chemical agents in plaque biofilm control Flashcards
define systemic delivery
administering chemical agents such as antibiotic, in the form of tablet or capsule
define local delivery? example?
placing a chemical agent into the mouth or even into a perio pocket
example is toothpaste that contains a chemical agent that can kill bacteria such as stannous fluoride
what inhibits calculus formation
pyrophosphates
examples of chemical agents used in perio patients
- therapeutic mouth rinses
- therapeutic dentifrices
- subgingival irrigation
- controlled-release delivery devices
what could cause resistance of biofilm to delivery of chemical agents
- surface of plaque biofilm is covered by an extracellular slime layer
- slime layer acts as a natural barrier to protect organized bacterial colonies living in plaque biofilm
- slime layer prevents chemical from contacting and killing bacteria
what is a microbial reservoir
secure place that allows periodontal pathogens to live undisturbed during routine periodontal therapy and subsequently repopulate periodontal pockets quickly.
is there a chemical agent that can control perio?
no
examples of chemical agents
antibiotics, fluorides, metal salts, antimicrobial, phenolic compounds, and antiseptics
examples of antibiotics studied for use in perio care
- penicillin and amoxicillin
- tetracyclines
- clindamycin
- erythromycin
T/F: routine use of systemic antibiotics for plaque-induced gingivitis and chronic perio is recommended
false; not recommended
why is antibiotics not recommended
bacterial antibiotic resistance and good response to plaque-induced gingivitis and chronic perio can come from NSPT
how often would antibiotics need to be taken to control bactiera in mouth?
many many years
when is antibiotics indicated?
for patients with aggressive perio and other rarer forms of perio
what is microbiologic analysis used for?
used to identify the antibiotic that is effective against the bacterial pathogens present in patient’s biofilm
use of tetracyclines
- higher concentrations of the drug concentrate
- effective against A.A.
- inhibit action of collegenase
how is controlled-release delivery device used in the mouth
- an antibacterial chemical embedded in a carrier material
- device is placed directly into perio pockets
- material dissolves slowing producing a steady release of antimicrobial agent over a period of several days within the perio pocket
benefits of controlled-release delivery device
- result in a small increase in attachment level in perio pocket
- when used with perio instrumentation they can result in both an improvement in probing depth reduction and a clinical attachment gain
mechanisms of controlled-release delivery
- tetracyclin hydrochloride-containing fibers
- minocycline hydrochloride microspheres
- doxycycline hyclate gel
- chlorhexidine gluconate chip
features of tetracycline fibers
- no longer available in US
- gingival retraction cord impregnated with tetracyclin
- fiber laid back and forth all around tooth
minocyclin hydrochloride microspheres features
- cannula tip is used to expel microsphere into perio pocket
- within 5-7 days the microspheres dissolve so nothing to remove from pocket
reactions from minocyclin
- oral candidiasis
- allergic reaction
- don’t use in women who are pregnant or nursing
doxycycline gel features
- tetracycline derivate
- antibiotic is delivered in a gel to perio pocket with cannula
- gel solidifies into a waxlike substance
- gel dissolves
reactions from doxycycline
- oral candidiasis
- allergic reactions
- do not use in pregnant or nursing mothers
chlorhexidine gluconate chip features
- tiny gelatin chip containing the antiseptic chlorhexidine
- can be used in pockets with 5 mm or greater in depth
- chip dissolves
- no risk of antibiotic resistance with the use of gelatin chip
what must you have to use gluconate chip? why?
5 mm pocket because if not then the chip will fall out of the pocket
uses of cosmetic mouth rinses
used to cover up or mask odors of halitosis
-do not control oral disease such as gingivitis
therapeutic mouth rinse purposes
- decrease dental plaque enough to also decrease the severity of gingivitis
- can decrease the risk of dental caries
characteristics of an ideal mouth rinse
efficacy, stability, substantivity, safety
define efficacy
inhibits or kills perio pathogens
define stability
stable at room temp and have a reasonable shelf life
define substantivity
retained in the oral cavity and released slowly over several hours with continued effect
define safety
does not produce any harmful effects on local tissues
define active ingredient
component that produces a benefit for the patient
define inactive ingredient
component added to give color or taste, preserve, or keep in a liquid state
3 ingredients that have some effect on gingivitis are….
- chlorhexidine gluconate
- essential oils
- cetylpyridinium chloride
how much can chlorhexidine reduce the overall severeity of gingivitis by?
by 50 % when used as directed
what is chlorhexidine effective against?
gram positive and negative bacteria, very low level of toxicity and shows no permanent retention in the body
why is the primary mechanism of action for chlorhexidine
disruption of the integrity of the cell walls of bacteria
patients who would benefit from using chlorhexidine
special needs, patients with dental caries, oral piercings, candida infections, and patients in nursing homes
chemical agents included in essential oils
thymol, menthol, and methyl salicylate
features of mouth rinses containing essential oils
reduces gingivitis by 35%
- less effective than chlorhexidine
- less expensive than chlorhexidine
- pre-procedural rinses reduces bacteria in aerosols by more than 90%
quaternary ammonium compounds features
- released so rapidly that is has very little substantivity, limiting its effectiveness
- less effective than chlorhexidine and essential oils
povidone iodine as a mouth rinse features. who shouldn’t use this?
- used in medical practice as a presurgical scrub for skin disinfection
- safety concerns
- shouldn’t be used with patients who have sensitivity to iodine, allergies to shellfish, thyroid dysfunction, or women who are lactating or pregnant
what ingredient inactivates chlorhexidine
sodium laurel sulfate
side effects of essential oils
burning sensation in mouth, bitter taste, drying out mucous membranes
ADA classificiation of dentifrices
-antitartar activity, caries prevention, whitening, gingivitis reduction, plaque formation reduction, tooth sensitivity reduction
what ingredients reduce supragingival calculus
pyrophosphates, triclosan, and zinc citrate
