Chemotherapeutics In Periodontal disease Flashcards
Differentiate antiseptics and antibiotics
Antiseptics
• Usually topical
• Slows the growth of a variety of organisms instead of killing them
Mechanism of action
• Targets a variety of organisms which reduces likelihood of resistance
Antibiotics
• Can be systemic and topical
• Prevents growth and kills bacteria
Mechanism of action
• Specially targets bacteria; damages cell walls, impedes protein synthesis, nucleic acid and metabolism
List the functions of mouth rinses (5)
· Plaque control · Caries prevention: via fluoride · Manage dentinal hypersensitivity: via potassium · Manage dry mouth · Freshen breath
List the criteria for acceptable mouth rinses (7)
· Ability to inhibit plaque
· Ability to prevent gingivitis
· Should not cross react with toothpaste ingredients
· Have acceptable taste
· Should not promote bacterial resistance
· Should not have adverse effects
· Should not be toxic
Describe the role of mouth rinses in modern oral health
Mouth rinses act as an adjunct to mechanical plaque control
· They help prevent bacterial colonisation and alleviate inflammation
Describe the spectrum and method of using of chlorhexidine
Spectrum: · Broad- spectrum effect · Affects mainly G+ bacteria · Moderate activity against Mycetes · Weak activity against G- bacteria
Use:
• Plaque removal prior to CHX rinsing increases the efficacy of CHX
• Toothbrushing is essential in breaking and exposing the bacteria to CHX
Describe the properties of chlorhexidine
Properties (binding):
• CHX binds to bacteria in plaque, enamel and acquire pellicle
• CHX binds to mucosa by binding to the carboxyl group in the mucin layer
• After a single rinse, 30% of CHX remains in the mouth and is gradually released. This can help provide 24 hr bacterial prevention
Describe the mechanism of action of chlorhexidine
Concentrations:
• Low concentrations (0.05 - 0.06%): bacteriostatic actions
• High concentration (0.12%): gives bactericidal activity
Mechanism of action:
• Anti- plaque properties: Alters osmotic structure of bacterial cell wall
- Prevents formation of new acquired pellicle: reduces attachment of salivary glycoproteins to tooth
- Prevents bacteria from binding to acquired pellicle: Firstly, it reduces the vital bacteria in saliva and secondly, it binds to the surface of salivary bacteria and interferes with their absorption mechanisms
- Disrupts structure of existing bacterial plaque: Displaces Ca+ from sulphate groups that is known to ‘glue’ biofilm together
Describe the spectrum of Essential Oils (EO)
Spectrum: • Broad antimicrobial spectrum • Affects G+ • Affects G-bacteria • Affects fungi, some viruses
Describe the mechanism of action of Essential Oils (EO)
Mechanism of action:
• Extracts endotoxins: reduces the pathogenicity of biofilm bacteria
- Penetrates plaque mass: Able to penetrate plaque mass and exert antimicrobial effects on bacteria growing in the biofilm
- Disruption of the cell wall and precipitation of cell protein
- Inactivates of essential enzymes
- Phenolic compounds of EO are anti-inflammatory and inhibit prostaglandin synthesis
- Act as scavengers of free oxygen radicals
- Interferes with plaque formation and maturation
List common commercial antiseptics
- CHX
- EO- essential oils
- CPC- cetylpridinum chloride
- Natural mouth rinses
Describe the effectiveness (with evidence) of CHX
Chlorhexidine- 0.12%:
• Preventing mild gingivitis/ minor issues: 2 weeks of consist use is required
• Treating chronic, severe diseases: 4-6 weeks of consist use is required
• Alcohol free CHX is as effective in being anti-plaque and anti-gingivitis as those containing alcohol
Describe the effectiveness (with evidence) of EO
EO
• In a RCT study, the test group using toothbrushing, floss and Listerine had reductions in interproximal plaque and in gingival inflammation
• Mouthwash is as effective as floss in controlling ID plaque and gingivitis
• Significant reduction of anaerobic microorganisms, volatile sulphur compounds producing microorganisms responsible for halitosis up to 12 hours after a single rinse
Describe the effectiveness (with evidence) of CPC
CPC (Cetylpyridinium chloride):
• Low substantivity of CPC means oral retention is very low
• More frequent rinsing with CPC (4x per day) to have an efficacy comparable to CHX. However, patient compliance would be low
• Like CHX, it interacts with SLS in toothpaste
• Similar side effects as CHX but less severe
Describe the effectiveness (with evidence) of natural mouth rinses
Natural mouth rinses:
• Are alcohol and preservative-free mainly contain herbal ingredients like tea tree oil and aloe vera extracts
- Most herbal rinses claim to reduce microbes associated with halitosis, however, some manufacturers claim plaque inhibitory and anti-inflammatory potential
- Oil-pulling (coconut, sesame seed, sunflower oil) -swishing a tablespoon of oil for 20 min before breakfast
• Very little evidence related to clinical effects of natural mouth rinses
Describe the potential risks associated with daily use of CHX
• Temporary sensation of burning and dry oral mucosa
• Desquamative lesions
• Swelling or parotid glands
• Type I and Type IV hypersensitivity reactions
• Risk of anaphylaxis (in central venous catheters)
• Extrinsic yellow/ brown stains: of teeth, oral mucosa (tongue) and composite restorations
- Improper removal of biofilm/ supply of staining sources like coffee can increase chances of staining
Describe the potential risks associated with daily use of EO
- 40% less effective than Chlorhexidine
- Tingling and burning - due to high amounts of alcohol
BUT
• Less staining
• Rare hypersensitivity reaction
Rare taste
Provide recommendations for the daily use of chlorhexidine and EO
CHX
-20mg 2x per day for 30sec-1min
EO
-20mls 2x per day 20-30 secs
Explain why antimicrobial agents cannot replace instrumentation and mechanical plaque removal
instrumentation and mechanical plaque control is the start basics of prophylaxis and prevents periodontal disease. Mechanical and instrumentation disrupts biofilm and exposes bacteria.
antimicrobial agents don’t disrupt the biofilm it prevents bacterial colonisation and alleviates inflammation
list how systemic antibiotics work
- enters the periodontal pocket through the epithelial lining and can be found in GCF
- reaches bacteria in hard to reach sites; furcations and Intra-boney defects, epithelium and connective tissue
list how local antibiotics work
Local delivery antibiotics work by directly applying treatment to the source. This is especially effective since the majority of bacteria associated with periodontal disease reside in the periodontal pockets. While other treatments can reach and treat various areas of the mouth, most cannot reach into these pockets. This leaves a good amount of bacteria behind to reproduce and continue to progress the disease.
List instances when systemic antibiotics are used (5)
- Pts with unresolved/ progressive site of mechanical debridement
- Rapid progressing forms of periodontal disease
- Acute forms of periodontal disease resulting in systemic systems such as a abscess
- Antibiotic proxylaxisis- if the pt is at risk of developing bacterial endocarditis and immune-compromised pts
- Implant Therapy
List instances when local antibiotics are used
- Periodontitsis- supra and subgingival scaling
- Localised pockets- BOP and LOA
List the adverse effects for systemic antibiotics (6)
- Allergies
- Superinfection
- Bacterial resistance
- Drug Interactions
- patient compliance
- GIT issues
List the adverse effects for local antibiotics
- Headache
- Bitter taste
- temporary local tenderness
