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Perio II > EXAM I Chemotherapy and Plaque Control > Flashcards

EXAM I Chemotherapy and Plaque Control Flashcards

1
Q

what is the goal of oral hygiene?

A

to provide an environment that encourages normal flora (health) and prevent growth of pathogenic flora

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2
Q

in what 3 ways can oral hygiene be achieved?

A
  • mechanical
  • chemical
  • combination of means
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3
Q

describe mechanical plaque control

A
  • primary method to prevent dental disease and maintain oral health
  • patient education and OHI with proper aids is critical
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4
Q

what are 6 reasons why oral hygiene can’t always be controlled by mechanical means alone

A
  • motivation
  • lack of understanding
  • impaired manual dexterity
  • systemically compromised
  • inaccessable (deep pockets, furcations)
    • tooth brushing (reaches 1-2mm)
    • flossing (reaches 2-3mm)
  • recent oral/periodontal surgery
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5
Q

what are the 2 clinical benefits of chemotherapeutic agents?

A
  • antimicrobial actions
  • ability to increase the host’s resistance
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6
Q

what are 4 chemotherapeutics used in periodontal treatment management?

A
  • systemic antibiotics
  • drugs that modulate host response
    • periostat, NSAIDS
  • topical antimicrobial agents
    • mouth rinses, dentrifices
  • drug deliver systems
    • “controlled”
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7
Q

name 5 desirable characteristics of local chemotherapeutics

A
  • substantivity (sticks to the surface)
  • low toxicity
  • high potency
  • good permeability
  • intrinsic efficacy
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8
Q

describe first generation chemotherapeutics

A
  • agents that have antimicrobial activity
  • phenolic, H2O2
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9
Q

describe second generation chemotherapeutics

A
  • agents that have antimicrobial activity and proven substantivity
  • CHX, local delivery
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10
Q

describe third generation chemotherapeutics

A
  • agents that target specific bacteria or bacterial products that are essential to disease development (none available today) and have proven substantivity
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11
Q

what are the 4 antimicrobial activities of chemotherapy on plaque?

A
  • bacteriocidal
  • bacteriostatic
  • substantivity
  • inhibitory dosage
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12
Q

what is the ADA seal for chemotherapeutic agents for the control of gingivitis?

A

to make a plaque control, the benefit must demonstrate significant effects against gingivitis

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13
Q

what is the efficacy data of chemotherapeutic agents for the control of gingivitis?

A
  • statistically significant for both the reduction of gingivitis and inhibition of plaque
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14
Q

safety data of chemotherapeutic agents for the control of gingivitis:

soft/hard tissues

A

no deleterious effects

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15
Q

safety data of chemotherapeutic agents for the control of gingivitis:

oral flora (microbiology)

A

no development of opportunistic or pathogenic organisms

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16
Q

safety data of chemotherapeutic agents for the control of gingivitis:

toxicology

A
  • possible toxic/adverse effects
  • document any mutagenic/carcinogenic effects
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17
Q

what are some common topical anti-microbials?

A
  • chlorhexidine
  • essential oils
  • oxygenating agents
  • povidine iodine
  • quaternary ammonium compounds
  • sanguinarine
  • sodium benzoate, sodium lauryl sulfate, and sodium hypochlorite
  • stannous fluoride (SnF)
  • triclosan
  • zinc chloride
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18
Q

describe localized chemotherapeutics

A
  • topical antimicrobials
    • mouthrinses, gels, dentrifices (toothpaste)
  • site specific local drug delivery by professionals
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19
Q

what are 4 patient options for localized chemotherapeutics?

A
  • over the counter rinses
  • Rx rinses
  • home irrigation
  • dentrifice

site specific local drug delivery by professionals

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20
Q

describe chlorhexidine

A
  • “CHX”
  • the “gold standard”
  • cationic bisbiguanide
  • 0.12% chlorhexidine digluconate (bisbiguanide)
  • 11.6% alcohol
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21
Q

what is the pH of CHX?

A

5.5

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22
Q

T or F

CHX has the ADA seal and is FDA approved

A

true

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23
Q

is CHX effective?

A

yes, it is a highly effective agent

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24
Q

what is the mechanism of action of CHX?

A
  • ruptures cell membranes
  • good substantivity
  • broad spectrum
    • effective against gram +, gram -, and yeast
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25
Q

describe the substantivity of CHX

A
  • binds to soft tissues
    • 30% retained after 8-12 hours
    • detectable in saliva 8-12 hours later
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26
Q

what are 6 side effects of CHX?

A
  • staining
  • increased supragingival calculus
  • altered taste sensation
  • reversible desquamation
  • transient swelling of salivary glands
  • rare hypersensitivity
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27
Q

what is the available concentration of CHX available in the US? what is it outside of the US?

A
  • in the US:
    • 0.12% with 11.6% alcohol (and H2O)
  • outside the US:
    • 0.2%
    • no significant different in antimicrobial or clinical effects
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28
Q

how much does CHX reduce pland and gingivitis?

A
  • reduces plaque by 50-55%
  • reduces gingivitis by 45%
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29
Q

what are the patient instructions for the administration of CHX?

A
  • 2x daily
    • 30 second rinsing with 1/2 oz (15ml)
  • allow 30 minutes between rinsing with CHX and brushing teeth
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30
Q

how is CHX affected by sodium lauryl sulfate and fluoride ion?

A

reduces the effectiveness of the CHD

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31
Q

what is the effect of pre-rinsing with CHD?

A
  • ehanced wound healing for extractions, SRPs, and periodontal surgeries
  • 30-60 second pre-rinse can reduce bacterial load by >90-95%
  • significantly decreases aerosol contamination/bacteremia
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32
Q

what are 3 main uses for CHX rinses?

A
  • gingivitis rampant caries
  • candida infections
    • dentures
    • immunocompromised
  • post-op (oral/perio surgeries)
    • tongue piercing after-care
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33
Q

what are 4 examples of phenolic related essential oils?

A
  • thymol
  • menthol
  • eucalyptol
  • methyl salicylate
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34
Q

describe phenolic related essential oils

A
  • oldest product (1865 - Lister)
  • ADA approved
  • listerine (original product) and over 60 generics
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35
Q

when was listerine (essential oil) developed, marketed, and when were new formulations made available?

A
  • developed in 1879
  • marketed in 1881
  • new formulations in 1992
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36
Q

what is the main example of essential oils?

A

listerine

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37
Q

what is the method of action for essential oils like listerine?

A
  • cell wall disruption and inhibition of bacterial enzymes
  • contains:
    • thymol
    • eukalyptol
    • menthol
    • methyl salicylate
  • can “extract” LPS
  • anti-inflammatory properties
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38
Q

what is the pH of listerine?

A

4.2

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39
Q

what is the alcohol content of listerine?

A

ranges from 22-27% depending on the brand

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40
Q

what are the patient instructions for listerine use?

A

30 second rinses with 2/3 oz AM and PM

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41
Q

how much do phenolic essential oils reduce plaque and gingivitis?

A
  • 20-34% reduction in plaque
  • 28-34% reduction in gingivitis
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42
Q

what is the effect of phenolic essential oils on candida?

A

it has an anti-candida effect

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43
Q

what are the benefits of phenolic essential oils?

A
  • decreases plaque and increases wound healing 7 days (oral surgery)
  • when used as a pre-rinse for SRP:
    • >90% reduction of bacteria in aerosols
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44
Q

what is the benefit of thymol in essential oils?

A

principal antibacterial component

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45
Q

do essential oils have high or low substantivity?

A
  • low substantivity (first generation)
  • effectiveness related to duration of contact
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46
Q

what are 3 side effects of essential oils?

A
  • burning
  • bitter taste
  • possible staining
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47
Q

can listerine be used as a replacement for flossing?

A
  • no, although ads claimed that listerine is as effective as flossing in reducing interdental plaque and gingivitis
  • recommendation is to use listerine as an adjunct to brushing and flossing
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48
Q

what is the requirement for ADA approval for a product to claim a reduction in gingivitis?

A
  • requires that the product be able to demonstrate a 20% reduction of gingivitis
  • only chlorhexidine and listerine can make this claim
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49
Q

T or F

there are many studies that address the use topical antimicrobials, like chlorhexidine and listerine, for periodontitis

A

false

there are no studies

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50
Q

what are 5 examples of quaternary ammonium compound products?

A
  • viadent
  • scope
  • cepacol
  • clear choice
  • crest pro-health rinse
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51
Q

what are the available concentrations of quaternary ammonium compounds (cetylpyridinium)?

A
  • 0.045-0.07% cetylpyridinium (CPC)
  • range 0-18% alcohol
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52
Q

what is the pH of CPC?

A

5.5-7.0

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53
Q

what is the effect of dentrifice abrasives and flavoring agents on CPC?

A

alters activity

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54
Q

T or F

there is no waiting requirement between rinsing with CPC and brushing

A

false

at least 30 minutes between rinsing and brushing

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55
Q

what is the method of action of quaternary ammonium compounds?

A
  • rupture cell walls
  • cationic surface active
  • they bind but release rapidly; limits substantivity
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56
Q

what is the effect of quaternary ammonium compounds on plaque and gingivitis?

A
  • 14% reduction in plaque
  • 24% reduction in gingivitis
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57
Q

describe in detail the mechanism of action of CPC

A
  • initial attachment is strong (cation)
  • released from binding site more rapidly than CHX
  • increases cell wall permeability
  • decreases cell metabolism
  • decreases ability to attach to the tooth
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58
Q

what is the difference in ethanol content between the original listerine developed in 1879 vs. newer products?

A
  • 26.9% (original)
  • 21.6% (newer products)
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59
Q

does CPC have the ADA seal?

A

no

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60
Q

at what general rate is CPC cleared from the mouth?

A

rapidly

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61
Q

according to published research on CPC, was there a difference between placebo and CPC groups?

A

no

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62
Q

describe the gingival inflammation benefit of crest pro-health vs placebo

A
  • the use of crest pro-health reduced gingival inflammation compared to the placebo
  • reduction of 13% at 3mo, and 15% at 6mo
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63
Q

describe the gingival bleeding benefit of crest pro-health vs placebo

A
  • reduction in bleeding with use of crest pro-health compared to placebo
  • reducted by 23% at 3mo, and 33% at 6mo
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64
Q

describe the plaque benefit of crest pro-health vs placebo

A
  • crest pro-health resulted in a reduction in plaque compared to the placebo
  • reduced plaque by 20% at 3mo, and 16% at 6mo
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65
Q

what types of patients should you consider the use of alcohol-free rinse for?

A
  • children (6+ years), including orthodontic patients
  • patients with dry mouth
  • diabetics
  • alcoholics
  • patients with sensitive soft tissue
    • patients undergoing chemotherapy
  • patients of certain religious faiths
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66
Q

what is sanguinarine?

A
  • herbal alkaloid extract from blood root
  • studied in mouthwash and dentrifices
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67
Q

discuss studies of sanguinarine used in mouthwash and dentrifices

A
  • claims most effective when agents are used together
  • claimed to reduce plaque 17-42% and gingivitis 18-75%
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68
Q

is sanguinarine available in the US? why or why not?

A
  • no
  • supporting research data had mixed and questionable results
  • data supported increased leukoplakia in patients and increased risk for cancer
69
Q

what are some oxygenating products used for the control of plaque and gingivitis?

A
  • oxyfresh, hydrogen peroxide, peroxyl
70
Q

what is the mechanism of action of oxygenating products?

A
  • inhibits anaerobic bacteria
  • may have short-term anti-inflammatory properties
71
Q

describe safety concerns of oxygenating products

A
  • black, hairy tongue
  • tissue injury
  • co-carcinogen
  • delayed wound healing
72
Q

does research support the use of oxygenating products for the control of plaque and gingivitis?

A

no

73
Q

what is plax?

A
  • pre-brushing rinse
  • 2% sodium benzoate
  • 0.25% sodium lauryl sulfate
  • sodium salicylate 0.2%
  • 8.7% alcohol
74
Q

describe plax research

A
  • disparity in the research
  • no ADA seal
75
Q

describe povidone iodine (betadyne) as a use for the control of plaque and gingivitis

A
  • polyvinyl-pyrrolidone and iodine
  • pre-procedural rinse (5%)
    • rinse for 30sec
    • bacteria will not respond for 90min
76
Q

povidone iodine has a broad spectrum for what 3 things?

A

bacteria, fungi, and viruses

77
Q

povidone iodine used in combination with ___ results in a significant reduction in ___

A
  • H2O2
  • bleeding
  • *studies also show good results when used in combination with SRP
78
Q

what are the side effects of povidone iodine?

A
  • development of toxicity
  • allergy
  • avoid in pregnant women and thyroid reduction
  • stian
79
Q

describe the use of sodium hypochlorite for the control of plaque and gingivitis

A
  • one of the first antimicrobials used as a locally delivered treatment for periodontitis (antiform irrigation)
  • low cost and easy to use
80
Q

sodium hypochlorite has a broad spectrum for what 3 things?

A

bacteria, fungi, and viruses

81
Q

sodium hypochlorite is effective at reducing what?

A

endotoxin from the root surface

82
Q

how often is sodium hypochlorite used today?

A

rarely

83
Q

what are the side effects of sodium hypochlorite?

A
  • odor
  • fresh preparation
  • corrosive
  • bleaching
84
Q

which topical antimicrobial effects plaque and gingivitis due to tin ion aggregation and metabolism?

A
  • SnF2 (gel-kam)
  • this results in a significant anticarogenic effect
85
Q

describe the benefits of SnF2 as a topical antimicrobial

A
  • reduction in gingivitis but not in plaque scores
  • limited benefits as subgingial irrigant
86
Q

what is Keyes’s technique?

A
  • the use of baking soda, NaCl, and H2O2 as a topical antimicrobial
  • showed no significant differences compared to other topical antimicrobials
  • the difference lies in the correct brushing mechanism
87
Q

describe triclosan as a topical antimicrobial toothpaste

A
  • broad spectrum antimicrobial
    • soaps (dial) and antiperspirants
  • colgate total
    • only toothpaste with ADA seal for plaque/gingivitis reduction
88
Q

describe the contents of colgate total

A
  • 0.3% triclosan
  • 2% PVM/MA copolymer polyvinyl methyl ether and maleic acid, Zn citrate, pyrophosphates
89
Q

describe the mechanism of action of triclosan

A
  • primary site of action is in bacterial cytoplasmic membrane
  • prevents essential amino acid uptake causing cell leakage of contents
90
Q

describe the side effects of triclosan

A
  • no development of resistance
  • no adverse effects on hard/soft tissue
  • has an anti-calculus effect fromt he copolymer
  • may also add anti-tartar ingredient (pyrophosphate)
91
Q

describe research conducted on triclosan

A
  • 29% reduction in gingivitis
  • 17-25% reduction in supragingival plaque
  • 47.6% fewer sites with severe gingivitis
92
Q

describe biotine

A
  • glucose oxidase, lactoperoxidase, and lysozyme
    • biotene dry mouth toothpaste, dry mouth gum, and gentle mouthwash
    • oral balance moisturizing gel and dry mouth liquid
  • alcohol-free
93
Q

biotene is alcohol-free. why should it not be used with other rinses that contain alcohol?

A

alcohol destroys antimicrobial enzymes in biotene

94
Q

studies have not documented effectiveness of ___ in the treatment of periodontitis

A

topical chemical plaque control agents

95
Q

describe supragingival irrigation

A
  • delivery coronal to the gingival margin (90*)
  • patient/professional
96
Q

describe marginal irrigation

A
  • delivery is angled apically to the FGM (45*)
  • patient/professional
97
Q

describe subgingival irrigation

A
  • deliver is in the sulcus/pocket
  • professional/patient
98
Q

decribe rationale for irrigation

A
  • flush away bacteria
  • LPS is loosely adherent
  • non-specific reduction of microbes
99
Q

what is the depth of penetration with mouth rinsing?

A

4% pocket depth

100
Q

what is the depth of penetration of supragingival irrigation?

A
  • 29-71% of shallow pockets
  • 44-68% of moderately deep and deep pockets (3-4mm or less)
101
Q

what is the depth of penetration of subgingival irrigation?

A

75-93% pocket depth

102
Q

describe hydrokinetics and water pressure of supragingival irrigation

A
  • pulsating stream with compression and decompression phases
  • decompression facilitates displacement of debris and bacteria
  • 80-90psi can be tolerated by human gingival tissues
103
Q

describe the supragingival irrigation technique

A
  • twice daily
  • start at lowest pressure setting
  • aim jet across proximal papilla for 10-15 sec
  • trace along gingival margin to the next interproximal papilla
  • should use the full reservoir
  • use from buccal to lingual surfaces
  • not a substitute for toothbrushing and flossing
104
Q

describe supragingival irrigation with water as a monotherapy

A
  • results varied for plaque removal and reduction of plaque indices
  • irrigation with water inferior at attaining or maintaining health
  • do not use in lieu of toothbrushing
105
Q

supragingival irrigation with water or a placebo combine with toothbrushing is most beneficial for which patient?

A
  • pt with gingivitis that perform inadequate interproximal cleaning
  • pt with mild to moderate periodontitis
    • routine OH plus irrigation associated with significant reduction of proinflammatory cytokines IL-1 and PGE2
106
Q

describe supragingival irrigation vs rinsing with medicaments

A
  • no conclusive data to show one method is superior to the other
107
Q

describe subgingival penetration of solutions after supragingival irrigation

A
  • most studies usually projected 3mm subgingivally
  • gingival inflammation frequently diminished despite unchanged plaque levels
  • possible due to diluting plaque toxicity, interference with subgingival plaque maturation, washing away of unattached plaque
108
Q

subgingival penetration of solutions after supragingival irrigation is beneficial in treating ___ but not ___

A

gingivitis, but not periodontitis

109
Q

describe the bacteremia of supragingival irrigation

A
  • appears to have similar levels of bacteremia as toothbrushing, floss, periodontal dressing changes, SRP, and chewing
  • no particular hazard to healthy patients
  • risk unknown for patients that require premedication
110
Q

who are likely candidates for supragingival irrigation?

A
  • those with inadequate oral hygiene
  • orthodontic patients
  • gingivitis patients
111
Q

describe methods of delivery of subgingival irrigation

A
  • syringe - cannula with an end or sideport
  • jet irrigator with cannula
  • ultrasonic
112
Q

what are limiting factors of subgingival irrigation?

A
  • calculus
  • lateral dispersion (even with ultrasonic)
113
Q

___ should precede subgingival irrigation

A

SRP

114
Q

in subgingival irrigation, ___ should be utilized to avoid projecting bacteria into tissues

A

low irrigation forces

115
Q

for subgingival irrigation, is there a difference in end port or side port cannula?

A

no

116
Q

for subgingival irrigation, how far should the tip be inserted?

A

3mm

117
Q

describe subgingival irrigation and SRP

A
  • controversial
  • currently insufficient data to indicate routine use to augment SRP
  • recent data using high concentration and prolonged multiple applications of antimicrobials show promise
118
Q

describe chlorhexidine as a subgingival irrigant with ultrasonics

A
  • no significant difference than with H2O
  • possible difference in pockets 4-6mm but not in pockets >7mm
119
Q

describe iodine as a subgingival irrigant with ultrasonics

A
  • possible enhanced effect in pocket depths >7mm
120
Q

what are limitations to subgingival irrigation with medicaments?

A
  • short half-life of injected solutions
  • minimal dispersion (use circumferentially)
  • CHX reduces quickly when introduced subgingivally; contact with blood inactivates CHX
  • gingival crevicular fluid flows outward
  • little contact time with subgingival microflora
121
Q

describe methods of delivery of professional irrigations

A
  • hand syringe ok but can cause damage to tissues
  • forces up to 80-90psi can be tolerated by tissues, but a safe level is at about 20psi
  • hand syringes can deliver pressure 10-20 times this, making it easier to damage tissue
122
Q

in professional irrigation, ___ irrigators have been shown to be more effective

A
  • jet
  • they deliver the H2O or medicament in a pulsating manner
  • pulsating jet irrigators have a built-in tissue decompressing phase
  • constant tissue compression, as seen with syringe irrigators, can block proper plaque displacement
123
Q

describe what to use with home irrigation

A

chlorhexidine, listerine, or fluoride

124
Q

is there a benefit to home irrigaiton?

A
  • yes, likely
  • benefits are from daily delivery
  • patient can become a co-therapist
125
Q

describe the requirements for locally delivered chemotherapeutic to be considered effective

A
  • the drug must reach the base of the pocket, where disease activity is
  • the drug must be delivered in high enough concentrations to destroy the bacteria
  • the drug must stick around long enough to demonstrate effective results
126
Q

what are the advantages of locally delivered chemotherapeutics?

A
  • sustained higher drug concentrations in the GCF
  • better patient compliance/acceptance
  • drug resistance has not become a problem
  • site specific
127
Q

describe the characteristics of minocycline microsphere polymer

A
  • bioadhesive
    • no retentive dressing necessary
  • bioresorbable
    • hydrolyzes to CO2 and H2O - nothing to remove
  • proven safety
    • suture material
128
Q

what is minocycline?

A

potent, broad spectrum antibiotic

129
Q

minocycline is a semi-synthetic derivative of ___

A

tetracycline

130
Q

minocycline is effective against what 3 periodontal pathogens?

A
  • p. gingivalis: MIC = 0.06 mcg/ml
  • p. intermedia: MIC = 0.25 mcg/ml
  • a actinomycetemcomitans: MIC = 2.00 mcg/ml
131
Q

minocycline microspheres achieve high ___ with minimal ___

A
  • local concentrations
  • systemic levels
132
Q

microspheres vary in size from ___ to ___ microns, which confer their ___ ___ characteristics

A
  • 20-60 microns
  • sustained release
133
Q

describe the PD reduction and increase in AL of the locally delivered chemotherapeutic, actisite

A
  • PD reduction: 1.38 - 2.15
  • increase in AL: 0.69 - 1.56
134
Q

describe the PD reduction and increase in AL of the locally delivered chemotherapeutic, arestin

A
  • PD reduction: 1.32 - 1.99
  • increase in AL: N/A
  • *arestin is considered the “gold standard”
135
Q

describe the PD reduction and increase in AL of the locally delivered chemotherapeutic, atridox

A
  • PD reduction: 1.1 - 1.8
  • increase in AL: 0.8 - 1.0
136
Q

describe the PD reduction and increase in AL of the locally delivered chemotherapeutic, periochip

A
  • PD reduction: 0.95 - 1.16
  • increase in AL: 0.31 - 0.75
137
Q

in minocycline microsphere clinical trials, the trial design was focused on treating ___

A

the whole mouth

138
Q

describe the results of minocycline microsphere clinical trials

A
  • 60% of responding site treated with minocycline microspheres and SRP exhibited probing depth reductions of 2mm or more versus SRP alone
  • patients treated with minocycline microspheres and SRP maintained a >1.5mm reduction in pocket depth over 12 months
139
Q

clinical trials showed that minocycline microspheres and SRP delivered enhanced efficacy to a broad range of which difficult to treat sites and patients?

A
  • molars
  • furcation sites
  • smokers
  • elderly
  • patients with CV disease history
140
Q

describe the safety results of minocycline microsphere clinical trials

A

adverse events same as control group

  • no antibiotic resistance
  • no staining
  • no taste alterations
  • no GI upset
141
Q

clinical trial results showed that minocycline microspheres and SRP is significantly more effective in ___ than SRP alone

A

reducing pocket depth

142
Q

clinical trial results showed that the effect of minocycline microspheres and SRP is ___ with the baseline depth of the pockets

A

incremental

143
Q

clinical trial results showed that repeated therapy with minocycline microspheres and SRP does what?

A

prolongs the efficacy

144
Q

clinical trial results of minocycline microspheres showed what about ease of use, toleration, and safety?

A

they are very easy to use, well tolerated, and safe

145
Q

what are the patient after-care instructions for the use of minocycline microspheres?

A
  • do not brush for 12 hours
  • avoid eating hard, crunchy, or sticky foods for one week
  • postpone use in interproximal cleaning devices for 10 days
146
Q

minocycline microspheres maintain their therapeutic concentration for up to ___ days

A

14 days

147
Q

what is atridox?

A
  • locally delivered chemotherapeutic
  • doxycycline gel
  • comes in two syringes or one pre-mixed
  • subgingival controlled-release
148
Q

with atridox, ___ may be packed into the pocket with a cord packer

A

overflow material

149
Q

with atridox, perio dressing or adhesive may aid in ___, but it is not necessary

A

retention

150
Q

after local delivery of atridox, patients may be instructed to remove residual material after what amount of time?

A

7 days, via toothbrushing and/or floss

151
Q

what are the indications for atridox?

A
  • chronic adult periodontitis
    • gain in clinical attachment
    • reduction in probing depth
    • reduction in bleeding on probing
152
Q

what are the contraindications for atridox?

A
  • should not be used in patients who are hypersensitive to doxycycline or any other drug in the tetracycline class
153
Q

what are the patient after-care instructions for the placement of atridox?

A
  • patient should avoid brushing, flossing, and eating at affected sites for one week
154
Q

describe the FDA approval of atridox

A
  • FDA approved as a monotherapy, but should be used as an adjunct to mechanical treatment
  • will not remove any calculus by itself
155
Q

what is a chlorhexidine chip?

A

aka perio chip

  • locally delivered chemotherapeutic that resembles a small chip and is placed subgingivally
156
Q

describe storage of perio chip

A

can be stored at room temp

157
Q

what should be done to improve the efficacy of perio chip placement?

A
  • keep chip and tissues dry
    • Mfgr claims improved formulation has improved handling
  • pockets must be at least 5mm
    • difficult in narrow pockets
158
Q

after the placement of perio chip, patients should not brush or floss for how long?

A

7 days

159
Q

T or F

local delivery systems are useful adjuncts, even if a site continues to break down after therapy

A

false

they should not be used if a site continues to break down

160
Q

it is useful to re-evaluate a patient who receives a locally delivered system. describe

A
  • 10 days to two weeks, if improvement, resume recalls
  • if no improvement, reapply or refer
161
Q

describe antibiotic therapeutic strategies from the early 70s

A
  • treat periodontitis as a bacterial infection
  • only a few specific organisms that needed to be targeted
  • thought to be exogenous and could eliminate from the body indefinitely
  • noteworthy successes
162
Q

describe antibiotic therapeutics prescribed for perio treatment

A
  • not respond to conventional mechanical therapy
  • acute periodontal infections associated with systemic manifestations
  • prophylaxis for medically compromised patients
  • adjunct to surgical therapy
  • adjunct to non-surgical therapy
163
Q

describe the generation of protective antibodies in the regulation of immune/inflammatory responses

A
  • immunization as a method to prevent periodontitis
  • animal models showed reduction in alveolar bone loss
  • successful vaccine problems
164
Q

describe nitric oxide (NO) inhibitor in the regulation of immune/inflammatory responses

A
  • PMN and macrophages release reactive oxygen species such as NO to kill bacteria
  • released in excess initiate inflammation
  • NO inhibitor decreased bone loss ligature induced periodontitis in rats
165
Q

describe the primary MMPs involved in periodontal tissue degradation

A
  • family of 17 metalloproteinases
  • degrade ECM molecules
    • collagen, gelatin, elastin
  • good evidence participate in tissue deestruction and AL
166
Q

describe inhibitors of MMPs

A
  • chemically modified tetracycline and low-dose doxycycline inhibit activity of MMPs
  • appear to be good candidates for inhibiting the destruction of periodontal structures
167
Q

what is collagenase?

A
  • a MMP
  • breaks down collagen
  • release is triggered by cytokines in response to bacterial endotoxins
168
Q

periostat is targeted at elevated ___ levels found in periodontitis patients

A

collagenase

169
Q

what is the indication for periostat?

A
  • for use as an adjunct to SRP to promote attachment level gain and to reduce pocket depth in patients with adult periodontitis

Perio II (5 decks)

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