3 - Non-surgical Therapy - Chemical Home Care

Question 1

What chemical cleaning options are available to patients for home use?

Answer 1

toothpaste and mouthwash

Question 2

What ingredients are present in toothpaste (8)?

Answer 2

fluorides, triclosan, humectants (xylitol), surfactants, abrasives

foaming, thickening, and flavoring agents

Question 3

What abrasives are present in toothpaste (6)?

Answer 3

Ca++ phosphates, Ca++ pyrophosphates, Ca++ carbonate, Na++ bicarbonate, hydrate silica, alumina

Question 4

_______ _____ control is necessary to reduce gingival inflammation. This can be done through brushing and flossing. These ________ methods may not be enough.

Answer 4

• supragingival plaque

- mechanical

Question 5

Toothpaste as a drug:

1. Target: ?
2. Route: ?
   3: Carrier: ?

Answer 5

1. calcified and soft tissue (teeth/gums)
2. toothbrush - mouth
3. inactive ingredients potentiate

Question 6

(T/F) - Triclosan/copolymer toothpaste is equally or slightly more effective than regular fluoride for plaque reduction AND reducing gingival inflammation (Loe and Silness index).

Answer 6

T

Question 7

The normal triclosan MIC for bacteria is 0.29 - 0.78 ug/mL, whereas it is _______ for dental plaque.

Answer 7

4.14 ug/mL

Question 8

Triclosan inhibition of IL-1B and TNF-a inflammatory mediators leads to favorable inhibition of _______.

Answer 8

PGE2 (Prostaglandin E2)

Question 9

Though SnF (stannous fluoride) and triclosan both have anti-inflammatory effects, triclosan is favorable because ________.

Answer 9

SnF causes staining (looks fluorotic)

Question 10

Fluroide usage in higher concentrations for children under age 6 should balance ________ and _______.

Answer 10

• risk of fluorosis

- caries

Question 11

Mouth washing is good because: ________________.

Answer 11

Teeth are only 25% of the mouth, liquid caries can travel

Question 12

What is the only mouthwash that must be prescribed? What ingredient is the reason?

Answer 12

• 0.12% CHX (cetylpridinium chloride)

- chlorhexidine

Question 13

Supragingival Mouthwashes: __________

• 26% acohol (phenolic)
• indication: plaque, bad breath, gingivitis
• action: essential oils inhibit gingivitis symptoms
• 56% gingivitis reduction, 36% plaque reduction

Answer 13

Listerine

Question 14

Mouthwash Mechanism of action: __________
- broad spectrum G+ and G-
- disrupts CW
reduce plaque endotoxin levels

Answer 14

Listerine

Question 15

Supragingival Mouthwashes: _________

• 0.05% cetylpyridinium chloride
• reduce plaque and gingivitis

Answer 15

CPC (cetypyridinium chloride) - Viadent

Question 16

Supragingival Mouthwashes: _________

• 0.05% cetylpyridinium chloride
• antiseptic mouthwash
• quaternary ammonium compound

Apparently also works on plague and gingivitis…

Answer 16

CPC (cetylpyridinium choride) - Cepacol

Question 17

Mouthwash Mechanism of action: __________

• Ruptures bacterial cell wall
• alters bacterial metabolism to inhibit cell growth

Answer 17

CPC

Question 18

Supragingival Mouthwashes: ___________

• 0.12% chlorhexidine gluconate
• treat gingivitis and bleeding gums
• action: alters PM permeability of bacteria

Answer 18

CHX / Chlorhexidine / Peridex

Question 19

Chlorhexidine has what negative side effects if used in too high a concentration (3)?

Answer 19

• tooth discoloration/increase calculus
• hypersensitivity/allergic reaction (local)
• bitter taste/taste disruption

Question 20

Mouthwash Mechanism of Action: ________

• rupture PM
• binds salivary mucins, reducing pellicle, inhibits plaque colonization
• 60% plaque reduction, 42% gingivitis reduction

Answer 20

CHX/Peridex

Question 21

_______: bad breath caused by chemical by byproducts of bacteria. What 3 chemicals? General others?

Answer 21

• Halitosis
• H2S, CH3SH, CH3SCH
• Short chain FA’s, polyamines (cadaverine, putricine), N byproducts (urea), ketone byproducts, alkalines, phenyl byproducts

Question 22

If bad breath is not removed by periodontal treatment, what else could be a cause (that we discussed), and to whom would you refer your patient?

Answer 22

• Sinus infections

- ENT

Question 23

What 3 steps should a dentist use in treating halitosis?

Answer 23

1. eliminate etiological factors
2. review oral hygiene habits
3. recommend dietary changes

Question 24

Is mouthwash recommended for patients with halitosis?

Answer 24

Yes

Question 25

What should a dentist do preoperatively to help with an antiseptic oral environment?

Answer 25

Mouthwash is NOT effective preoperatively. Professional cleaning is recommended.

Question 26

(T/F) - Herbal medicines are an uncommonly used health remedy for people, as many seeking treatment can be properly treated by their dentist or physician.

Answer 26

F

Question 27

(T/F) - Most people that use herbal medicines in the USA are middle-aged, college-educated individuals.

Answer 27

T ex of herbal meds: Chitosan (derived from chitin)

Question 28

(T/F) Based on the FDA's 3 categories of safety, the mouthwashes EO, CPC, and CHX are classified as category I.

Answer 28

F EO and CPC are category I, but CHX must be prescribed

Question 29

When HEALTHY patients used CHX and EO long term, what 3 effects did these mouthwashes have on oral bacteria?

Answer 29

- no microbial overgrowth - no opportunistic infection - no development of microbial resistance

Question 30

Alcohol mouthwashes are contraindicated in what 2 groups (since mouthwashes are meant to be expectorated)?

Answer 30

- alcoholics | - children at or under 12 years old

Question 31

(T/F) - Alcohol mouthwashes should be used only as needed, because there is a link between them and oral cancers.

Answer 31

F | - there are no carcinogens in it, use as directed by dentist

Question 32

In patients with xerostomia, _______ ______ on tissues that aren't thoroughly irrigated is (low/high). In addition, salivary flow rates are (lower/higher) after use of EO mouthwash.

Answer 32

- irritation potential / low | - higher

Question 33

(T/F) - Fluorine is a safe element that we're exposed to on a regular basis though things we consume such as tea, fish, meat, fruit, as well as non-edibles (toothpaste, razor blades, Teflon, etc.).

Answer 33

F - fluorine is a toxic element that can be harmful to the CNS in high concentration, but we are indeed regularly exposed to it

Question 34

(T/F) - Triclosan is generally considered safe, even though we have high exposure rates to it in soaps, toothpastes, deodorants, etc.

Answer 34

T

Question 35

Aside from offering a true/accurate portrayal of the intended use and _______ of a product, the ADA Seal of Acceptance for antiplaque/antigingivitis agents requires what time requirement (in studies) and what minimum amount of gingivitis reduction?

Answer 35

- efficacy - two 6-month studies - 20% gingivitis reduction

Question 36

ADA Clinical Trial Guidelines: How must studies be "designed?"

Answer 36

- randomized, crossover, or parallel group, well-controlled - normal VS placebo - 2+ studies from independent investigators

Question 37

ADA Clinical Trial Guidelines: Population info?

Answer 37

must represent typical product users

Question 38

ADA Clinical Trial Guidelines: What methodology must be employed?

Answer 38

- 6+ months - scoring performed at baseline - qualitative plaque sampling - quantitative plaque sampling - must be safe