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SP15 - Periodontology Exam 1 > *Exam 1 Review of 01/14-01/20 Lectures > Flashcards

*Exam 1 Review of 01/14-01/20 Lectures Flashcards

1
Q

In periodontology, what are the 6 things we are treating?

A
  • plaque-induced gingivitis
  • non-plaque related gingival diseases
  • chronic periodontitis (localized, generalized, slight, moderate, severe)
  • aggressive periodontitis (localized, generalized, slight, moderate, severe)
  • other forms of periodontal diseases
  • peri-implant diseases
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2
Q

What brushing method works better?

A

NONE

if patient doesn’t brush at all, teach them modified bass method (45 degree angle with the bristles pointing toward the gingiva; movement with a vibratory circular motion and additional sweeping motion)

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3
Q

Does toothbrush design make any difference?

A

a slender brush (17 degree angulation of brush head to the handle) reduced more plaque in the study

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4
Q

Does brushing time have any effect on plaque removal?

A

in the graph, the plaque reduction for 1 min and 2 min were similar and increased a bit for 3 and 4 min

recommend a minimum of 2 min but after 2 min, there is really no difference

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5
Q

What about brushing frequency and gingival inflammation?

A
  • by the end of 6 weeks, brushing every day and brushing every other day was very equivalent (brushing every 72-96 hours raised plaque significantly)
  • recommend 2x per day because people don’t brush for a long enough time
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6
Q

What else do we recommend for patients with periodontal problems?

A
  • brush every day 2x per day

- brush for at least 2 minutes

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7
Q

How often do we need to replace our brush?

A
  • tooth brush can effectively remove plaque for at least 2 months and after 9 weeks, one should consider a replacement
  • keep tooth brush dry to reduce bacterial growth
  • replace interproximal brushes every 10 days to 2 weeks
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8
Q

Are power toothbrushes better than regular toothbrushes?

A

powered toothbrushes with a rotation oscillation action provide slightly better plaque removal and may provide better protection against gingival inflammation than a manual toothbrush

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9
Q

How do power toothbrushes work?

A
  • rotation

- oscillation with sonic waves

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10
Q

What type of defects do we see due to trauma from brushing/flossing at the hard tissue level? At the soft tissue level?

A
  • HARD TISSUE: cervical abrasion
  • SOFT TISSUE: gingival erosion, gingival recession, lines created by floss, ulceration

*round-ended bristles are more gentle than cut-ended bristles (provided the force is gentle too)

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11
Q

True or false: All patients are efficient at brushing their teeth.

A

FALSE: Not all patients are efficient at brushing their teeth.

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12
Q

What are the ingredients in toothpaste?

A
  • humectants
  • water
  • buffers/salts/tartar control
  • organic thickeners
  • abrasives
  • actives (ex. fluoride, triclosan)
  • surfactants
  • flavor, sweetener
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13
Q

Calcium phosphates, calcium pyrophosphates, hydrated silica, alumina, calcium-carbonate, and sodium bicarbonate are all examples of what?

A

abrasives

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14
Q

Abrasion of an abrasive depends on what?

A
  • particle size
  • particle shape
  • also bristle hardness, forces applied during brushing, and tooth surface
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15
Q

What are the 3 types of fluorides in toothpastes? What is their purpose?

A
  • sodium fluoride
  • monofluoro-phosphate (MFP)
  • stabilized stannous fluoride
  • caries prevention and anti-inflammatory
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16
Q

Glycerine, sorbitol, xylitol, and propylene glycol are all examples of what?

A

humectants

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17
Q

Sodium-lauryl-sulfate and sodium-n-lauroyl sarcosinate are examples of what?

A

surfactants

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18
Q

Toothpaste is a sophisticated drug delivery system that will deploy efficacious medications in a ___ manner and through a medium that can ___ the therapy’s administration.

A
  • intact

- control

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19
Q

Which was shown to reduce more plaque: fluoride or triclosan? Which reduced gingival inflammation more effectively?

A
  • triclosan

- triclosan (although stannous fluoride also has anti-inflammatory effects)

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20
Q

True or false: The concentration of triclosan in dental plaque is lower than the MIC of plaque bacteria.

A

FALSE:
MIC = 0.29-0.78 ug/mL
triclosan in dental plaque = 4.14 ug/mL
(concentration stays high after 14 hours)

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21
Q

True or false: Triclosan is effective at inhibiting TNF-alpha and IL-1beta production of PGE2.

A

true

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22
Q

What active ingredient in toothpaste can cause staining?

A

stannous fluoride (triclosan does not cause staining)

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23
Q

In testing toothpaste and calculus, what toothpaste was best at reducing the calculus score?

A

Colgate Total and Colgate Tartar Control (both have triclosan?)

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24
Q

The relative caries preventative effects of fluoride toothpastes of different concentrations increase with ___ (higher/lower) fluoride concentrations. For children under age ___, the benefits of fluoride should be balanced with the risk of fluorosis and caries.

A
  • higher

- 6

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25
Q

True or false:

  1. Mouth rinses are needed to help fight against bacterial recolonization.
  2. It has both anti-plaque and anti-gingivitis effect.
A

true

true

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26
Q

What are the 3 common active ingredients in mouth rinses?

A
  • essential oils
  • cetylpridinium chloride (quaternary ammonium compound)
  • chlorhexidine (0.12%)
27
Q

For essential oils, what are the active ingredients? What is the indication? What is the action?

A
  • ACTIVE: thymol, eucalyptol, methyl salicylate, menthol
  • INDICATION: to help prevent and reduce plaque, gingivitis, and bad breath
  • ACTION: inhibits symptoms of gingivitis
28
Q

What percentage of alcohol is in essential oils? Does it have the ADA seal of acceptance?

A
  • 26.9% (*know this)

- yes, for helping to control plaque and gingivitis

29
Q

How do essential oils work? What percentage of plaque and gingivitis reductions are seen?

A
  • broad spectrum activity against gram positive and gram negative bacteria
  • non-selectively and rapidly disrupts bacterial cell wall
  • reduces plaque endotoxin levels and pathogenicity for gingivitis
  • plaque reductions up to 56.3%
  • gingivitis reductions up to 35.9% (*know this)
30
Q

What is the active ingredient in CPC (Viadent)? In CPC (Cepacol)? What is the indication for them?

A
  • VIADENT: 0.05% cetylpryidinium chloride and 0.2% zinc chloride
  • CEPACOL: 0.05% cetylpryidinium chloride
  • INDICATIONS: to reduce plaque and gingivitis as an antiseptic
31
Q

What is the alcohol content of CPC? What is the percentage of plaque reduction? Of gingivitis reduction? Is this ADA accepted?

A
  • 14% alcohol
  • 15-25% plaque reduction
  • 20% gingivitis reduction
  • yes
32
Q

How does CPC work?

A
  • ruptures bacterial cell membrane, leading to rapid leakage of cell contents and cell death
  • may alter bacterial metabolism, inhibiting cell growth
33
Q

What is the active ingredient of chlorhexidine (Peridex)? What is the indication? What is its action?

A
  • ACTIVE: 0.12% chlorhexidine gluconate
  • INDICATION: treat gingivitis and bleeding gums
  • ACTIONS: kills bacteria by altering the permeability of the cell membrane of the bacteria; causes cell to leak which kills it
34
Q

What does chlorhexidine bind to? What can it cause in and on the tooth? What does it taste like?

A
  • binds to bacteria but also other surfaces so it stays in the oral cavity longer
  • may cause tooth discoloration, increase in calculus formation, local hypersensitivity, or generalized allergic reactions
  • bitter taste
35
Q

How does chlorhexidine work?

A
  • ruptures bacterial cell wall membrane leading to rapid leakage of cell contents and cell death
  • binds salivary mucins, reducing pellicle formation which in turn inhibits plaque bacteria colonization
  • binds bacteria, inhibiting adsorption onto teeth
36
Q

What is the percentage of plaque reduction in chlorhexidine? Of gingivitis reduction?

A
  • 60.9% plaque reduction

- 42.5% gingivitis reduction

37
Q

Herbal extracts are the primary form of healthcare for what percentage of the world’s population?

A

80%

38
Q

True or false: A few herbal extracts have the ADA seal, but the majority do not.

A

FALSE: No herbal extracts have the ADA seal.

39
Q

What mouth rinse does this describe?

  • more effective as antimicrobial
  • requires prescription
  • specifically prescribed for patients with periodontal issues
A

bisbiguanides (chlorhexidine gluconate)

40
Q

What are some possible ways to treat halitosis?

A
  • eliminate etiological factors
  • review oral hygiene habits
  • recommend dietary changes
  • consult ENT or internal medicine doctor if needed
41
Q

What is the efficacy of preprocedural mouthrinsing?

A
  • in some cases, you may want to do this, but initial therapy is key
  • helps prevent contamination of the office
42
Q

What is the role of alcohol in mouth rinses? Who is contraindicated for alcohol-containing mouth rinses?

A
  • solubilizes ingredients

- alcoholics and children less than 12 years old

43
Q

Where is triclosan found?

A
  • wide variety of household and personal care products (hand soap, toothpaste, deodorants, textile fibers)
  • some surgical sutures
44
Q

What is the general consensus about the safety of fluoride?

A
  • exposure is routine (tea, fish, meat, fruits, toothpaste, dental gels, non-stick pans, razor blades)
  • fluoride can accumulate in the body and continuous exposure can cause damaging effects, particularly in the nervous system
45
Q

What is the general consensus about alcohol-containing mouth rinses and patients with xerostomia?

A
  • oral irritation potential of EO-containing mouthrinses is minimal
  • salivary flow rates are higher post-rinse than pre-rinse
  • in a few studies, at day 7, some in mouth rinse group had mucosal abnormalities, but tissues were back to normal at day 14
  • EO-mouth rinse that contains alcohol is safe for patients with xerostomia as long as usage is monitored by dentist
46
Q

What is the general consensus about alcohol-containing mouth rinses and the risk for oral cancer?

A
  • evidence does not support a causal relationship

- pharmaceutical-grade alcohol is free from contaminating carcinogens

47
Q

When does locally-delivered antimicrobials have a critical benefit in threatening periodontitis?

A

in localized non-responding sites and localized recurrent disease

48
Q

What are the 2 targets of in-office local therapy for periodontitis?

A
  • reduce bacterial burden

- modify destructive host response

49
Q

What is controlled delivery? Who is it applied by?

A
  • reagent introduced into site at low dose; will stay at the site at high concentrations and slowly be released over multiple days
  • applied by therapist
50
Q

What are the 3 local antimicrobial delivery reagents?

A
  • chlorhexidine
  • doxycycline
  • minocycline
51
Q

What is the only antibiotic systemically prescribed at sub-antimicrobial dose to modify host response?

A

doxycycline (20 mg/day for 3 months)

52
Q

What are the devices of local antimicrobial delivery?

A
  • fibers
  • strips and compacts
  • films
  • injectable systems (microparticles and gels)
53
Q

What are the indications for local antimicrobial delivery?

A
  • localized SLIGHT TO MODERATE chronic periodontitis patient with limited amount of sites that are unresponsive to non-surgical therapy
  • should be considered as ADJUNCTIVE therapy to SRP for LIMITED sites with 5+ mm probing depths
54
Q

What are the contraindications for local antimicrobial delivery?

A
  • allergies to specific antimicrobial reagent
  • several sites in the mouth with residual periodontal pockets following SRP
  • applications without performing SRP (may cause a periodontal abscess if there is anything left in the pocket)
55
Q

What are the 3 host modulatory agents?

A
  • bisphosphonates
  • non-steroidal anti-inflammatory drugs (NSAID)
  • low-dose tetracyclines
56
Q

How do bisphosphonates work? What are the side effects? What is its effect on attachment loss and bone density?

A
  • incorporated into the bone and incapacitates the osteoclast, thereby reducing bone resorption (Paget’s, hypercalcemia, osteoporosis, metastatic bone diseases)
  • SIDE EFFECTS: osteomalacia, allergic reactions, and jaw osteonecrosis
  • modest effect on bone density and little or no effect on attachment loss
57
Q

How do NSAIDs work? What are the side effects? What is its effect on attachment levels and gingival inflammation?

A
  • inhibit the biosynthesis and release of prostaglandings in cells
  • SIDE EFFECTS: gastrointestinal ulceration, allergic reactions, gastrointestinal and renal toxicity
  • reduce gingival inflammation; however, effects on attachment loss are modest
58
Q

How do low dose tetracyclines work? What is its effect on attachment levels?

A
  • concentrates in GCF and uses cementum as reservoir; inhibits tissue destructive enzymes (MMP-8)
  • increased attachment levels on average by 0.5 mm, decreased PD and BoP
59
Q

What is needed for local delivery of the active ingredient into the pocket?

A
  • need to be applied easily (shelf life, handling characteristics, chair time, etc.)
  • need a carrier
  • need to be delivered at high concentration (locally)
  • need to stay at high concentration and released slowly for a certain time
  • side effects (allergies, GI problems, etc) should be minimal
60
Q

What are the strengths of controlled delivery?

A
  • rate control: >24 hours release
  • active over multiple days
  • active only at site
  • high concentrations (many times MIC)
  • low total dose
  • applied by therapist
61
Q

According to the study, what was the efficacy of chlorhexidine delivered in a gelatin chip?

A

there was a difference in the probing depths after 6 months in those who had the chlorhexidine and the controls

62
Q

According to the study, what was the efficacy of minocycline locally delivered in microcapsules?

A

statistically significant reduction in probing depth with SRP+minocycline m. spheres compared to those with SRP and SRP+vehicle

63
Q

According to the study, what was the efficacy of doxycycline locally delivered in patients with moderate to severe chronic periodontitis vs. those in the periodontal maintenance program?

A

equal effectiveness

64
Q

True or false: Mechanical debridement before the application of a locally delivered agent and plaque control after therapy are essential for success of the agent.

A

true!

SP15 - Periodontology Exam 1 (7 decks)

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