Antimicrobials and Caries Risk Assesment

Question 1

: harmful to patient

Answer 1

Adverse effect

Question 2

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

Answer 2

Compliance

Question 3

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

Answer 3

Substantivity:

Question 4

: may be harmful, useful, or beneficial

Answer 4

Side effect

Question 5

pleasant taste and sensation, decrease in microorganisms, halitosis control

Answer 5

Cosmetic:

Question 6

reduction in plaque, gingivitis and/or dental caries

Answer 6

Therapeutic:

Question 7

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

Answer 7

Food and Drug Administration (FDA)

Question 8

Advertising OTC and Rx

Answer 8

Federal Trade Commission (FTC)

Question 9

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)

Answer 9

ADA Seal of acceptance

Question 10

Is it enough for an antimicrobial to reduce plaque only?

Answer 10

No; must be therapeutic

Question 11

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

Answer 11

Alcohol

Question 12

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

Answer 12

Cholorohexidine

Question 13

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

Answer 13

ALCOHOL-FREE CHLORHEXIDINE

Question 14

Side effects of \_\_\_\_\_\_:
Staining
Altered taste
Supragingival calculus
mucositis

Answer 14

Chlorhexidine

Question 15

What is the dosage and how many time a day for how long should it be used?

Answer 15

15 ml; Twice daily 30 secs

Question 16

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)

Answer 16

CHX

Question 17

_____ 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.

Answer 17

CHX

Question 18

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

Answer 18

CHX

Question 19

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

Answer 19

Phenolic Compounds (Listerine)

Question 20

Side effects of _______:
Bad taste
Burning sensation
Tooth staining

Answer 20

Phenolic compounds

Question 21

How often per day, how much, and for how long do you use phenolic compounds?

Answer 21

20 ml twice a day for 30 secs

Question 22

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

Answer 22

LISTERINE ZERO

Question 23

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

Answer 23

Cetylpyridinium chloride (CPC)
0.5%

Question 24

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

Answer 24

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

Question 25

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

Answer 25

Hydrogen peroxide based rinses

Question 26

“...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

Answer 26

PLAX

Question 27

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 surgeryPatients undergoing disease control therapy

Answer 27

Mouthrinse

Question 28

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)

Answer 28

THERAPEUTIC

Question 29

Are the following products therapeutic or cosmetic? Scope, Cepecol, Lavoris, etc. (.05% CPC) Whitening rinses Plax and other pre-brushing rinses Listerine Zero

Answer 29

COSMETIC

Question 30

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.

Answer 30

Oil Pulling

Question 31

``` 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 ```

Answer 31

Caries

Question 32

 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

Answer 32

CPP-ACP (Recaldent)

Question 33

□Active caries □Restorations within 3 years □Areas of demineralization, including interproximal

Answer 33

Caries disease indicators

Question 34

``` □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 ```

Answer 34

Caries risk factors

Question 35

``` □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 ```

Answer 35

Caries protective factors

Question 36

_____ caries risk: | no disease indicators, <2 risk factors, has protective factors

Answer 36

□Low

Question 37

_____ caries risk | no disease indicators, >2 risk factors (but no caries

Answer 37

□Moderate

Question 38

_____ caries risk: | (cavitated lesion(s)/disease indicators OR > 3 risk factors)

Answer 38

□High

Question 39

Cleansing action Re-mineralization and repair of enamel Antimicrobial Properties Diltuion of Plaque acids

Answer 39

Saliva

Question 40

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

Answer 40

Saliva

Question 41

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)

Answer 41

Salivary bacterial count

Question 42

_______ 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

Answer 42

Insufficient salivary flow

Question 43

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

Answer 43

Diet assessment

Question 44

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

Answer 44

Diet diary

Question 45

During what appointment should caries assessment and prevention/management?

Answer 45

Diagnosis appt