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Perio II > Ch 23 > Flashcards

Ch 23 Flashcards

1
Q

what are the 2 classifications of oral rinses

A
  1. therapeutic rinses: treat diseases (gingivitis, NUG)

2. cosmetic rinses: freshen breath

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2
Q

what are indications for oral rinses

A
  • in addition to home care for supragingival biofilm reduction and gingivitis
  • as an addition to periodontal instrumentation
  • following surgical procedures when brushing and flossing are generally not practical
  • maintenance of dental implants
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3
Q

how do mouthrinses work

A
  • supragingival only
  • suppress the pathogenicity of existing biofilm(s)
  • does not reach subgingivally
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4
Q

contents of mouthrinses and their purposes

A
  • alcohol: enhances flavour, solubilizes flavour component, antibacterial
  • flavour: taste, refreshing cool quality
  • humectant (glycerin): adds body, inhibits crystallization around closure
  • surfactant (sodium lauryl sulfate): solubilizes flavour, foams, removes debris by lowering surface tension
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5
Q

what is substantivity

A
  • binds to tissues or tooth surfaces and slowly releases over time
  • ideal for rinse to have high substantivity
  • major requirement for the success of antimicrobial therapy
  • 3 “generation” agents for substantivity
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6
Q

what are first generation agents of substantivity

A
  • ex. colgate
  • low substantivity
  • limited therapeutic value in reducing biofilm and gingivitis
  • phenolic compounds: listerine
  • quaternary ammonium compound: scope, cepacol
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7
Q

what are second-generation agents of substantivity

A
  • ex. chlorhexidine
  • antibacterial properties in addition to high substantivity
  • bisbiguanide (0.12% chlorhexidine gluconate) – best percentage for substantivity
  • peridex
  • periogard
  • fluorides
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8
Q

what is chlorhexidine gluconate 0.12%

A
  • binds to salivary proteins, bacteria cell wall, mucous membranes, tooth enamel
  • enters the bacterial cell wall and causes death of the bacteria
  • concentration of alcohol is 11.6%
  • GUM makes alcohol-free chlorhexidine
  • chx binds to fluoride and sodium lauryl sulfate in toothpaste, thus, rinse for 30 secs with chx either 30 mins before or after toothbrushing (8-12 hour substantivity)
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9
Q

what are examples of phenolic compounds and what are their contents

A
  • listerine (low substantivity)
  • essential oils: eucalyptol, thymol, methyl salicylate, menthol. first generation agent
  • percentage of alcohol in original listerine: 26.9%
  • percentage of alcohol in newer listerine products: 21.6%
  • there is a 0 alcohol as well
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10
Q

what are quaternary ammonium compounds

A
  • positively charged
  • readily bind to oral surfaces and are released more rapidly or lose their activity upon binding to the surface
  • approximately 3 hours substantivity
  • cetylpyridinium active ingredient
  • same as chx don’t brush for 30 mins before or after
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11
Q

what are oxygenating agents

A
  • peroxides and perborates
  • used for acute necrotizing ulcerative gingivitis and pericoronitis
  • provides a cleaning action and gentle effervescence for oral wounds
  • <3% deemed safe
  • long term studies do not demo any benefit over home care
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12
Q

what is povidone iodine

A
  • broad spectrum: bacteria, viruses
  • binds to proteins: deliver at site of debridement
  • can stain
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13
Q

what is povidone iodine

A
  • broad spectrum: bacteria, viruses
  • binds to proteins: deliver at site of debridement
  • can stain
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14
Q

what are fluorides

A
  • the only fluoride with antibacterial/antibiofilm activity is stannous fluoride
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15
Q

what are indications for alcohol free mouthrinses

A
  • pregnant women
  • former alcoholics
  • patients taking medications
  • patients who prefer to avoid alcohol
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16
Q

what do we use for oral irrigation

A
  • no inflammation: water

- inflammation: medicament

17
Q

what was the goal of oral irrigation in the 60s, 70s and 90s

A
  • 60s: remove food debris
  • 70s: unattached of loosely adherent biofilm
  • 90s: flush out and detoxify
18
Q

where can we conduct supragingival irrigation

A
  • home supplied
19
Q

where can we conduct subgingival irrigation

A
  • home applied

- office applied

20
Q

what is the purpose of oral irrigation

A
  • disruption of biofilm
  • decreases toxicity
  • slows down recolonization
21
Q

what are the pros and cons to oral irrigation

A
  • limitations
  • mixed results
  • maintenance patients
  • single irrigation: 1 week
  • 14-28 days
  • prolonged – longer time (up to 8 weeks)
22
Q

what is supragingival irrigation

A
  • adjunct to mechanical removal or biofilm/calc
  • removes debris
  • flushes out loosely adherent biofilm
  • reduces inflammation
  • detoxifies bacteria
  • pockets up to 3-4 mm
  • pulsating (jet) stream of water
  • plastic jet tips
  • tip placed at right agnle
  • removes debris
23
Q

what is water irrigation

A
  • minimal decrease in biofilm
  • improved inflammation
  • alters bacteria toxicity
24
Q

what devices can be used for subgingival irrigation

A
  • squeeze containers
  • push syringes
  • powered devices: via jet, water pik
  • non-electric: max-i-probe
  • ultrasonic devices: piezon master 400
25
Q

what is a disadvantage of subgingival irrigation in office

A
  • there is reinfection of the pocket with bacteria
26
Q

what is home irrigation

A
  • 1-2 mm subgingival (pik pocket) for 5 seconds results in penetration of:
  • 90% in < 6 mm PD
  • 64% in > 7 mm PD
27
Q

how many clinicians perform chair-side subgingival irrigation

A
  • 43.4%
28
Q

how does calculus in pocket affect penetrability of subgingival oral irrigation

A
  • reduces penetrability
29
Q

what are some cautions for oral irrigation

A
  • 60 PSI pressure
  • tissue trauma
  • transient bacteremia
  • periodontal abscess; ulceration
30
Q

how can we make irrigation more affective

A
  • remove calculus deposits prior to irrigation
  • supragingival irrigation as an adjunct to OH, may be of value in treatment of gingivitis
  • professional subgingival irrigation takes time, is done infrequently, and shows no advantage to scaling and root planing alone
31
Q

what solutions can be used for irrigation

A
  • water
  • chx 0.02%
  • hydrogen peroxide
  • povidine iodine
  • fluorides
  • antibiotics
32
Q

what is the solution for supragingival irrigation with chx

A
  • chx 0.02%

- 1-1/4 glass of water + 4 capfuls

Perio II (5 decks)

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