Antimicrobials Flashcards
What are antimicrobials in dentistry?
- Substance that kills or hinders the growth of microorganisms
- Therapeutic agents used to prevent or treat infections
What are examples of antimicrobials?
- Antiseptics
- Antibiotics
- Antivirals
- Antifungals
- Antiparasitics
- Even fluoride is considered an antimicrobial!
What is an adverse effect?
an undesired effect of drug or other
treatment; range from mild to severe, can be life-threatening (aka: adverse event/adverse reaction
What is a side effect?
secondary, undesirable effect in addition to its desired effect; can be harmful or beneficial
What is compliance?
ability of patient to follow through/motivation to use product
What is substantivity?
ability of an agent to remain active in oral cavity for a prolonged period
What is cosmetic?
pleasant taste/sensation, decrease microorganisms, halitosis control
What is therapeutic?
reduction in plaque, gingivitis and/or caries
What is efficacy?
the quality of being successful in producing an intended result
What is an antiseptic?
agent for use on the skin or mucous membrane
What are examples of antiseptics?
include mouth rinses (for therapeutic or cosmetic use) that contain chlorhexidine (CHX), essential oils and Cetylpyridinium chloride (CPC)
What are antibiotics?
drug that inhibits growth of or destroys microorganisms
What are examples of antibiotics?
include localized or systemic delivery (Arestin® {Minocycline}, Amoxicillin, Clindamycin), metronidazole (also used to treat parasitic infections)
What are antivirals?
drug or treatment effective against viruses
What are examples of antivirals?
include acyclovir, valacyclovir to treat viral infections against herpes simplex 1 (cold sores)
What are antifungals?
drug used to treat fungal infections
What are examples of antifungals?
include Nystatin in treating angular cheilitis (polyenes, imidazoles, triazoles)
What are the two types of antiseptic mouth rinses?
cosmetic
therapeutic
What are the features of cosmetic antiseptic mouth rinses?
- Available over-the-counter
- Helps to enhance taste in mouth (i.e., minty fresh breath)
What are the features of therapeutic antiseptic mouth rinses?
- Available over-the-counter or prescription
- Help reduce/control plaque, gingivitis, halitosis, caries, xerostomia
What are the purposed of mouth rinses?
- Used to mask mouth odors post food consumption
- Freshen breath
- Deposit fluoride on teeth (if fluoridated)
- Available in liquid form
- Primarily cosmetic benefit
What is halitosis?
bad breath
What are intraoral causes of halitosis?
- Gingival and periodontal disease; Sjogren’s syndrome; cancer treatment; bone pathologies; deep carious lesions; food traps; exposed necrotic pulp; ill-fitting dentures; ortho appliances; coated tongue; candidiasis
- A drop in the oxygen saturation of saliva lowers the pH level of saliva and causes diamines to form resulting in malodor
What are the extraoral causes of halitosis?
- Respiratory system: sinus issues, tonsils, upper respiratory issues (many nidus for bacterium to thrive)
- GI system: accounts for most of the extraoral causes of halitosis
- GI reflux; gastric and peptic ulcers; congenital broncho-esophageal fistula; diverticulitis; stomach cancer; hiatus hernia; pyloric stenosis; duodenal obstruction
- Endocrine disorders: diabetes; uremia
What are drug-related causes of halitosis?
Acetaminophen; antihistamines; amphetamines; bisphosphonates; chemotherapeutic agents
Most mouth rinses have no effect on breath after ______ hours
3-5
Mouth rinses ______ odors/provide little antibacterial function
mask
What are in mouth rinses in general?
Typically contain flavoring agent, astringent refreshing the mouth, and other ingredients
Bacteria & plaque accumulation on the tongue contribute to…
halitosis
What are alternative remedies for halitosis?
- meticulous/excellent oral hygiene habits
- chew xylitol-based chewing gum during the day
- utilize a tongue scraper to gently remove accumulation of debris from dorsal aspect of tongue
- consume water throughout the day
- less sugar consumption (sugar is a food source for odor-producing bacteria)
- see PCP if all previous attempts to alleviate halitosis fall short
What are the active ingredients in mouth rinse?
- Sanguinarine
- Ammonium compounds
— Cetylpyridinium chloride [CPC] (added to reduce bad breath) - Phenolic compounds (low substantivity)
- Fluoride (reduces incidence of caries)
- Chlorhexidine (helps control plaque & gingivitis)
- Stannous fluoride (helps control plaque & gingivitis)
- Essential oils (helps control plaque & gingivitis)
- Triclosan (reduced production of plaque & gingivitis)
What does cetylpyridinium (CPC) do?
reduce bad breath
What do phenolic compounds do?
low substantivity
What does fluoride do?
reduces incidence of caries
What does chlorhexidine?
helps control plaque & gingivitis
What does stannous fluoride?
helps control plaque & gingivitis
What do essential oils do?
helps control plaque & gingivitis
What does triclosan do?
reduced production of plaque & gingivitis
What is the mechanism of actio of chlorhexidine, stannous fluoride, and essential oils?
chemotherapeutic effect against plaque/biofilm accumulation as they decrease the amount of free-floating planktonic bacteria, by binding their positive ions to the bacteria’s negative ions resulting in cell lysis
What is alcohol for?
solvent, taste enhancer, and an agent providing aftertaste
What are the negative effects of alcohol?
burning mouth, drying of oral tissues, risk of oral cancer
→ do not recommend ANY products containing alcohol to patients who verbalized struggling with alcoholism or are actively in recovery from alcohol abuse
What are the goverment level regulations on antimicrobials?
Food and Drug Administration (FDA)
→ Protects consumers from useless/harmful products
→ Therapeutic claims must have research to support claims
→ Evaluates prescription/OTC products
What are the professional level regulations on antimicrobials?
Council on Scientific Affairs of the American Dental Association
(ADA)
→ Voluntary program that companies pay into
→ Helps consumers “make wise choices”
→ Products submitted must have controlled studies to demonstrate effectiveness/safety of product
→ Seal is only found on consumer products
→ New submission costs $14,500 to evaluate product; if approved, yearly fee of $3,500 to maintain
Should dentists recommend products based on the ADA only?
- Not necessarily
- Some products that have evidence to support claims do not have ADA seal (i.e., Sonicare toothbrush)
What are the features of listerine?
- 18 different products listed on website
- If product has “zero” in its name, then NO alcohol present
What are the active ingredients in listerine?
→ if claim is for “gum health” or “tartar control” then active ingredients are Essential Oils
→ if claim is for “cavity protection” then active ingredients are sodium fluoride 0.02%
What are the features of ACT?
6 different products, ranging from basic mouthwash to kids’ formulated mouthwash, and mouthwash for dry mouth
What are the active ingredients in ACT?
sodium fluoride 0.05%
- ACT Whitening mouth wash: sodium fluoride 0.02% as active
ingredient
What are the features of Crest?
- Crest website does not provide information defining ‘active’ ingredient vs. ‘inactive’ ingredient
- Ingredients overall are like previous mentioned mouth wash products
- The Crest ® brand includes the Scope ® brand as well
What are the features of Colgate?
- Website does not provide ingredients list for different products
- Whitening mouth washes typically utilize hydrogen peroxide as whitening agent
What are the active ingredients in Colgate?
- Colgate Peroxyl- helpful for mouth sores as it has 1.5% hydrogen peroxide
- Colgate Ortho Defense- has sodium fluoride 0.04%
What are the active ingredients in Closys?
CPC 0.075% or Sodium Fluoride 0.05%
Mouth rinses formulated for xerostomia typically have added ___________in the ingredients list along with other chemical compounds that mimic saliva.
fluoride
What are the claims of Biotene?
- combination of natural salivary enzymes and protein
- it claims to boost and replenish the natural defenses of saliva while killing harmful bacteria and maintaining healthy bacteria
What are the claims of Oasis?
- moisturize the mouth from its
mucoadhesive formula, to lock in moisture from xanthum gum polymer and carboxymethyl cellulose compound - helps protect the mouth from dryness owing to a glycerin coating of the mucosal surface
What are the claims of Spry?
- xylitol, aloe vera concentrate and other natural ingredients to produce a successful product that aids in reducing dry mouth symptoms.
- This product may be more conducive for individuals struggling with xerostomia as an on-the-go product to alleviate dry mouth symptoms throughout the day with using mouth wash may be more difficult.
What is the most effective antiplaque agent?
CHLORHEXIDINE GLUCONATE
What is clorhexidine gluconate?
Is a cationic compound that binds to hydroxyapatite of tooth enamel, pellicle, plaque, extracellular matrix of plaque, and mucous membrane
What is the substantivity of clorhexidine gluconate?
8-12 hours
Clorhexidine gluconate is used most often during…
- perio therapy, however, not proved beneficial as SOLE method of treating perio with deep pockets
- irrigate perio pockets following SRP which can help decrease inflammation and subgingival plaque accumulation
CHX (Clorhexidine gluconate) absorbed to hydroxyapatite is believed to inhibit…
bacterial colonization and prevent pellicle formation
What is in chlorhexidine gluconate?
- 12% alcohol concentration in CHX w/ alcohol
- Alcohol-free formula available as well (0.12% CHX)
- Evidence suggests alcohol-free formula is just as effective as alcohol-based CHX
- Both alcohol-based and non-alcohol based have FDA approval; ADA seal of approval not given due to changes in the program
How long can you use chlorhexidine gluconate?
Short-term use ONLY
- changes taste buds and stains teeth
How do you prescribe chlorhexidine gluconate?
Rx: Peridex (chlorhexidine gluconate) 0.12% mouthwash
Dispense 15 mL
Sig: Apply 1 tablespoon as directed twice per day for 30 seconds
Use until gone
Refills: none
What are the home care instructions for chlorhexidine gluconate?
- brushing/flossing should be done prior to rinsing; CHX mechanism of action is inactivated by toothpaste
- DO NOT rinse with water immediately after rinsing with CHX, wait 30 minutes
What are the pros of CHX?
- Antimicrobial affect on bacteria, fungus, viruses
- Aids in management of periodontitis, caries, peri-implantitis, infections associated with extractions
- Gold-standard following most oral surgeries (i.e., tooth extractions, periodontal surgery)
What are the cons of CHX?
- Stains teeth with prolonged use
- Can cause metallic taste with excessive use
- Can cause black hairy tongue appearance
- Supragingival calculus
- Requires prescription
- Not to be used long-term
What is similar to CHX?
Saltwater mouth rinse has been determined to be as efficient as 0.12% CHX in reducing inflammation following minimally invasive perio therapy
What are the benefits of saltwater rinse compared to CHX?
inexpensive, easily accessible
How do you make saltwater rinse?
1 cup warm water to 1 teaspoon salt, mix well, rinse in mouth for 30 seconds, then expectorate
When do you use mouth rinses?
- Based upon need (caries/gingivitis/perio/surgery)
- Patients who have manual dexterity issues and thus need assistance with plaque control
- Pre/post surgery
- Mouth sores (Colgate Peroxyl)
What mouth rinse is used for mouth sores?
Colgate Peroxyl
Are there negative outcomes of mouth rinse use?
- Alters natural microbiome that occurs in the oral cavity1
- Dries out oral mucosal tissues (especially alcohol-based mouth rinses)
- Causes imbalances in pH levels2
- May worsen halitosis
- May cause ulcers/increased risk for oral cancer
- May contribute to development of gingivitis
What are the origins of oil pulling?
- Ancient Ayurvedic practice of swishing oil in your mouth for several minutes (replacing mouth wash)
- Originated in India centuries ago
- Coconut oil is ideal
What do people claim that oil pulling does?
- Claim: “reduced inflammation/improves gingival health”
- Some individuals claim it helps to “heal” cavities- no scientific support that oil pulling will arrest caries and remineralize tooth structures
How do you oil pull?
- Step 1. Floss/brush your teeth before you start oil pulling
- Step 2. Place a tablespoon of oil in your mouth
- Step 3. Swish the oil in your mouth for 1-3 minutes
- Step 4. Spit out the oil in the trash can (not the sink, oil can solidify and clogs pipes)
- Step 5. Rinse your mouth with water
What is the frequency you should oil pull?
if you have gingivitis/periodontitis, oil pull once per day to improve gum health; if you have good oral health, oil pull 1-2 times each week
What are the best oils to use for oil pulling?
coconut, sesame, safflower, sunflower, olive (anything that is cold pressed/organic)
What is important to know about oil pulling?
- oil pulling cannot replace brushing and flossing
- oil pulling doesn’t cure TMJ/TMD
- oil pulling does not loosen crowns or fillings
- oil pulling doesn’t whiten teeth
- oil pulling doesn’t cure diseases
- oil pulling doesn’t prevent caries or fix existing caries
- oil pulling doesn’t pull toxins from your bloodstream
- you don’t need to oil pull for 15-20 minutes for effectiveness
