16 - Local Chemotherapeutic Agents Flashcards by Michael Vieth

Ideal antimicrobial properties (3)

1) Delivered to diseased area in an effective form
2) Remain for a sufficient amount of time
3) No development of bacterial resistance or damage to oral tissues

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ADA standards for antimicrobials

Reduction of plaque and gingival inflammation for at least 6 months

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Keye’s Technique

SRP
Baking soda
Salt
H202
Tetracycline hydrochloride (sometimes)

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Chlorhexidine drug class

MOA

Cationic bisbiguanide

Ruptures cell membranes

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Listerine drug class

MOA

Essential oil

Cell wall disruption and inhibition of bacterial enzymes

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Iodophor drug class

MOA

Polyvinyl pyrrolidine + iodine (povidone iodine)

Water soluble antimicrobial for bacteria/fungus/virus

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Cepacol/Scope drug class

MOA

Quaternary ammonium compound

Cationic surface active agents to rupture cell walls

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Sanguinarine drug class

Used in?

Herbal alkaloid from bloodroot plant + zinc chloride

Adjunct to dentifrice

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Bleach drug class

Used for

Sodium hypochlorite

Subgingival irrigant for bacteria/virus/fungi

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Triclosan contents

Why the extra stuff?

Bisphenol + zinc citrate + maleic acid + copolymer

Increase substantivity and anti-calculus

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What are the 4 essential oils

Thymol
Eucalyptol
Menthol
Methylsalycylate

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CHX substantivity is ____ hours

Reduce aerosol bacterial loads by ____

6 hours

90%

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CHX side effects

Tooth staining
Calculus formation
Taste alteration

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Listerine reduces bacteria collected on ultrasonic scalers by ____

Plaque and gingivitis reduction by ___

Alcohol % is ___ to ____

94.1%

34%

21.6-26.9%

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Diluted povidone iodine effective against ____

Used with H202, reduction in ____

Streptococci in saliva

Papillary bleeding

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Caution w/ povidone iodine if patient is ____ (5 things)

Allergic to shellfish
Allergic to iodine
Thyroid dysfunction
Pregnant
Lactating

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Cepacol/Scope contents

Cetylpyridinium chloride + domiphen bromide

Problem with Scope/Cepacol

Reduces plaque and gingivitis by ____%

Low substantivity

14% plaque
24% gingivitis

Sanguinarine reduces plaque and gingivitis by _____%

17-42% plaque

18-57% gingivitis

Antiformin is what? Used for?

Sodium hypochlorite

Subgingival irrigation

Antiformin problems

Odor
Need fresh solutions
Bleaching surfaces
Corrosion of metals

Why does stannous fluoride work?

Tin ion

Stannous fluoride uses

Reduce gingivitis (not plaque)

Subgingival irrigant

Triclosan reduces plaque and gingivitis by ____?

20% gingivitis

25% plaque

Results expected for local drug delivery systems

2mm+ improvement in PD or CAL in 30-40% of treated sites

4 types of delivery devices

1) Fibers w/ tetracycline 2) Biodegradable films of hydrolyzed gelatins 3) Liquid biodegradable polymer that hardens on placement 4) Bioabsorbable microencapsulated microsphere

What is Actisite? How is it used?

25% tetracycline hydrochloride woven fibers (12mg Tetracycline) Placed 1mm subgingivally and sealed with isocyanoacrylate

What is Periochip? How is it used?

2.5mg CHX 4x5mm Self retentive in pockets 5mm+ PD

Periochip post-op instructions

No brush or floss for 7 days BID CHX rinse

What is Atridox? How is used?

Doxycycline gel polymer Mix 2 syringes, hardens after placement and lasts for 7 days

Atridox clinical results

Equal to SRP

What is Arestin? How is it used?

Minocycline microspheres in a bioabsorbable polymer gel Placed in sulcus

Arestin post-op instructions

No brush for 24 hours No floss for 10 days

Arestin clinical results

Arestin + SRP better than SRP alone

% of Metronidazole gel used? How is it used?

25% Not in US No more effective than SRP

% of Minocycline gel used? How is it used?

2% Not in US. When used with SRP, more effective than SRP alone but no more effective than other adjuncts

CHX reduces plaque and gingivitis by _____?

50-55% plaque | 45% gingivitis

What solution is Povidone Iodine used in?

Triclosan MOA

Inhibit bacterial adhesion | Anti-inflammatory

Actisite post-op instructions

No brush/floss CHX rinse 2 weeks