*Exam 1 Review of 01/14-01/20 Lectures Flashcards
In periodontology, what are the 6 things we are treating?
- 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
What brushing method works better?
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)
Does toothbrush design make any difference?
a slender brush (17 degree angulation of brush head to the handle) reduced more plaque in the study
Does brushing time have any effect on plaque removal?
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
What about brushing frequency and gingival inflammation?
- 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
What else do we recommend for patients with periodontal problems?
- brush every day 2x per day
- brush for at least 2 minutes
How often do we need to replace our brush?
- 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
Are power toothbrushes better than regular toothbrushes?
powered toothbrushes with a rotation oscillation action provide slightly better plaque removal and may provide better protection against gingival inflammation than a manual toothbrush
How do power toothbrushes work?
- rotation
- oscillation with sonic waves
What type of defects do we see due to trauma from brushing/flossing at the hard tissue level? At the soft tissue level?
- 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)
True or false: All patients are efficient at brushing their teeth.
FALSE: Not all patients are efficient at brushing their teeth.
What are the ingredients in toothpaste?
- humectants
- water
- buffers/salts/tartar control
- organic thickeners
- abrasives
- actives (ex. fluoride, triclosan)
- surfactants
- flavor, sweetener
Calcium phosphates, calcium pyrophosphates, hydrated silica, alumina, calcium-carbonate, and sodium bicarbonate are all examples of what?
abrasives
Abrasion of an abrasive depends on what?
- particle size
- particle shape
- also bristle hardness, forces applied during brushing, and tooth surface
What are the 3 types of fluorides in toothpastes? What is their purpose?
- sodium fluoride
- monofluoro-phosphate (MFP)
- stabilized stannous fluoride
- caries prevention and anti-inflammatory
Glycerine, sorbitol, xylitol, and propylene glycol are all examples of what?
humectants
Sodium-lauryl-sulfate and sodium-n-lauroyl sarcosinate are examples of what?
surfactants
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.
- intact
- control
Which was shown to reduce more plaque: fluoride or triclosan? Which reduced gingival inflammation more effectively?
- triclosan
- triclosan (although stannous fluoride also has anti-inflammatory effects)
True or false: The concentration of triclosan in dental plaque is lower than the MIC of plaque bacteria.
FALSE:
MIC = 0.29-0.78 ug/mL
triclosan in dental plaque = 4.14 ug/mL
(concentration stays high after 14 hours)
True or false: Triclosan is effective at inhibiting TNF-alpha and IL-1beta production of PGE2.
true
What active ingredient in toothpaste can cause staining?
stannous fluoride (triclosan does not cause staining)
In testing toothpaste and calculus, what toothpaste was best at reducing the calculus score?
Colgate Total and Colgate Tartar Control (both have triclosan?)
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.
- higher
- 6
True or false:
- Mouth rinses are needed to help fight against bacterial recolonization.
- It has both anti-plaque and anti-gingivitis effect.
true
true
What are the 3 common active ingredients in mouth rinses?
- essential oils
- cetylpridinium chloride (quaternary ammonium compound)
- chlorhexidine (0.12%)
For essential oils, what are the active ingredients? What is the indication? What is the action?
- ACTIVE: thymol, eucalyptol, methyl salicylate, menthol
- INDICATION: to help prevent and reduce plaque, gingivitis, and bad breath
- ACTION: inhibits symptoms of gingivitis
What percentage of alcohol is in essential oils? Does it have the ADA seal of acceptance?
- 26.9% (*know this)
- yes, for helping to control plaque and gingivitis
How do essential oils work? What percentage of plaque and gingivitis reductions are seen?
- 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)
What is the active ingredient in CPC (Viadent)? In CPC (Cepacol)? What is the indication for them?
- VIADENT: 0.05% cetylpryidinium chloride and 0.2% zinc chloride
- CEPACOL: 0.05% cetylpryidinium chloride
- INDICATIONS: to reduce plaque and gingivitis as an antiseptic
What is the alcohol content of CPC? What is the percentage of plaque reduction? Of gingivitis reduction? Is this ADA accepted?
- 14% alcohol
- 15-25% plaque reduction
- 20% gingivitis reduction
- yes
How does CPC work?
- ruptures bacterial cell membrane, leading to rapid leakage of cell contents and cell death
- may alter bacterial metabolism, inhibiting cell growth
What is the active ingredient of chlorhexidine (Peridex)? What is the indication? What is its action?
- 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
What does chlorhexidine bind to? What can it cause in and on the tooth? What does it taste like?
- 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
How does chlorhexidine work?
- 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
What is the percentage of plaque reduction in chlorhexidine? Of gingivitis reduction?
- 60.9% plaque reduction
- 42.5% gingivitis reduction
Herbal extracts are the primary form of healthcare for what percentage of the world’s population?
80%
True or false: A few herbal extracts have the ADA seal, but the majority do not.
FALSE: No herbal extracts have the ADA seal.
What mouth rinse does this describe?
- more effective as antimicrobial
- requires prescription
- specifically prescribed for patients with periodontal issues
bisbiguanides (chlorhexidine gluconate)
What are some possible ways to treat halitosis?
- eliminate etiological factors
- review oral hygiene habits
- recommend dietary changes
- consult ENT or internal medicine doctor if needed
What is the efficacy of preprocedural mouthrinsing?
- in some cases, you may want to do this, but initial therapy is key
- helps prevent contamination of the office
What is the role of alcohol in mouth rinses? Who is contraindicated for alcohol-containing mouth rinses?
- solubilizes ingredients
- alcoholics and children less than 12 years old
Where is triclosan found?
- wide variety of household and personal care products (hand soap, toothpaste, deodorants, textile fibers)
- some surgical sutures
What is the general consensus about the safety of fluoride?
- 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
What is the general consensus about alcohol-containing mouth rinses and patients with xerostomia?
- 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
What is the general consensus about alcohol-containing mouth rinses and the risk for oral cancer?
- evidence does not support a causal relationship
- pharmaceutical-grade alcohol is free from contaminating carcinogens
When does locally-delivered antimicrobials have a critical benefit in threatening periodontitis?
in localized non-responding sites and localized recurrent disease
What are the 2 targets of in-office local therapy for periodontitis?
- reduce bacterial burden
- modify destructive host response
What is controlled delivery? Who is it applied by?
- 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
What are the 3 local antimicrobial delivery reagents?
- chlorhexidine
- doxycycline
- minocycline
What is the only antibiotic systemically prescribed at sub-antimicrobial dose to modify host response?
doxycycline (20 mg/day for 3 months)
What are the devices of local antimicrobial delivery?
- fibers
- strips and compacts
- films
- injectable systems (microparticles and gels)
What are the indications for local antimicrobial delivery?
- 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
What are the contraindications for local antimicrobial delivery?
- 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)
What are the 3 host modulatory agents?
- bisphosphonates
- non-steroidal anti-inflammatory drugs (NSAID)
- low-dose tetracyclines
How do bisphosphonates work? What are the side effects? What is its effect on attachment loss and bone density?
- 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
How do NSAIDs work? What are the side effects? What is its effect on attachment levels and gingival inflammation?
- 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
How do low dose tetracyclines work? What is its effect on attachment levels?
- 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
What is needed for local delivery of the active ingredient into the pocket?
- 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
What are the strengths of controlled delivery?
- rate control: >24 hours release
- active over multiple days
- active only at site
- high concentrations (many times MIC)
- low total dose
- applied by therapist
According to the study, what was the efficacy of chlorhexidine delivered in a gelatin chip?
there was a difference in the probing depths after 6 months in those who had the chlorhexidine and the controls
According to the study, what was the efficacy of minocycline locally delivered in microcapsules?
statistically significant reduction in probing depth with SRP+minocycline m. spheres compared to those with SRP and SRP+vehicle
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?
equal effectiveness
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.
true!
