer Lock" - which is
the standard modern fitting for syringes.
5mm syringe - workhorse - I bought a box of 100
veterinary syringes for like $20. Once the syringe
starts to stick can just throw away. But don't
have to be too quick as long as you rinse the
syringe out well. Good thing is it can deliver a
lot of fluid. It expecially works out well with
the 23 guage irrigation needle. The main problem
is that when you get deep into the periodontal
pockets sometimes the fluid just does not want to
come out. Essentially you are trapped inside the
pocket. For that you need a smaller diameter
syringe to deliver more pressure.
3mm syringe - delivers more pressure - especially
good where you are using a thicker fluid, like
DuoDerm or less quantity or need to overcome
back-pressure from the periodontal pocket.
SPECIAL NOTE - Obviously it is a bad idea to force
fluid into periodontal pockets under extreme
pressure. But can back off the needle and the
fluid can track in it's wake. Likewise can insert
the needle and create a well of fluid in front of
the needle to push it in deeper. This is known as
"pumping the needle." So major issue is correct
combination of needle guage and appropriate
syringe size.
SPECIAL NOTE - Also keep in mind that if the
pocket is filthy that most of the benefits you
might imagine that irrigation are going to deliver
are in fact going to largely be illusionary.
With some exceptions, like delivery of Povodine
Iodine, which is dangerous and not for the
foolish. Especially since you could kill a nerve
that way. Or poison yourself. Or could try your
luck with the Hyaluronic Acid and see if it does
actually "frack." Which I decided it doesn't since
there is not enough water in calculus for it to
expand and break. SUMMARY - most of the imaginary
functions you might imagine irrigation delivering
are just not going to happen. The only thing that
is going to deliver the results is the curette, as
unpleasant, difficult and futile as that process
might seem
= = =
PRIMARY NEEDLES - I wouldn't
bother with the rounded nose irrigation tips with
the holes in the side. The half-moon 23 guage
1.25" endodontic needles work fine in spite of the
two sharp corners. Turns out largely don't really
need the extra 1/4 inche over the 1 inch needles
most of the time.
23 guage needle (skinny) - endodontic (half-moon)
1.25 inches - OR - blunt-tip 1 inch - The key
attribute of this needle is it is skinny. And able
to slip into fissures into fairly deep pockets. It
only works with fairly fluid not so thick fluids.
Can dilute to suit. Such as Honey or Hyaluronic
Acid. Likewise works well with Urea-Papain. This
is a workhorse. Works well with the 4mm syringe.
Can also be used as an aspiration needle.
20 guage needle (fatter) - 1 inch blunt tip - This
needle works great with the thicker Hyaluronic
Acid or thicker Honey. Won't slip in as easily as
the 23 guage needle. I use it with the 5mm
syringe. Could work with slightly diluted DuoDerm.
18 guage needle (fatter) - 1 inch blunt tip - I
have this needle but haven't tried it out. Could
possible work with DuoDerm
16 guage needle (fatter) - 1 inch blunt tip - 3mm
syringe - DuoDerm hydrocolloid bandage. Idea is to
lay this stuff up into the pocket for autolyctic
debridement and to protect healing tissue. Has
lots and lots of potential. Especially in final
stages of debridement, like after months and
months of primary and secondary debridement, with
still some softening left to go.
= = =
UPDATE - Think aspiration has its merits. But it
is very easy to end up thinking you are getting
somewhere with the aspiration when the real
problem is calculus instead. In which case the
answer is the curette, not the needle. But the
needle is still good for finishing an area that
really really is otherwise clean. And doesn't have
calculus lurking somewhere.
LIKEWISE FOR ABSCESSES - Aspiration may end up
relieving the symptoms temporarily by relieving
the pressure. But the abscess is still there and
possibly growing too. So while the aspiration
might be useful it doesn't really address the
underlying issue. And the small amounts of blood
and debris may not add up to much when compared
against the actual abscess.
KICKING THE CAN DOWN THE ROAD - Aspiration is
likely to make people feel they accomplished
something while getting some blood and debris for
their efforts. Realityland is the problem is
likely much deeper and much more serious. So
aspiration can easily become a FOOLS PARADISE.
Like what happened to me. Otherwise referred to as
BATTLING THE TAIL OF THE DRAGON - So you really
showed them. Meanwhile the disaster just gets
bigger and bigger and you are putting on band aids
that don't do anything and relieving symptoms, not
cause. WHAT TO REPLACE WITH? Think hyaluronic acid
irrigation has its merits. But ultimately
curettage is the only solution that actually
words. JUST HAVE TO DIG.
= = =
Aspiration strategy -- idea is to use an endodontic needle and
syringe to suck up the bacterial colonists and
associated xenomorph
infrastructure out from underneath the gum line.
Like a vacuum cleaner. Why not an irrigation
needle? Which has a blunt tip instead of the
square corner half-moon tip of the endonontic needle. Which
could potentially cause damage.
Good question. Could use an irrigation needle
instead. But the endodontic
needle seems to work just fine. There are some
laceration issues because of the sharp upper
corners of the half-moon shaped end of the endodontic needle. But the
open hole of the endodontic
needle is capable of sucking up large xenomorphs. Which I think
makes it superior. Additionally have successfully
"walked the dog," i.e. the edge of the needle,
along quite sensitive gum margins. Albeit with
some trauma, but still very reasonable.
NOTE - In a nutshell, aspiration cannot remove
calculus ledges. Its forte is removing
non-attached blobs. Especially in narrow spaces
where it is like a weasel.
NOTE - If irrigation hits the jackpot bingo ie an
abscess then expect lots and lots of crud to come
out. But this does not mean that irrigation is
superior to aspiration.
NOTE - OK OK - In a perfect world irrigation would
be better than aspiration. But irrigation is very
very difficult to control. With aspiration can use
thumb to lock-in vacuum and do detail work in much
greater detail than with irrigation.
SUMMARY - MIX OF IRRIGATION AND ASPIRATION IS BEST
- USE EACH FOR THEIR STRONG POINTS AND DON'T PUSH
YOUR LUCK WITH IRRIGATION. ASPIRATION IS SAFER.
Syringes -- purchased a box of
100 cheap 6ml veterinary syringes for around $20
plus shipping.
Aspiration needle -- I use a Kendall
23 gauge x 1.25 inch needle. (32 mm). With Luer tip The length is
long enough to reach around the teeth into my
deepest pockets. I bought a box of 25 needles for
roughly $12 plus shipping.
NEEDLES - STANDARD NEEDLE - KENDAL 23G - 1.25
INCHES HALF MOON ENDODONTIC - this needle is a
compromise between narrow access and draw.
NEEDLES - THIN NEEDLE - KENDAL
27G - 1.25 INCHES - this needle is only practical
for very narrow areas. It has very little draw.
NEEDLES - FAT NEEDLE - KENDAS 20G - 1.0 INCHES -
this needle is indeed FAT - It does not fit well
into narrow spaces. It has very good draw.
Ideas for setup. Five needles
appear to be the minimum reasonable setup. Each
needle is attached
-- Straight needle -- very practical any time
there is no need to bend the needle. Can also be
bent when needed.
-- 45° bend needle -- very practical as an
alternative to the straight needle.
-- 90° bend needle -- largely I have that these
needles as close to the base as possible. To get
maximum reach. Alternately it might be practical
to bend angles closer to the tip.
-- Right-hand corkscrew -- which is not really a
corkscrew. Rather it is a double-bend needle
angling the right.
-- Left-hand corkscrew -- mirror image of the
right-hand corkscrew.
= = =
WHAT IS AN ASPIRATION-IRRIGATION NEEDLE?
Basic premise is to use a whole metal irrigation
needle to remove crud and debris and loose
periodontal infection out from underneath the gum
line.
Aspiration uses vacuum pressure to suck out the
crud into the syringe. Irrigation uses water
pressure to dislodge the crud.
In addition the mechanical action of either
irrigation or aspiration can dislodge the crud and
stimulate the body to release fairly large quanties of bloody plasma
and what is called sinovial
fluid. Which flushes the crud out from under the
gums without any need for irrigation. This is what
happens in the dentist's office.
To see for yourself how this process works check
out the scaling and root planing
videos on YouTube. Google - diy perio
Or wonder why the stuff that gets scraped off at
the dentist's office flushes itself away rather
than stay under the gums. What happens is that
largely once a piece of crud gets dislodged it
will tend to flush itself out on its own accord.
Aided by the release of bloody plasma and sinovial fluid.
The mechanical action can also dislodge the crud
so it comes out on its own accord. Flushed out by
the body. Which releases bloody plasma for the
express purpose of washing out the crud. This is
why the calculus and debris will naturally flush
itself out from underneath the gum line at the
dentist's office. For this reason irrigation is
not strictly needed for the body to be able to
flush out the crud all on its own once the biofilm infrastructure is
successfully mechanically disrupted.
But largely the needle has to be applied directly
into the actual physical structure of the
particular periodontal pocket underneath the gum
line. And realistically the hard calculus
structures will tend to remain mostly unaffected
by the needle. So the needle can only get out
portions of the crud. The rest will only come out
under instrumentation with curettes or ultrasonic.
It is also hard to figure out where the pockets of
infection are located. In the area around the
opening at the gum line there may be multiple
series of periodontal pockets that resemble
tunnels in different directions. Likewise the gum
tissue will tend to swell in the vicinity around
an active periodontal infection.
In addition there can be fairly large ledges of
calculus that don't even get touched in a regular
cleaning and that can even get overlooked in a
deep cleaning. Especially if the periodontist or hygienist
was just not quite thorough enough within the
allotted cleaning time to be able to identify and
remove the tenacious difficult to remove calculus
ledges.
So, in effect, deep infections can remain well
hidden. Protected by nearby swelling from nearby
infections. Indeed the infected areas can be
highly unyielding. What this ends up meaning is
that a periodontal pocket can be much much deeper than it
appears.
Only when the areas of relatively shallow
infections are disrupted will the deeper
infections reveal themselves. What this means is
that the process of using aspiration and
irrigation is progressive. Which can very easily
require multiple treatments over a period of weeks
or even months to get to the bottom of the
infection.
= = =
MY OPINION ON THE NEEDLE - I
had several great success stories. The primary
advantage of the needle is it is so thin it can
creep up narrow passageways, spelunking so to
speak, since the subterranean redoubts and
passageways can be very narrow.
1) Used the needle to suck out
a deep crater between my upper right bicuspid and
first molar. Maxillary.
This is part of what I term as my "triple deck." Which is particularly nasty and
terminal. Piling bad
upon bad.
The shallowest deck is the
normal gumline,
combined with collapsed bone. But the bone did not
completely collapse. Below that is apparently the
general level of the nerve. So the nerve is
literally dangling in mid-air. Once the eventual
certainty happens that nerve gets compromised the
tooth is basically a goner. Since
it is not worth a root canal or other heroic
efforts to save a dead tooth. And once
the tooth goes it will most certainly create a
large hole into the maxillary sinus.
The deepest deck is the sinus
itself. Otherwise termed as
"skull." Hence
representing a "clear and present danger."
But what to do? What to
do?
DIYs
position is that the dental profession can offer
surgery in this situation. But that the situation
is oftentimes explained as long-past any
reasonable dental professional answers involving
Scaling & Root Planing
(SRP). But alternate position in the dental
profession is for continued SRP. Which is the same
as DIY Perio's postion.
SO WHAT HAPPENED? - After hours
and hours of DIY SRP when things got to looking
somewhat clean went in with the needle. 22 guage
Kendell half-moon
tip endodontic
needle. With artful
bends. Primary use was sweeping up the
fringes of the periodontal pockets. Where each attempt might yield a
small amount of blood & crud.
But other primary use was going
in deeper. Issue of going in deep in so-called Nerve
& Skull Territory
is that the diseased tissue has been largely
turned into mush.
WHAT IS MUSH? So-called "MUSH"
is diseased tissue where it is very difficult to
determine what is what. Life blends with death.
And both living and dead blend with disease and
infection. What is what? The only one who knows is
God. So the role of man is to give the dead and
diseased the opportunity to leave without
destroying the opportunity for the living to gain
back its life. Which also includes so-called -
ZOMBIE BONE - which is bone that has died that
does indeed have the opportunity to become the
scaffolding for future living bone. But which also
may be a chimera or product of wishful
imagination. And what is the means? At its
simplest level it is - COMMUNICATION - or contact
of diseased tissue with the outside world.
Allowing the diseased material to exit or be
flushed out by release from the body of blood and
plasma to flush out the infection. Which a natural body response.
HUH? - (PER LIVING BODY vs NON-LIVING BODY) -
Don't carelessly go in too deep with the needle or
you might just punch a hole into your sinus. Or
foolishly spread a dangerous infection even
further. That is what this all means. So what to
do instead? Basic answer is to be respectful of
disease. Try to remove as much infection as
possible without disturbing what might in fact be
living body. Go
as far as you can go with a 100% confidence level.
Then what happens is the living
tissue, which then becomes less burdened by
disease, will tend to recover. But if there is too
much disease left over then the recovery won't be
very good. Perhaps just enough to keep the pain to
a moderate level if you go back in again say three
days or two weeks or so later.
BUT ISN'T THIS HOW ALL THE BAD
AREAS START OUT? - YES - Yes, in general all the
bad areas will start out feeling like mush. But
you forge ahead anyway and remove as much crud as
you can without making the problem even worse.
Then after awhile, even if the area is still
hugely filled with disease, the trauma will tend
to go down and the area will tend to recover. WHAT
TO DO THEN? WHACK IT AGAIN.
= = =
NOTE - OR could even very very carefully blow
air under the gumline. OR if you have access to pure
oxygen can try that - BUT ISN'T THIS
DANGEROUS? YES IT IS. SINCE YOU COULD CAUSE AN AIR
EMBOLISM AND DIE OR HURT A LOT - ESPECIALLY IF THE
POCKETS ARE DEEP AND YOU BREAK THROUGH INTO DEEPER
STRUCTURES - BUT FOR SHALLOW POCKETS IT IS PROBABLY
NOT VERY DANGEROUS - Which would be true in very
deep pockets. BUT... I have done some irrigation
with air into super-deep pockets and abscesses. But
mostly to drive the needle plasma-missile style.
Issue being that many deep pockets do not accept any
type of irrigation in a friendly manner. Meaning it
would be very easy to force the fluid or air into
nominally healthy areas and damage them or cause air
embolism. But again if person accepts the danger and
tries to be careful and is not foolish even a mild
mistake is not likely to prove fatal.
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