Mouthrinses Flashcards
● When Do You Recommend a Mouthrinse?
o Determine need (caries and/or periodontal) and Caries risk (OTC fluoride, Rx fluoride)
o Patients who are unable to mechanically remove plaque
o Patients who, despite their best attempts, need adjunctive measures (it is NOT intended to replace brushing)
o Patients with ANUG (acute necrotizing ulcerative gingivitis) – Patients unable to brush teeth because its so painful
o Pre/post periodontal surgery or Patients undergoing disease control therapy
● Alcohol is used as solvent for active ingredient
o Alcohol is NOT the active ingredient!
● Alcohol is used as solvent for active ingredient
o Alcohol is NOT the active ingredient!
● OTC Fluoride mouth rinse
o Most have about 225ppm (neutral sodium mouth rinses)
o Bottom line: active ingredients are the most important thing, and it’s the NaF.
o Essential oils are in these for flavor, NOT therapeutic for gingivitis
▪ Alcohol is the solvent for the essential oils
● Chlorhexidine (CHX)
o Most effective anti-plaque agent available at this time = GREATEST SUBSTANTIVITY
o Characteristics
▪ 0.12% CHX (2% CHX available for use in restorative, but please don’t use)
▪ 12% alcohol
▪ 35-40% decrease in plaque and gingivitis
▪ Cytoplasmic poison; causes rupture of cell membrane allowing leakage
▪ Binds to mucins, reducing pellicle formation and inhibiting colonization
▪ Binds to bacteria, inhibiting their adhesion onto teeth
▪ Substantivity: 12-24 hours (only agent right now w/ this availability)
CHX: Side effects
▪ Staining – very hard to remove, cannot just polish off
▪ Altered taste
▪ Supragingival calculus (slight increase)
● Kill bacteria, so more dead bacteria end up getting stuck in the matrix
▪ Mucositis – mostly with European version, which is a little higher concentration
CHX: Usages
Dosage: rinse with 15ml, bid (2x day), for 30 seconds
▪ Don’t rinse with water afterwards even though it tastes bad
o Most effective anti-plaque agent available at this time
o CHX will only have superficial effects on established biofilm (thicker plaque)
▪ More effective when plaque is (professionally) removed prior to rinsing
▪ Biofilm will adapt and protect itself form the effects of CHX
WTF does toothpaste do to CHX
o Inactivated by toothpaste – important to rinse well with water prior to rinsing with CHX
▪ Or wait 30 min before rinsing with CHX
o DO NOT rinse with water immediately after rinsing with CHX (this will rinse away the flavoring agent + dilute CHX)
● Water pik
o Only works on unattached plaque. Not a lot of unattached plaque bc a lot of it is attached…so the water pik is mostly good for displacing unattached plaque, food debris. Use as AN AID to regular brushing and flossing if patient likes it/wants to try it. Always use in conjunction with brushing.