Mouth Rinses Flashcards
Harmful to patient:
adverse affect
May be harmful, useful, or beneficial:
side effect
Ability of patient to follow through/motivation to use product
compliance
Ability of an agent to absorb to teeth and surfaces and be released at therapeutic levels:
substantivity
Pleasant taste/sensation, decrease microorganisms, halitosis control:
cosmetic
The quality of being successful in producing an intended result
efficacy
Cosmetic mouth rinses are available:
OTC
Therapeutic mouth rinses are available:
OTC or prescription
A mouth rinse that helps to enhance taste in mouth (i.e. minty fresh breath):
cosmetic mouth rinse
A mouth rinse that helps to reduce/control plaque, gingivitis, halitosis, caries, and xerostomia:
therapeutic mouth rinse
Describe the effects of a cosmetic mouth rinse on plaque/caries/xerostomia etc.
no real beneficial effects
List the purposes of mouth rinses: (5)
- flush out food debris from the oral cavity
- freshen breath
- deposit fluoride on teeth (if fluoridated)
- available in liquid form
- primarily cosmetic benefit (Freshening breath)
Why should you wait 30 minutes to eat or drink following use of mouth rinse?
if not, it will inactivate sodium hypochlorite
What was the traditional purpose for mouth rinse?
freshen breath
What contributes to halitosis?
bacteria and plaque accumulation on the tongue
____% of halitosis originates from the oral cavity; ____% from systemic or nonoral cause
90%; 10%
Describe the effect of mouth rinses on breath after 3-5 hours
no effect
Mouth rinses ___ odors/ provide little ___
“mask”; antibacterial function
What is the best treatment for bacteria and plaque accumulation on the tongue?
tongue scraping
List the active ingredients in mouth rinse: (8)
- sanguinarine
- amonium compounds
- phenolic compounds
- fluoride
- chlorhexidine
- stannous fluoride
- essential oils
- triclosan
Why are ammonium compounds added to mouth rinse? Give an example of one:
added to reduce bad breath; CPC
Describe the substantivity of the active ingredient “phenolic compounds” in mouth rinses:
low substantivity
What is the purpose of fluoride as an active ingredient in mouth rinses?
reduces incidence of caries
What is the purpose of chlorhexidine as an active ingredient in mouth rinses?
helps control plaque and gingivitis
What is the purpose of stannous fluoride as an active ingredient in mouth rinses?
helps control plaque and gingivitis
What is the purpose of essential oils as active ingredients in mouth rinses?
helps control plaque and gingivitis
What is the purpose of triclosan as an active ingredient in mouth rinses?
reduces production of plaque and gingivitis
What active ingredients of mouth rinses are beneficial and DO have chemotherapeutic effects?
- chlorhexidine
- stannous fluoride
- essential oils
- triclosan
What beneficial effects of chlorhexidine, stannous fluoride and essential oils?
chemotherapeutic effect against plaque/biofilm accumulation as they DECREASE the amount of free-floating planktonic bacteria
How do hlorhexidine, stannous fluoride and essential oils work to DECREASE the amount of free-floating planktonic bacteria?
By binding their positive ions to the bacteria’s negative ions resulting in cell lysis
Describe the mechanism of action of triclosan in mouth rinses:
chemical inhibitor of fatty acid synthesis which is required for lipid production in the bacteria, which in turn, eventually kills the cell
When biofilm forms, before it becomes an organized mass, it is composed of:
planktonic (free-floating) bacteria
Why might alcohol be incorporated as an ingredient in mouth rinses?
used as a solvent, taste enhancer, and agent providing aftertaste (burn)
What are the negative effects of alcohol used in a mouth rinse?
- burning mouth
- drying of oral tissues
- risk of oral cancer
What category of patients should NEVER be recommended an alcohol-based mouth rinse? Why?
previous/recovering alcoholics; could serve as a stumbling block
What are the levels of regulations for prescription and overt counter products (regarding mouth rinses):
- government level
- professional level
The government level of regulation to oral care products:
FDA
The professional level of regulation to oral care products:
ADA
- protects consumers from useless/harmful products
- therapeutic claims must have research to support claims
- evaluates prescription/ OTC products
Food and Drug Administration (FDA)
Council on Scientific affairs of the American dental association:
ADA (Professional level regulation)
- voluntary program that companies pay into
- helps consumers “make wise choices”
- products submitted must have controlled studies to demonstrate effectiveness/safety of product
- seal is only found on consumer products
- new submission cost $14,500 to evaluate product; if approved, yearly fee of $3500 to mainitain
ADA
The ADA seal is found on:
consumer products only
What is required in order to turn in product to ADA for review?
controlled studies to demonstrate effectiveness/safety of product
Does oral B products have ADA seal?
Yes
Does sonicare products have ADA seal?
No- they don’t want to pay that fee
Do we recommend based ONLY on ADA?
not necessarily- some products have evidence to support claims and do not have ADA seal (for example sonicare toothbrush)
T/F: Toothpastes without fluoride do NOT have ADA seal
true (Which she says is crazy because plenty of beneficial tooth paste without fluoride that contain hydroxyapatite)
What signifies if a listerine mouth rinse has NO alcohol present?
if product has “zero” in its name
Describe what active ingredients are found in listerine mouth rinses:
dependent on product claim
If listerine product claim is “gum health” or “tartar control” then the active ingredients are:
essential oils
If listerine product claim is “cavity protection” then active ingredients are:
sodium fluoride (0.02%)
How many different listerine products are listed on the website?
18
Professor discussed this mouth rinse as a “good OTC option for patients with moderate risk for caries”
ACT mouth rinse
How many different formulas of mouth rinse are provided by ACT? (ranging from basic mouthwash to kid’s formulated mouthwash and mouthwash for dry mouth)
6
What is the active ingredient in ACT mouth rinse? (generic)
sodium fluoride (0.05%)
What is the active ingredient in ACT Whitening Mouth wash?
sodium fluoride (0.02%) - note this is less than the other ACT mouth rinses
Professor states that whitening mouth rinses:
do not actually work
T/F: The crest website provides a comprehensive list of active and inactive ingredients.
False- crest website does NOT provide information defining active and inactive ingredients
The Crest brand includes:
Scope brand
Professor states that crest brand mouth rinses ____ more than any other brand:
stains teeth
What type of mouth rinse would you recommend to a patient with mouth sores?
Colgate Peroxyl
Colgate whitening mouth rinses typically utilize ____ as a whitening agent
hydrogen peroxide
Why is Colgate peroxyl helpful for patients with mouth sores?
contains 1.5% hydrogen peroxide
What is the active ingredient in Colgate ortho defense?
sodium fluoride (0.04%)
What is the professors favorite mouth rinse due to to having a lot of active ingredients?
Closys
What are the active ingredients in Closys mouth rinse?
CPC 0.75% OR sodium fluoride 0.05%
What is the best over the counter option for a mouth rinse according to professor?
Closys
Mouth rinses and sprays for xerostomia include:
- biotin mouth rinse
- oasis mouth rinse
- spry mouth spray
If a patient presents with xerostomia, what mouth rinse/srpay might you recommend?
- biotin mouth rinse
- oasis mouth rinse
- spry mouth spray
Spry mouth moisturizing spray for xerostomia, utilizes what ingredients?
xylitol and aloe
How do mouth rinses and sprays for xerostomia function?
All are very viscous and coat the oral tissues to help alleviate dryness
Considered the gold standard of mouth rinses and prescription only:
chlorhexidine gluconate
Proved to me the most effect anti plaque oral rinse:
chlorhexidine gluconate
Chlorhexidine gluconate is a ____ compound that binds to ___ of tooth enamel, pellicle, plaque, extracellular matrix of plaque and mucous membrane
cationic; hydroxyapatite
chlorhexidine gluconate is a cationic compound that binds to hydroxyapatite of:
tooth enamel, pellicle, plaque, ECM of plaque and mucous membrane
chlorhexidine gluconate absorbed to hydroxyapatite is believed to:
inhibit bacterial colonization and prevent pellicle formation
What is the substantivity of chlorhexidine gluconate?
8-12 hours
chlorhexidine gluconate is used most often during ____, however not proved beneficial as:
perio therapy; SOLE method of treating perio with deep pockets
T/F: CHX has been proven to be the sole method of treating perio with deep pockets
False- although its advantages with perio therapy, mouth rinses alone will not go deep into perio pockets and will only go about 2 mm
CHX is used to irrigate perio pockets following SRP which can help:
decrease inflammation and SubG plaque accumulation
What is the alcohol concentration of CHX w/ alcohol
12%
The alcohol free formulation of CHX is comprised of
0.12% CHX
T/F: Evidence reveals that the alcohol free CHX formulation is less effective than the alcohol-based CHX formulation:
False- evidence suggests the alcohol free formulation is just as effective
Discuss the approvals of CHX alcohol and non alcohol version:
Both have FDA approval; ADA seal of approval not given due to changes in the program
What mouth rinse can be used if you feel a sore throat coming on?
CHX
How would you write the prescription for CHX?
Rx: Peridex (chlorhexidine gluconate) 0.12% mouthwash
Dispense: 15ml
Sig: Apply 1 tablespoon as directed twice per day for 30 seconds
Refills: none
Homecare instructions for CHX include:
- brushing/flossing should be done PRIOR to rinsing
- DO NOT rinse with water immediately after rinsing with CHX. wait 30 min
Why should brushign and flossing be done PRIOR to rinsing with CHX?
CHX mechanism of action is inactivated by toothpaste
What are the PROS of CHX? (3)
- Antimicrobial effect on bacteria, fungus, and viruses
- Aids in management of periodontitis , caries, peri-implantitis, & infections associated with extractions
- Gold-standard following most oral surgeries
What are the CONS of CHX? (6)
- Stains teeth with prolonged use
- Can cause metallic taste with excessive use
- Can cause black hairy tongue appearance
- May aid in formation of supra gingival calculus
- Requires prescription
- Should not be used long-term
What mouth rinse is very similar to CHX?
saltwater mouth rinse
Has been determined to be as efficient as 0.12% CHX in reducing inflammation following minimally invasive perio therapy (SRP or surgery):
Saltwater mouthrinse
What are the benefits of saltwater mouth rinse over CHX:
inexpensive and easily accessible
If you were to give directions to a patient on how to make & use saltwater mouth rinse, what would they be?
1 cup of warm water to 1 teaspoon of salt, mix well, rinse in mouth for 30 seconds, then expectorate
When to use mouth rinses: (4)
- based upon need (caries/gingivitis/perio/surgery)
- patients who have manual dexterity issues (plaque control)
- pre/post surgery
- mouth sores (Colgate Peroxyl)
What are the negative outcomes of mouth rinses (in general) (6):
- alters natural microbiome that occurs in the oral cavity
- dries out oral mucosal tissues (especially alcohol based)
- causes imbalances in pH levels
- may worsen halitosis
- may cause ulcers/increased risk for oral cancer
- may contribute to development of gingivitis
What mouth rinse would you not prescribe to someone with xerostomia?
alcohol based - as this may further dry out the mouth
Why may a mouth rinse contribute to the development of gingivitis?
because of its ability to alter the micro flora
