Antimicrobials and Caries Risk Assesment Flashcards
: harmful to patient
Adverse effect
: patient’s ability, desire, and motivation to use a product
Compliance
ability of an agent to absorb to teeth and surfaces and be released at therapeutic levels
Substantivity:
: may be harmful, useful, or beneficial
Side effect
pleasant taste and sensation, decrease in microorganisms, halitosis control
Cosmetic:
reduction in plaque, gingivitis and/or dental caries
Therapeutic:
Protects consumers from useless or harmful products
Therapeutic claims must be backed with proof
Evaluates Rx and OTC
Food and Drug Administration (FDA)
Advertising OTC and Rx
Federal Trade Commission (FTC)
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)
ADA Seal of acceptance
Is it enough for an antimicrobial to reduce plaque only?
No; must be therapeutic
Used as solvent for active ingredients
High content can cause hyper-keratotic lesions
Possible link to oral cancer? (inconclusive and still heavily debated)
Alcohol
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
.12%
-Peridex, perio-gard
Cholorohexidine
0.12% CHXAlcohol 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
ALCOHOL-FREE CHLORHEXIDINE
Side effects of \_\_\_\_\_\_: Staining Altered taste Supragingival calculus mucositis
Chlorhexidine
What is the dosage and how many time a day for how long should it be used?
15 ml; Twice daily 30 secs
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)
CHX
_____ on established biofilm will have only superficial effects.
is more effective when plaque is removed prior to rinsing.
The biofilm will adapt and protect itself from the effects.
CHX
Inactivated by toothpaste—important to rinse well with water prior to rinsing with it (or wait 30 min before rinsing with it)
DO NOT rinse with water immediately after rinsing with it
Recommend for patients who cannot or will not maintain adequate plaque control
Post (periodontal) surgical cases
CHX
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
Phenolic Compounds (Listerine)
Side effects of _______:
Bad taste
Burning sensation
Tooth staining
Phenolic compounds
How often per day, how much, and for how long do you use phenolic compounds?
20 ml twice a day for 30 secs
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
LISTERINE ZERO
Ingredient in many OTC ‘cosmetic’ mouthwashes (.05%)
Quaternary ammonium compound
Marginally effective in reduction of plaque and gingivitis
Little to no substantivity
Cetylpyridinium chloride (CPC) 0.5%
ie: Crest Pro-Health Rinse Multi-Protection Rinse* // 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 metabolism and inhibit cell growth
CETYLPYRIDINIUM CHLORIDE (CPC) (.07% THERAPEUTIC CONCENTRATION)
Alcohol free
Cleanses oral wounds, irritations
Preliminary information reported H2O2 to be effective against COVID
*More investigation: Data does not currently support
Hydrogen peroxide based rinses
“…Plaque Loosening Rinse”
Marketed as pre-brushing rinse
Ingredients: surfactants (detergents), sodium bicarbonate, glycerin, alcohol (7.5%)
Non-toxic, non-irritating, no enamel damage
- No active ingredients
- Not therapeutic
PLAX
The following are reasons to recommend 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 surgeryPatients undergoing disease control therapy
Mouthrinse
Are the following products therapeutic or cosmetic?
Peridex(CHX)
Listerine Antiseptic (and generic equivalents)
Crest Pro-Health Multi-Protection Rinse/Colgate Total Advanced Pro-Shield (0.07% CPC)
THERAPEUTIC
Are the following products therapeutic or cosmetic?
Scope, Cepecol, Lavoris, etc. (.05% CPC)
Whitening rinses
Plax and other pre-brushing rinses
Listerine Zero
COSMETIC
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.
Oil Pulling
Multifactorial disease Can be altered by secondary factors: fluoride, saliva flow, etc. Bacterial infection, followed by acid attack Remin/demin Controlled by multiple risk factors Trends Decline: fluoride Increase: fermentable carbohydrate
Caries
stabilize high concentrations of calcium and phosphate ions, together with fluoride ions, at the tooth surface by binding to pellicle and plaque
The ions are supposedly freely bio-available and can diffuse into enamel subsurface lesions, thus promoting re-mineralization
Evidence suggests that, under highly favorable conditions, these agents may re-mineralize lesions to a low/modest extent. There is need for independent, randomized, controlled studies, under clinically relevant conditions
CPP-ACP (Recaldent)
□Active caries
□Restorations within 3 years
□Areas of demineralization, including interproximal
Caries disease indicators
□Multiple multi-surface restorations □Frequent snacking/sugared drinks □Reduced saliva □Exposed roots □Visible, heavy plaque □Deep pits and fissures □Ortho □Recreational drug use □Physical or mental limitations
Caries risk factors
□Regular dental care □Regular professional fluoride treatments/varnish □Sealants □Fluoridated water □Fluoridated toothpaste □OTC fluoride mouthrinse(daily) □Rx fluoride daily (5000 ppm) □Xylitol gum □Xylitol products □Adequate saliva flow
Caries protective factors
_____ caries risk:
no disease indicators, <2 risk factors, has protective factors
□Low
_____ caries risk
no disease indicators, >2 risk factors (but no caries
□Moderate
_____ caries risk:
(cavitated lesion(s)/disease indicators OR > 3 risk factors)
□High
Cleansing action
Re-mineralization and repair of enamel
Antimicrobial Properties
Diltuion of Plaque acids
Saliva
Many compounds (antibodies, enzymes, hormones) found in blood are also found in it
_____ can be source to monitor oral and systemic health
Contains biomarkers that serve as indicator of normal processes, pathologic processes, and pharmacologic response to therapy
Biomarkers can be used to predict disease
Contribute to prevention and treatment
Aid in assessment of potential health risks
Saliva
Detect levels of Strep mutans and lactobacilli (Most) require 48-hour incubation period and follow-up appointment to discuss results
Chairside tests available (15 minute result)
Salivary bacterial count
_______ can lead to demineralization and dental caries
Influenced by time of day, diet, age, disease, and medications
Testing flow rate can aid in caries susceptibility and in diagnosing salivary gland dysfunction
Buffer capacity measures response to acid challenge
Insufficient salivary flow
Provide opportunity for patient to objectively observe their dietary habits.
Gain overall picture of types of food in patient’s diet
To study food habits: ie. frequency and regularity of foods eaten. (record frequency of cariogenic foods)
Determine consistency of diet (fibrous vs sticky)
Overall objectives:
identify specific dietary behaviors that affect caries risk (identify the high-risk behaviors)
Enable clinician to open conversation regarding dietary habits
Diet assessment
Record 24 hr period –week-long
Explain purpose
Review form/app that you will send home with patient
Encourage to fill out soon after eating
Record everything eaten, including beverages and in-between meal snacks.
Encourage patient to be detailed
Encourage patient to be truthful
Consider having patient include when he/she brushes/flosses
Diet diary
During what appointment should caries assessment and prevention/management?
Diagnosis appt
