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Patient Care 3 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Adverse effect:
 Side effect:

A

harmful to patient
may be harmful, useful, or beneficial

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2
Q

Compliance:

A

patient’s ability, desire, and motivation to use a product

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3
Q

Substantivity:

A

ability of an agent to absorb to teeth and surfaces and be released at therapeutic levels

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4
Q

Cosmetic:

A

pleasant taste and sensation, decrease in microorganisms, halitosis control

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5
Q

Therapeutic:

A

reduction in plaque, gingivitis and/or dental caries

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6
Q

DELIVERY SYSTEMS
Local:

A

paste, gel,
liquid, fibers

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7
Q

DELIVERY SYSTEMS
Systemic:

A

antibiotics

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8
Q

REGULATION (PRESCRIPTION
AND OTC DRUGS):
Government level:
Food and Drug Administration (FDA)
(3)

A

 Protects consumers from useless or harmful products
 Therapeutic claims must be backed with proof
 Evaluates Rx and OTC

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9
Q

REGULATION (PRESCRIPTION
AND OTC DRUGS):
Government level:
Federal Trade Commission (FTC)
(1)

A

 Advertising OTC and Rx

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10
Q

REGULATION (PRESCRIPTION
AND OTC DRUGS):
Professional level:

A

Council on Scientific Affairs of the American Dental Association (ADA) (voluntary)

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11
Q

ADA SEAL OF ACCEPTANCE
(4)

A

 Program is voluntary
 Started in 1930 to “help consumers make wise choices”
 Products submitted for seal must have independent, controlled studies to demonstrate effectiveness and safety
 Seal is found on consumer products (professional product seal has been phased out)

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12
Q

ADA SEAL FOR ANTI-PLAQUE/ANTI-
GINGIVITIS AGENTS:
(4)

A

 Product must be tested in randomized, parallel-group,
cross-over design and compared to a negative control
 Must have minimum two 6-month studies, conducted
independently with indices recorded at baseline,
intermediate, and 6 months, and averaging 20% gingivitis
reduction
 Statistically significant reduction of plaque and gingivitis
(compared to control)
 Establish product safety (soft tissues, teeth, toxicology,
effects on oral flora)

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13
Q

New product submission: $

A

15,000

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14
Q

Annual maintenance fee (per product): $

A

4000

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15
Q

PLAQUE/GINGIVITIS REDUCING
MOUTHRINSES
(2)

A

 Claim to reduce plaque is not enough. Product should be
therapeutic.
 ADA Council on Scientific Affairs: must be therapeutic and
show long term safety to be approved

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16
Q

EVALUATING PRODUCT CLAIMS
(4)

A

 Published vs non-published
 Sponsor
 Peer review
 Length and duration

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17
Q

 Important to recommend
— products

A

ADA approved

Only applies to
consumer/OTC products

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18
Q

ALCOHOL IN
MOUTHRINSES/MOUTHWASHES
(3)

A

Used as solvent for active ingredients
High content can cause hyper-keratotic lesions
Possible link to oral cancer? (inconclusive and still heavily debated)

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19
Q

http://ebd.ada.org/en/evidence/evidence-by-topic/6066/mouthwash-and-oral-
cancer-risk-quantitative-meta-analysis-of-epidemiologic-studies
Conclusions:

A

This quantitative analysis of
mouthwash use and oral malignancy revealed no
statistically significant associations between
mouthwash use and risk of oral cancer, nor any
significant trend in risk with increasing daily use; and
no association between use of mouthwash
containing alcohol and oral cancer risk.

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20
Q

CHLORHEXIDINE
(8)

A

 0.12% CHX
 Peridex, Perio-gard and others
 Cytoplasmic poison; causes rupture of cell membrane allowing leakage
 Binds to mucins, reducing pellicle formation and inhibiting colonization
 Binds to bacteria, inhibiting their
adhesion onto teeth
 Substantivity: 12-24 hours
 12% alcohol
 35-40% decrease in plaque and gingivitis

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21
Q

ALCOHOL-FREE CHLORHEXIDINE
(5)

A

 0.12% CHX
 Alcohol free (water-based)
 Therapeutically equivalent (?)
 Evidence suggests it is as effective as AOH-based
CHX
 Consider as option for those pts who are intolerant
of AOH or who might have other risk factors

22
Q

SIDE EFFECTS (CHX)
(4)

A

 Staining
 Altered taste
 Supragingival calculus
 mucositis

23
Q

CHX
 Dosage:

A

15ml, bid, 30 seconds
each

24
Q

CHX
(3)

A

 Most effective anti-plaque agent currently available
 Available with prescription only
 FDA approved (no longer carries the ADA seal of
approval due to a change in the program)

25
Q

CHX on established biofilm will have only — effects.

A

superficial

26
Q

CHX is more effective when plaque is removed prior to —.

A

rinsing

27
Q

The biofilm will adapt and protect itself from the

A

effects of CHX.

28
Q

CHX
Inactivated by

A

toothpaste—important to rinse well
with water prior to rinsing with CHX (or wait 30 min
before rinsing with CHX)

29
Q

DO NOT rinse with water immediately after rinsing
with

A

CHX

30
Q

CHX
Recommend for patients who
(2)

A

cannot or will not
maintain adequate plaque control
Post (periodontal) surgical cases

31
Q

PHENOLIC COMPOUNDS (LISTERINE ANTISEPTIC AND ITS GENERIC EQUIVALENTS)
(7)

A

 Active ingredients: Essential oils: thymol, eucalyptol, methyl salicylate, menthol
 Original formula: 26.9% alcohol (Cool Mint: 21.6% alcohol)
 Alters cell membrane, causing leakage and cell death
 18-25% decrease in plaque and gingivitis
 Low substantivity
Rinse with 20ml, bid, for 30
seconds
ADA approved (Antiseptic)

32
Q

PHENOLIC COMPOUNDS (LISTERINE ANTISEPTIC AND ITS GENERIC EQUIVALENTS)
SIDE EFFECTS (3)

A

Bad taste
Burning
sensation
Tooth
staining (?)

33
Q

Label prior to

A

ADA acceptance

34
Q

LISTERINE ZERO
(6)

A

 Introduced in 2010
 “…powered by our 4 essential oils formula”
 “…for patients who prefer an alcohol-free rinse”
 This product is NOT Listerine Antiseptic without alcohol
 COSMETIC
 Contains essential oils for flavoring—they are NOT a therapeutic concentration

35
Q

CETYLPYRIDINIUM CHLORIDE (CPC)
(.05% COSMETIC CONCENTRATION)
(4)

A

Ingredient in many OTC ‘cosmetic’ mouthwashes (.05%)
Quaternary ammonium compound
Marginally effective in reduction of plaque and gingivitis
Little to no substantivity

36
Q

CETYLPYRIDINIUM CHLORIDE (CPC)(.07% THERAPEUTIC CONCENTRATION)
(4)

A

ie: Crest Pro-Health Rinse Multi-Protection Rinse* // Crest Gum Care //Colgate Advanced Pro-Shield
no alcohol
Studies indicate plaque and gingivitis reduction comparable to Listerine Antiseptic.
Mechanism of action: ruptures cell wall; also may alter bacterial

37
Q

Both products contain

A

.07% CPC

38
Q

CPC VS CHX
(2)

A

 CPC binds to tooth structure and plaque, but not as strongly as
CHX binds to them
 CPC is rapidly released from binding sites so it is not as
efficacious as CHX

39
Q

HYDROGEN-PEROXIDE-BASED
(4)

A

 1.5% hydrogen peroxide
 Alcohol free
 Cleanses oral wounds, irritations
 Preliminary information reported
H2O2 to be effective against
COVID
*More investigation: Data
does not currently support

40
Q

VIADENT
FORMER active
ingredient:

A

sanguinarine
(blood root plant)

41
Q

VIADENT
(5)

A

 In the mid to late 90’s, higher than normal incidence of leukoplakia was seen.
 Sanguinarine determined to be cause.
 Pts were 8-11 times more likely to develop leukoplakia
 Lesions seen in former users-5 yrsafter use
 Risk was highest in patients who used both mouthrinse and toothpaste

42
Q

PRE-BRUSHING RINSES
PLAX (and others)
“…Plaque Loosening Rinse”
(5)

A

Marketed as pre-brushing rinse
Ingredients: surfactants (detergents), sodium bicarbonate, glycerin, alcohol (7.5%)
Non-toxic, non-irritating, no enamel damage
Claims are
unsubstantiated with
sound research
“The data provided do
not support the use of
PLAX dental rinse as part
of an oral hygiene
program.”*

43
Q

SMART MOUTH
(4)

A

 Claim: “Eliminate & Prevent Sulfur
Gas, Never have bad breath again”
 Active ingredient: zinc
 What does the evidence say?
Evidence is unclear. Potential
efficacy is weak.
 Should be marketed as an ‘oral
deodorant’

44
Q

skipped
WHEN DO YOU RECOMMEND A
MOUTHRINSE?
(7)

A

Determine need (caries and/or periodontal)
Caries risk (OTC fluoride, Rx fluoride)
Patients who are unable to adequately
remove plaque
Patients who, despite their best attempts,
need adjunctive measures
Patients with ANUG (Acute Necrotizing
Ulcerative Gingivitis)
Pre/post periodontal surgery
Patients undergoing disease control therapy

45
Q

ADA HAS ALWAYS STRESSED THE IMPORTANCE
OF GOOD ORAL HYGIENE BY ADVISING
CONSUMERS TO:
(5)

A

 Brush your teeth twice a day with an ADA Accepted fluoride toothpaste.
 Clean between teeth daily with an ADA Accepted floss or an ADA-accepted inter-dental cleaner
 Eat a balanced diet and limit between meal snacks.
 Visit your dentist regularly for professional cleanings and oral exams.
 In addition to these basic oral hygiene recommendations, consumers should be aware of the oral health benefits of other ADA Accepted products, such certain kinds of mouthrinses and toothpastes.

46
Q

THERAPEUTIC
(5)

A

 Peridex (CHX)
 Listerine Antiseptic (and
generic equivalents)
(Essential oils)
 Crest Pro-Health Multi-
Protection Rinse (.07% CPC)
 Crest Gum Care (.07% CPC
 Colgate Total Advanced
Pro-Shield (0.07% CPC)

47
Q

COSMETIC
(4)

A

 Scope, Cepecol, Lavoris,
etc. (.05% CPC)
 Whitening rinses
 Plax and other pre-brushing
rinses
 Listerine Zero

48
Q

Oil Pulling
(2)

A

 Practice of holding a
tablespoon of edible oil
(coconut, sunflower,
sesame, olive) inside the
mouth and ‘pulling’ the oil
through the teeth, anywhere
from 1-5 minutes, up to 20
minutes or longer
 Ancient, traditional folk
remedy, practices in India
and Southern Asia.

49
Q

Benefits?

A

 Proponents claim it
improves oral health
and…

50
Q

What does the Evidence Say?
 Jauhari, D, et al: Comparative evaluation of the effects of fluoride mouthrinse,
herbal mouthrinse and oil pulling on the caries activity and streptococcus
mutans count using Oratest and Dentocult SM Strip Mutans Kit. Int J Clin
Pediatr Dent, 2015
 52 healthy children, ages 6-12, divided into four groups
 Fluoride (200ppm NaF)
 Herbal (Salvadora Persica)
 Oil pulling
 Control
 Estimation of caries activity and S. mutans done prior to and following respective rinsing for 2 wks
 Conclusions:
(2)

A

 Fluoride and herbal rinses were comparable. Both equally effective in reducing caries activity and S mutans
 Oil pulling did not provide any additional benefit as an effective antimicrobial agent in reducing bacterial
colonization

Patient Care 3 (25 decks)

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