Chemotherapeutics in periodontal therapy 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
- CPC
- 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
