localized chemotherapeutics in perio therapy Flashcards
chemotherapeutic agent is a general term for
achemical substance that provides clinical therapeutic benefit
clinical benefits of chemotherapeutic agent
- antimicrobial actions
- ability to increase the host’s resistance
chemotherapeutic in periodontal treatment management
- systemic antibiotics
- drugs that modulate host respnse(periostat, NSAIDS
- topical antimicrobial agents( mouth rinses, dentifrices)
- drug delivery systems (controlled)
desirable characteristics of local chemotherapeutic
- substantivity
- low toxictity
- high potency
- good permeability
- intrinsic efficacy
localized chemotherapeutics
- topical antimicrobials
- site specific local drug delivery by professionals
def. of substantivity
Persistence of effect of a topically applied drug or cosmetic, determined by the degree of physical and chemical bonding to the surface; resistance to removal or inactivation by sweating, swimming, bathing, and friction, among other factors
topical antimicrobials
- chlorhexidine
- essential oils
- povidine iodine
- quarternary ammonium chloride
- sanguinarine
- sodium hypochlorite
- stannous fluoride
- triclosan
chlorhexidine is
- considered the gold standard
- cationic bisbiguanide
- mech. of action (MOA) - ruptures cell membranes
- good substantivity (adheres and releases for 6+ hours)
side effects of chlorhexidine
- staining
- calculus formation
- taste alteration (less useful for long term treatment)
chlohexidine concentration in
US-.12 with 11.6 alcohol
outside us-.2
chlohexidine reduces plaque
by 50-55%
chlohexidine reduces gingivitis by
45%
use of chlohexidine
- 15 ml rinise for 30 seconds twice a day
- no rinsing or brushing for 30 minutes
- sodium lauryl sulfate and fluoride may decreses effectiveness
- effective as a pre-rinse to decrease bacterial load
- enhances wound healing
Essential oil MOA
cell wall disruption and inhibition of bacterial enzymes
essential oil contains
thymol
eucalyptol
menthol
methylsalicylate
essential oils contain
21.6-26.9% alcohol
essential oils reduces plaque and gingivitis by
34% when used twice a day
for essential oil, 91% reduction in bacteria
when used as a prerinse before Sc/Rp
Povidine iodine is a
- water soluble antimicrobialeffective against bacteria, viruses and fungi
- presurgical scrub for skin disinfection
avoid Povidine iodine in
- pats with allergies to shellfish or iodine
- thyroid dysfunction
- pregnant or lactating women
Quartenary ammonium compounds
- cetylpyridinium chloride alone
- combination domophenbromide
- MOA-rupture cell walls
- cationic surface active
- they bind but release rapidly, limits substantivity
- 14% and 24% reduction in plaque and ging
Sanguinarine
- herbal alkaloid extract
- studied in mouthwash and dentrifices
- most effectivewhen agents are used together
- reduces plaque 17-42%
- reduces ging 18-57%
Sodium Hypochlortie
- bleach
- endodontic irrigant for years
- corrosive effects on metals and bleaching if spilled on surfaces
sodium hypochlorite is effective
- against bacteria, virus and fungi
- cheap
- ease of access
Stannous fluoride
- ada seal in 1960 for prevention of decay
- exhibits effects on plaque and gingivitis
stannous fluoride MOA
- promotes remineralization of decalcified enamel
- inhbitsthe cariogenic microbial process in dental plaque
- increases tooth resistance to acid dissolution
Triclosan is
- bisphenol with broad spectrum antimicrobial activity
- found in several different oral products
- 20% reduction in gingivitis
- 25 % reduction in plaque formation
triclosan combined with
- zinc citrate, antiplaque and calculus effect
- polyvinylmethyl and maleic acid to increase substantivity and anticalculus
- pyrophosphates, anti calculus
variety of products that combineagents with vectors or devices that can be placed directly into
periodontally diseased pocket
goal of local or controlled delivery systems
ability to release up to 14 days at fractions of the systemic dose
