Test 3 Flashcards
What does CHG stand for?
Chlorhexidine Gulconate
What is CHG?
Chlorhexidine Gluconate is a bis-biguranide which are cationic, broad-spectrum antimicrobials effective for both gram-positive and gram-negative bacteria.
How is CHG used?
Predominantly used in prescription oral rinses, irrigation solutions, and controlled-realase products
When should CHG be prescribed?
To facillitate healing 4-6 weeks after perio surgery and in the DH clinic to aid in plaque reduction and gingivitis (gingival bleeding) with DD3 and DD4 clients. (Reeval visits)
How does CHG work?
Attaches to salivary proteins and prevents pellicle formation. Attaches to the bacterial cell wall and distrupts its ability to colonize
What is the dosage of CHG?
20mL dosage for 60 seconds twice daily
What are the disadvantages of CHG?
Brown staining
Increased calculus deposition
May cause allergic reaction
30 minutes between CHG and brushing to avoid interacion with the detergent (sodium lauryl sulfate) which deactivates the CHG
What are the contraindications for CHG?
Do not use for long periods of time
Anterior restorations
Allergies or hypersensitivites to chlorhexidine gluoconate, chlorhexidine compounds or other ingredients
What schedule category does chlorhexidine fall under?
Schedule 1
What is an example of a phenolic compound?
Listerine
What is the main reason that the level of reduction in plaque and gingivitis seen with chlorhexidine is greater than that noted for phenolic mouth rinses?
Superior substantivity of chlorhexidine - its binding lasts longer
Why did the authors exclude patients with systemic disease from the study?
To eliminate potential confounding factors that could interefere with the results
What is the evidence that proves professionally applied oral irrigation has limited clinic value?
Not retained in adequate concentrations for sufficient duration to have significant effects on periodontal disease
Some active ingredients such as chlorhexidine gluconate are deactivated by blood and proteins
Gingival crevicular fluid is replaced about every 90 seconds reducing the concentration of an antimicrobial agent that reaches the subgingival organisms
How should antimicrobials be used in the treatment of periodontal diseases?
To supplement mechanical debridement
What is the difference between local and systemic delivery methods?
Local - the antimicrobial agent is applied directly to the oral cavity or to a specific location within it
Systemic - ingested by the patient and delivered via the blood stream
What agent kills or prevents propagation of plaque microorganisms?
Antiseptic agents
What agent inhibits or kills specific or groups of bacteria, or modulates host inflammatory response?
Antibiotics
What agent alters structure and/or metabolic activity of bacteria?
Modifying agents
What agent interferes with the ability of bacteria to attach to acquired pellicles?
Anti-adhesives
What is the goal of professionally applied products?
Aimed at reducing pathogenic bacteria in diseased sites that have resisted healing
What are some pros of professionally applied products?
Controlled-release drug delivery
Does not require patient compliance
Non-invasive
Able to reach the base of the periodontal pockets
What are some cons of professionally applied products?
Active ingredients may not be retained in adequate concentrations for sufficient periods of time or may become deactivated by blood products
What is the main ingredient of Antridox?
Doxycycline hyclate 10%
How is Antridox delivered?
Gel polymer that flows to the pocket base and solidifies on contact with gingival crevicular fluid
What is the length of Antridox’s bacterial suppression?
7 days
What are the pros of Antridox?
Controlled release for 7 days
Reaches gingival crevicular fluid concentrations of over 1500mg/mL within hours
Absorbable by the body so does not require professional removal
What are the indications for Antridox?
Periodontal disease with deep pockets
What are the contraindications for Antridox?
Sensitivity/allergy to any drug in the tetracycline family
Pregnant women
Breast-feeding women
What is a Periochip?
Chlorhexidine chip with 2.5mg of chlorhexidine d-gluconate that is inserted into a 5 mm or greater periodontal pocket
What is the active ingredient in a Periochip?
Chlorhexidine d-gluconate 2.5mg
What is the length of Periochip’s bacterial suppression?
7-10 days
What are the pros of Periochip?
Suppression of subgingival bacterial flora is evident for up to 11 weeks
Self-retentive
Self-resorbs requiring no professional removal
Safe for pregnant women
No potential to develop bacterial resistance
Treatment can be repeated after 3-6 months
Delivery method of Periochip?
Place chip subgingivally
What is the contraindication for a Periochip?
Allergyy to chlorhexidine
What is the main ingredient of Arestin?
Minocycline hydrochloride 1mg
How is Arestin delivered?
As microsphere in a dry powder via a syrgine like handle with narrow tip to be inserted subgingivally
What is the length of Arestin’s bacterial suppression?
20 days
What are the pros of Arestin?
It well exceeds MIC levels within hours and remains effective for over 20 days
Resorbs and doesn’t require professional removal
What are the contraindications of Arestin?
Sensitivity or allergy to minocyclin or tetracyclines
Breat feeding women
Pregnant women
WHen would you use Atridox, Periochip and Arestin?
Isolated pockets
Before systemic antibiotics are applied
What is periowave?
A painless, non-invasive photo-disinfection procedure that can significantly improve treatment outcomes when combined with scaling and root planing
How is periowave applied?
A cold low-power diode laser as the activating light
What is the main goal of periowave?
Pathogen eradication
Are antiseptics and antimicrobials the same?
Yes
CHG rinses reduce plaque by how much?
16-45%
CHG rinses reduce gingivitis by how much?
27-80%
What is term referring to the prolonged adherence of an antiseptic to the oral mucosa/tooth and slow release of the effective dose?
Substantivity
What are antimicrobial and anti-gingvitis agents that reduce plaque accumulation and inflammation?
Phenolic compounds
What are components of plants that contain phenolic compounds that destroy microorganisms?
Essentil oils
True or False: professionally applied subgingival irrigation with various antrimicrobials has limited clinical value.
True
What size is a Periochip?
4 x 5 mm and 0.35 mm thick
Chemotherapeutics for self-applied delivery systems are typically used more often
at home with lower concentrations of active ingredients
Dental lasers are classified according to
Wavelength
Delivery system
Emission modes
Tissues absorption
Clinical applications
How do the lasers work?
Energy absorption will cause the target tissue to react in four ways: warm up, cogualte, vaporize or melt and recrystallize.
True or False: there has been very little research conducted with other adjunctive periodontal laser therapies so there is a low level of certainty regarding their use.
True
What are the primary objectives of periodontal surgery?
- Reduction in pocket depths
- Gain access for calculus and bioflim removal
- Regenerate periodontal tissue
- Arrest disease progression
- Create maintainable oral environment
How is clinical success measured for periodontal surgery?
Attainment of stable or improved clinical attachment levels, minimal inflammation and BOP, and reduced and stable probing depths.
What are the indications for peridontal surgery?
- Pocket elimination/reduction
- Correction of mucogingival defects
- Improve aesthetics
- Creating favourable restoration environment (crown lengthening)
- Placement of dental implants
- Icision and drainage of a gingival or periodontal abscess
- Regeneration of destroyed attachment apparatus
What are the contraindications for periodontal surgery?
- Systemic diseases that cannot be controlled by medications
- Systemic diseases that are associated with excessive bleeding
- Client taking blood thinners
- Clients taking inravenous or oral bisphosphonates
- Clients who are noncompliant with plaque control
- Concern for cosmetic outcome
- Treating teeth that have a hopless prognosis
- High risk for dental caries, sme surgeries expose root surface (relative contraindication)
When should a re-eval be completed?
4-6 weeks after initial NSPT is completed
After initial NSPT is completed, what should be done fo active periodontitis?
Refer to periodontist
What is the role of the dental hygienist pre-op periosurgery?
Removal or hard and soft deposits
Reinforcement of oral hygiene self care
Discuss the advantages and disadvantages of surgical treatment
What is the role of the dental hygienist post op perio surgery?
Periodontal dressing removal
Post surgical biofilm removal
Follow-up wound care and home care istructions
How do you know if the client has peri-implantitis or mucositis?
Peri-implant mucositis has damage to the soft tissue only while peri-implantitis has damage to the soft tissue and surrounding bone.
What are the characteristics of peri-implant mucositis?
Reversible
Plaque related
BOP
Erythema
Inflammation
Suppuration
Can lead to perio-implantitis