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Perio - Exam 2 > ABX - Part I - Chemotherapy and Plaque Control > Flashcards

ABX - Part I - Chemotherapy and Plaque Control Flashcards

1
Q

The goal of hygiene is to provide an environment that encourage normal _______ and prevent _______ of pathogenic flora.

A

Flora

Growth

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2
Q

What are the two ways to achieve oral hygiene?

A

Mechanical means

Chemical means

*Or a combination of means

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3
Q

Mechanical plaque control is the __________ method used to prevent dental disease and maintain oral health.

A

Primary

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4
Q

T/F - Just by brushing, even with just water, can be just as effective as brushing with toothpaste or other products.

A

TRUE

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5
Q

What are some issues with mechanical means of plaque control?

A

Lack of motivation or understanding

Impaired manual dexterity

Systemically compromised

Inaccessible
-Deep pockets or furcations

Recent surgery

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6
Q

T/F - Toothbrushing can only get down into the socket 1-2 mm.

Flossing can only get down into the 2-3 mm.

A

TRUE

TRUE

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7
Q

What is a chemotherapeutic agent?

A

Chemical substance that provides clinical therapeutic benefit

Benefits

  • Antimicrobial actions
  • Ability to increase the host’s resistance
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8
Q

What are some chemotherapeutics in periodontal tx management?

A

Systemic abxs

Drugs that modulate host response

  • Periostat
  • NSAIDS

Topical antimicrobial agents

  • Toothpaste
  • Rinses

Drug delivery systems
-Arrestin

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9
Q

What are 5 desirable characteristics of local chemotherapeutics?

A

Substantivity

Low toxicity

High potency

Good permeability

Intrinsic efficacy

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10
Q

What is substativity?

A

Product sticks to the teeth and slowly releases chemicals (chlorhexidine)
-Product has to get into the biofilm and disrupt it from within

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11
Q

1st generation products?

A

Agents that have antimicrobial activity

  • Phenolics
  • H2O2

NO SUBSTANTIVITY

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12
Q

2nd generation products?

A

Agents that have antimicrobial activity and proven SUBSTANTIVITY
-Chlorhexidine

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13
Q

3rd generation products?

A

Target specific bacteria or bacterial products that are essential to disease development and have substantivity

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14
Q

What are 4 antimicrobial activities?

A

Cidal

Static

Substantivity

Inhibitory dosage

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15
Q

T/F - To make a plaque control, benefit MUST demonstrate significant effects against gingivitis.

A

TRUE

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16
Q

How is data efficacious?

A

2 independent, well-designed trails
-Minimum of 4 weeks

Placebo control

Assess plaque qualitatively and quantitatively

Statistically significant

References must be published

One study of US-like population

Typical product users

Use ADA-sealed products

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17
Q

What about safety data of products?

A

Soft/hard tissues
-No deleterious effects

Oral flora
-No development of opportunistic or pathogenic organisms

Toxicology

  • Toxic/adverse effects
  • Document any mutagenic/carcinogenic effects
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18
Q

Do mouth rinses effect the sub-gingival plaque?

A

NO

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19
Q

What are some popular topical antimicrobial

A

Chlorhexidine

Essential oils

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20
Q

What products can the pts get OTC?

A

Rinses

Rx rinses

Home irrigation

Toothpaste

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21
Q

T/F - Chlorhexidine is the “Gold Standard.”

Cationic bisbiguani

A

TRUE

22
Q

What is the most common concentration of chlorhexidine in the US?

A

0.12%

  1. 6% alcohol
    - pH 5.5
    - For shelf-life

ADA/FDA approved

High effects

23
Q

What is chlorhexidine’s mechanism of action?

A

Ruptures cell membranes

Good substantivity

  • Binds to soft tissue
  • Detectable in saliva 8-12 hrs later

Broad spectrum
-G+ and G- and yeast

24
Q

Side effects of chlorhexidine?

A

Staining*

Increased suprgingival calculus*

Altered taste sensation

Reversible desquamation

Transient swelling of salivary glands

Rare hypersensitivity

25
Q

What is the chlorhexidine concentration outside of the US?

A
  1. 2%

- No significant difference in antimicrobial or clinical effects

26
Q

By how much does chlorhexidine reduce plaque?

By how much does chlorhexidine reduce gingivitis?

A

50-55%

45%

27
Q

What are the pt instructions for CHX (Chlorhexidine)?

A

2x/day for 30 seconds with 1/2 ounce

28
Q

T/F - Pts should allow 30 minutes b/t rinsing with CHX and rushing teeth.

Why?

A

TRUE

Sodium lauryl sulfate and fluoride ion in toothpaste can reduce the effectiveness of CHX

29
Q

T/F - Periodontitis (or dead tissue) is the most common cause of halitosis.

A

TRUE

30
Q

T/F - Enhanced wound healing has been shown when CHX was used as a pre-rinse for extractions.

A

TRUE

31
Q

T/F - 30-60 second pre-rinse can reduce bacterial load by >/= 90-95% and significantly decreasing aerosol contamination/bacteremia.

A

TRUE

32
Q

What are uses of CHX?

A

Gingivitis rampant caries

Candida infections

  • Dentures
  • Immunocompromised

Post-operative

33
Q

T/F - The supragingival plaque influences the subgingival plaque.

A

TRUE

34
Q

T/F - CHX does kills fibroblasts.

A

TRUE

35
Q

What is the oldest phenolic product?

A

Listerine - 1865

-ADA approved

36
Q

Listerine used to have ______% ethanol, and since 1992 has ______% EtOH.

A
  1. 9%

21. 6%

37
Q

What is the pH of listerine?

A
  1. 2
    - 30 second rinse 2/3 ounce 2x/daily
    - Alcohol can range from 22-27% depending on the brand
38
Q

What is Listerine’s mechanism of action?

A

Cell wall disruption and inhibition of bacterial enzymes

39
Q

T/F - Published research shows with essential oils:

  • 20-34% plaque reduction
  • 28-34% gingivitis reduction
  • Anti-candida effect
  • Decreases plaque and increases wound healing 7 days
  • Used as a pre-rinses for SRP >90% reduction of bacteria in aerosols.
A

TRUE

40
Q

Phenolic “essential oils” (Listerine), can __________ LPS, have anti-inflammatory properties, _____________ is the principal antibacterial component, and have low substantivity (effectiveness related to _________ or contact)

A

Extract

THYMOL

Duration

41
Q

3 side effects of listerine-type products?

A

Burning

Bitter taste

Possible staining

42
Q

T/F - Listerine does NOT take the place of floss.

A

TRUE

Used as adjunct only

43
Q

What 2 mouthwashes meet the ADA approval stating that it req’s the product be able to demonstrate a 20% reduction of gingivitis?

A

Chlorhexidine

Listerine

44
Q

What is one quaternary ammonium compound?

A

Cetylpyridinium (CPC)

  • Viadent
  • Scope
  • Cepacol
  • Clear choice
  • Crest Pro-Health Rinse
45
Q

Tell me about CPC.

A

0.045-0.07% CPC

0-18% EtOH

5.5 - 7.0 pH

Dentifrice alters activity

30 minutes b/t rinsing and brushing

46
Q

What is the MOA for quartenary ammonium compounds?

A

Rupture cell walls

*Bind surface, but release rapidly, and that limits substantivity

  • 14% reduction in plaque and gingivitis for Cepacol
  • 24% reduction in plaque and gingivitis for Scope
47
Q

CPC MOA?

A
  • Strong initial attachment
  • Increases cell wall permeability
  • Decreases cell metabolism
  • Decreases ability to attach to tooth
  • -Released from binding site more rapidly than CHX
48
Q

T/F - CPC’s do NOT have the ADA seal.

A

TRUE

49
Q

What pts should be considered for alcohol-free rinses?

A

Children

Pts with dry mouth

Diabetics

Alcoholics

Pts with sensitive soft tissue

Pts of certain religious faiths

50
Q

What is sanguinarine?

A

Herbal blood root extract

Mouthwashes and dentrifices

*Claimed to reduce plaque by 17-42% and gingivitis by 18-57%

**Research found mixed results

Data supported increased leukoplakia in pts and increased risk for cancer

Perio - Exam 2 (8 decks)

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