The effect of oral irrigation with
a magnetic water treatment device on plaque and calculus.
J. Clin. Periodontal 1993: 20: 314 - 317. Copyright
Calculus formation on tooth surfaces is analogous to the formation
of lime and scale deposits in plumbing. Magnetic water devices have
been shown to significantly reduce scale deposits in industry: therefore
an oral irrigator with a magnetic water device may have a similar
effect on calculus. To test this hypothesis, a double blind clinical
study was established using 64 irrigators, 30 of which had their
magnetic devices removed. 54 patients with heavy supragingival calculus
were given irrigators at random after rophylaxis. Instructions were
given to irrigate twice a day, particularly the lower 6 anterior
teeth. The patients were also told not to floss these 6 teeth which
were to be the study teeth. They were examined after 3 months and
measurements were taken of the accretions adhering to the study
teeth. No attempt was made to determine whether the adhering material
was hard or soft so it must be assumed that at least some of the
measured material was also plaque. The measurements of the group
using an irrigator with a magnetic device showed a 44% greater reduction
in calculus volume (p < 0.0005) and a 42% greater reduction in
area (p < 0.0001) over the group using an unmagnetic irrigator.
There appears to be a statistically significant difference in supragingival
accretion volumes between conventional irrigation and using an irrigator
with a magnetic water treatment device.
Adherence of supra-gingival calculus and its accompanying
bacterial plaque to the surfaces of teeth has been implicated as
a possible factor in initiating periodontal diseases. Tooth brushing
has been universally accepted as the standard method of oral hygiene
to control the formation of supra-gingival calculus. Standard oral
hygiene procedures have greatly improved dental health, but periodontal
diseases are still common and pose a tremendous health care expense
(Sheiham 1991). Many studies have demonstrated that the use of irrigation
devices may be an effective means to reach into areas inaccessible
to tooth brushing. The addition of agents such as chlorhexidine
and fluoride have in creased this effectiveness (Flint et al, 1988,
Vignarajah et al,1989, Wikesjo et al, 1989, Landet et al, 1986).
Another method of increasing the effectiveness of irrigation may
be through the use of magnets.
The application of magnetic water treatment devices
has been used in Eastern Block countries and China for over twenty-five
years (Hibben 1973). Grutsch & McClintock (1984) demonstrated
a positive corrosion and deposit control by the use of magnetically-treated
water at an AMOCO refinery. Kronenberg (1985) described the observations
of reduced formation of new hard lime scale deposits and the elimination
of old lime scale deposits. A Baylor research team (McAtec et al,1985)
under contract from the American Petroleum Institute concluded that
"the passage of conducting solutions (tap water) through a
magnetic treatment device generates voltages and currents which
result in an electrolysis reaction, producing nucleation centers
that favor precipitation of scaling salts in the bulk of the solution
rather than on the walls of plumbing." Certain theories have
been proposed to explain mechanisms of adherence of calculus. It
has been shown that amphipatic substances change the charge of the
tooth surfaces, which can effect the attachment of bacteria (Krasse
l9m. Ca++ and P04 - ions are concentrated on hydrated tooth surfaces
(Stem Layer) which are covered by a protein pellicle. Rolla (1977)
stated "that gram positive bacteria are negatively charged
and these bacteria are the first colonizers of the negatively charged
tooth surface. The well-known delay (3 - 4 hours) which may be observed
before bacteria colonize teeth may well be ascribed by the repulsive
forces between the surfaces involved. Divalent cations will reduce
the repulsion and permit the bacteria to approach the teeth. An
adhesion based on some specific interaction may be the final stage
of the electrostatically mediated approach of the bacteria to the
tooth surface." It can be hypothesized that this adhesive interaction
is similar to the naturally occurring phenomenon of adherence of
particulate matter to any hard surface in an aquatic environment
and that this adherence may be adversely affected by magnetic devices.
Recently, an oral irrigator with a magnetic device was manufactured.
Unpublished preliminary clinical pilot studies have indicated positive
results (Watt 1987, Vollmer & Barger 1988) along with numerous
ancedotal reports by several dental clinicians. Therefore a double-blind
clinical trial was established to test this hypothesis.
Material and Methods
64 irrigation units were provided by the manufacturer, 30 of which
had their magnetic devices removed. The units were coded and the
examiner did not know which units had magnetic devices and which
did not. 54 patients were selected because they formed heavy calculus
and they had been successfully treated for periodontal disease.
They were currently being seen on a 2 - 4 month recall for maintenance.
All patients received a thorough scaling and prophylaxis and had
the tooth surfaces carefully examined by 2 clinicians. They were
instructed in the use of the assigned irrigator, concentrating on
a thorough lavage of the lower 6 anterior teeth 2 x a day. These
6 teeth were not to be flossed, but the patients were to continue
normal maintenance procedures otherwise. They were appointed for
a recall visit in 3 months. At the recall visit, the patients were
questioned about their compliance. If the patients stated that they
were unable to perform the irrigation properly for more than 14
days, they were removed from the study. Three patients were removed
for this reason. Two patients reported that they had flossed the
study teeth. 7 patients reported irrigator malfunction and two patients
were traveling and could not schedule an appointment within 3 weeks
after their 3-month period. A total of 14 patients were removed
from the study. For the remaining patients, the study teeth were
stained with green food coloring and the same examiner performed
all evaluations. The teeth were first air dried and the adhering
residues were measured by comparing their height from the gingival
margin and thickness to a "Michigan O" periodontal probe.
Measurements were taken in 6 places on each tooth (DF, F, MF, ML,
L, and DL).
The majority of the adhering residue was most likely
calculus but, because no attempts were made to remove plaque and
the residues were not probed to determine if they were hard or soft,
it seems most appropriate to state that the residues were both plaque
and calculus. The value for the height measurement was confined
to 3 mm from the gingival sulcus. Thus by dividing the tooth surface
at each of the 6 measurement sites into 3 regions of 1 mm height
each, altogether there were 18 areas on each tooth at which thickness
could be measured. For each area, the thickness measurement was
recorded using the following code: 0.5 mm = 1,1 mm = 2,1+ mm = 3.
The sum of the 18 thickness codes represents an empirical measurement
which is correlated to the total volume of calculus and plaque on
a tooth, and by adding together the individual tooth volume measurements
an over all volume score was obtained for each patient. An empirical
score representing the total tooth area covered by calculus and
plaque was also recorded. This score was obtained by counting the
number of 1 mm high tooth regions (out of a possible total of 108)
that had at least 0.5 mm thick covering of calculus and plaque.
The observed distributions of the volume measurements suggests that
the presence of the magnetic device in irrigators causes a distributional
shift in the amount of calculus and plaque formed. There seems to
be an overall tendency for lower volume scores among the magnetic
water group. Smaller values for the sample mean (30.89 versus 55.55,
x reduction of 44%) and the sample median (28 versus 42, a reduction
of 33.3%) serve to summarize the difference in aver age values for
the two distributions.
Graphic results indicate a decreased variability
in the volume scores for the patients who had used the irrigators
furnished with magnets. This observation is supported by the fact
that the magnetic water group has both a smaller sample standard
deviation (16.9 versus 26.9) and a smaller interquartile range (9.75
versus 42) than the unmagnetized water group.
The combined effect of reductions in both the location
of central tendency and the amount of distribution spread which
are apparently due to the treatment effect of the magnetized water
is a propensity to obtain a decreased proportion of patients having
large amounts of calculus and plaque when compared to the amount
which result when unmagnetized water is utilized. It is noteworthy
that 9 of the 22 patients who used unmagnetized irrigators had volume
scores of 62 or greater, while only one patient from the magnetized
water group had a score that high. Formally, it seems best to describe
the distributional shift by stating that the distributions for the
magnetized water group appear to be stochastically smaller than
the distributions of the unmagnetized group (which implies a smaller
distribution mean). The Mann-Whitney U-test can be used to show
that the observed distributional shift is statistically significant,
and in this case the data yields the highly significant re result
p < 0.0005. The effect of the magnets in the irrigators can also
be assessed by comparing the area scores for the calculus and plaque
measured for the two groups. A thorough analysis of the data yields
results analogous to those obtained from the volume measurements.
Overall, the distribution of area scores for the magnetized water
group is stochastically smaller than the distribution of scores
for the unmagnetized water group (p < 0.0001 by the Mann-Whitney
U-test). The magnitude of the distribution shift can be summarized
by a comparison of the sample means and the sample standard deviations.
The mean of the eighteen area scores for the magnetized water group
(26.50) is 42% smaller than the mean for the 22 area scores for
the unmagnetized water group (62.32), and a reduction in the standard
deviation is also observed (10.4 versus 18.35).
On the basis of the proceeding statistical analysis one can conclude
that a magnetic device properly attached to an oral irrigator appears
to greatly reduce the formation of supra-gingival calculus and its
accompanying plaque. This author is unaware of any other similar
studies in the dental literature and, if other independent studies
result in findings similar to those reported here, it is logical
to assume that such an irrigator would then be of extreme benefit
to a self-care oral hygiene regime.
One can speculate that the probable mode of action
of magnetically treated water affects the Ca++ and PO4- - ions in
the stern layer by bringing these ions closer together, thus reducing
their activity. This could, in turn, reduce the effect of free divalent
cations in mediating attachment. Another possibility is that the
amount of free divalent cations is reduced because the magnetized
water encourages their precipitation. An excellent research question
would be if the addition of chemical agents, such as salt solutions,
to the irrigation solution could enhance or hinder the effect on
calculus. Further, long-term studies need to be completed to assure
that there are no side effects such as reduced hydration of the
tooth surfaces which may be detrimental to tooth vitality. However,
such side effects are highly unlikely. Article References follow
Flint, D. J., Gerdis, G., Pearson, B.S. & Collier, C.M. (1988)
Use of stannous fluoride irrigation in periodontal therapy. Journal
of General Dentistry 36.4, 334-336.
Grutsch, J. F., McClintock, J. W. (1984) Corrosion
and deposit control in alkaline cooling water using magnetic water
treatment at AMOCO's largest refinery. Corrosion 84, no. 330 (available
Hibben, S.O. (1973) Magnetic treatment of water,
National Technical Information Service, no. 1622-4. Krasse, B. (1977)
Adherence of bacteriato tooth surfaces. Swedish Dental Journal I,
Kronenberg,K.J.(1985) Magnetic water treatment demystified.
Magnets Magazine 6-27.
Lander, P. E., Newcomb, G. M., Seymour, G.J. &
Powell, R.N. (1986) The antimicrobial and clinical effects of a
single subgingival irrigation of chlorhexidine in advanced periodontallesions.
Journal of Clinical Periodontology 13, 74-80.
McAtee, J. L., Darling, R. E., Parker, D. H. (1985)
Evaluation of the principles of magnetic water treatment. American
Petroleum Institute Publication 960 (available from American Petroleum
Institute, Washington D.C.).
Rolla, G. (1977) Formation of dental integuments
- some basic chemical considerations. Swedish Dental Journal I,241-251.
Sheiham,A. (1991)Public health aspects of periodontal
diseases in Europe. Journal of Clinical Periodontology 18, 362,
Vignsrajah, S., Newman, H. N. & Bulman, J. (1989)
Pulsated jet subgingival irrigation with 0.1% chlorhexidine, simplified
oral hygiene and chronic periodontitis. Journal of Clinical Periodontology
Vollmer, D. & Barger, B. (1988) A 6 patient
clinical trial of hydro floss irrigator. Preliminary report for
Magna Marketing, Inc. (Available from HydroFloss, Inc. Birmingham,
Wat, D. L. (1987)5-patient clinical trial on effects
of magnetically treated water on dental plaque and calculus. A preliminary
report for Magna Marketing, Inc. (Available from author).
Wikesjo, U. M. E., Reynolds, M. S., Christersson,
L. A., Zambon, J. J. & Genco, R. J. (1989) Effects of subgingival
irrigation on A. actinomycetemcomitans. Journal of Clinical Periodontology
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