Chemical plaque control and periodontal surgery

Question 1

Name some antiseptics used to inhibit growth of bacteria:

Answer 1

• quaternary ammonium compounds e.g. cetylpyridinium chloride used in mouth rinses
• phenols and essential oils e.g. triclosan used in toothpastes and mouth rinses
• natural herbal products e.g. sanguinarine used in toothpaste and mouth rinse
• bisguanide antiseptics e.g. chlorhexidine, inhibits plaque regrowth

Question 2

What are some implications of chlorhexidine?

Answer 2

• causes staining
• tastes bitter
• affects salivary glands, leading to a dry mouth
• differing electrical charges to toothpaste, so must be used 30 mins apart

Question 3

What is a periochip?

Answer 3

• a hydrolysed gelatine chip containing 2.5mg chlorhexidine
• effective in sites that have not responded well to initial non-surgical therapy

Question 4

What is the role of periodontal surgery?

Answer 4

• provides access to root surfaces for investigation of residual periodontal pockets
• debridement and scaling of root surfaces and access to furcation areas, osseous defects and may involve root amputation or an attempt to regenerate periodontal attachment
• may be able to improve mucogingival defects and enhance the outcome of implant related treatment

Question 5

What is the recall recommendation for supportive therapy/maintenance?

Answer 5

• 3 monthly recalls are usually recommended
• examine for pockets, BOP, plaque and mobility

Question 6

What are the components of toothpaste?

Answer 6

• water
• active components: antibacterial, anti-caries, desensitisers
• abrasives
• detergents and binding agents
• thickeners
• humectants and preservatives
• flavouring and sweetening agents

Question 7

What is the role of abrasives in toothpaste?

Answer 7

• used to aid plaque/stain removal
• relatively inert
• low intrinsic hardness
• appropriate distribution and particle size to provide low abrasiveness to teeth: need to clean adequately without causing unacceptable wear of enamel/dentine

Question 8

What is the role of detergents and binding agents?

Answer 8

Detergent: added to make paste foam on use
- helps distribute paste around oral cavity and loosen debris
Binding agents: prevent separation of liquid and solid phases of toothpaste during storage

Question 9

What are thickeners, humectants and preservatives?

Answer 9

Thickeners: give pate consistency
Humectants: conserve moisture especially if lid left off
Preservatives: prevent bacterial growth

Question 10

What disadvantages can flavours and sweeteners have?

Answer 10

• can cause mucosal irritation, ulceration and peri-oral dermatitis

Question 11

What is the anti-caries agent in toothpaste?
Antibacterial/anti-plaque?

Answer 11

Fluoride:
- 1000-1500ppM fluoride, commonly sodium monofluorophosphate
Anti-bacterial/antiplaque:
- bisbiguanides and phenols ? few side effects

Question 12

Name some agents used as desensitising in toothpaste:

Answer 12

• potassium nitrate
• potassium chloride
• sodium fluoride
• stannous fluoride
• silica
• strontium chloride
• formaldehyde