Lecture 11 Flashcards
Chemical Agents in Periodontal Care
systemic delivery
the chemical agent is circulated systemically throughout the body
topical delivery
intraoral placement of topical chemical agents/controlled-release devices
criteria for effective chemical agents
must reach the site of the disease activity
efficacy: ability to inhibit oral bacterial growth and be delivered in bacteriostatic/bactericidal concentrations
substantivity: remain in place long enough to be effective
therapeutic mouthrinses
many contain chemical ingredients that have little or no effect against gingivitis
clinical studies support the effectiveness of therapeutic mouthrinses used in addition to
proper home care
why not just mouthrinse
the surface of dental plaque biofilm is covered by the extracellular protective matrix/protective barrier
mechanical biofilm control is a must in order to disrupt the structure of the biofilm and allow the chemical agents to reach the bacteria themselves
therapeutic mouthrinses uses
can provide therapeutic benefit: decrease biofilm to decrease gingivitis, decrease risk of dental caries, aid in dentinal hypersensitivity
two mouthrinse ingredients that have demonstrated effectiveness against gingivitis are
chlorhexidine gluconate
essential oils
chlorhexidine gluconate
most effective
available by prescription
rinse twice daily
bactericidal
displays substantivity (binds to tissue, slowly released)
what is the most effective antimicrobial agent for long term reduction of biofilm and gingivitis
chlorhexidine
cons of chlorhexidine
may cause discoloration of the tongue, taste alteration, increased extrinsic stain, increase in calculus formation, prescription, costly
patients who benefit from chlorhexidine gluconate
special needs patients
postsurgical care patients
candida infections
high caries risk
oral piercings/implants
preprocedural rinse for powered instrumentation
essential oils
also control biofilm: antibiofilm/antigingivitis
over the counter
less expensive
lack the side effects
4 essential oils
thymol, menthol, eucalyptol, methyl salicylate
controlled-release antimicrobial agents
consists of an antibacterial chemical embedded in a carrier material
placed directly into the perio pocket, dissolving slowly providing a steady release of the antimicrobial agent
most subject subgingival bacteria to therapeutic levels of antimicrobial agents for approx. 1 week
non-responsive pockets/sites
controlled-release antimicrobial agents methods
products expelled into the pocket
adhere to tooth surfaces and dissolve slowly
arestin, atridox
gelatin chip inserted into pocket
adheres to tooth surface and dissolves slowly
periochip
why not antibiotics for all since gingivitis and periodontitis are bacterial infections
most cases can be controlled through conventional mechanical periodontal therapy
concern of antibiotic resistance
more frequent in treating rarer forms of periodontitis (necrotizing gingivitis/necrotizing periodontitis)
examples of stimuli for hypersensitivity
mechanical stimuli: toothbrush bristles, fingernail
thermal stimuli: ice cream, iced tea
chemical stimuli: acidic foods
exposed dentin
dentin that is visible in the oral cavity due to gingival recession or absence of enamel due to damage
not all exposed dentin displays hypersensitivity
hydrodynamic theory of dentinal hypersensitivity
dentinal tubules are filled with; an odontoblastic process, fluids
stimulation of the root surface may result in fluid flow within the tubules which is theorized to activate the nerve endings near the pulp leading to painful sensations
dentinal hypersensitivity associated with NSPT
most NSPT does not result in DH
resolution of inflammation frequently results in gingival recession which can result in dentinal hypersensitivity
dentinal hypersensitivity post NSPT
may not occur because of the smear layer
home-care is important
exposed root surfaces must be kept biofilm free
how to address DH
ask patients if they have existing DH
D-sense crystal/LA can be used to control discomfort
patient education: discuss possibility of DH following NSPT, management strategies
