Chemotherapeutic Agents

CPC mouth rinses

-Cetylpyridinium chloride .05-.07% -quaternary ammonium cmpds -Crest Prohealth -contains no alcohol: increase in calc, stain, sloughing -low substantivity -not for <12 -also in Scope, Cepacol, Viadent, and Rembrandt but low CPC%

Aids for xerostomia

-Colgate Optimoist -Biotene Oral Balance or gum -mouth rinses, sprays, or swab sticks -should be combined with fluoride: Salivart and Xero-lube -Oasis by Sensodyne is moisturizing and binds to tissues up to 2 hours (mucoadhesion) -alcohol often added to enhance flavor, aftertaste, increase solubility, NO link to drying tissues or cancer

Triclosan

-MR not available in U.S. -broad spectrum antibacterial agent -concern on the rise -Colgate Total -also in soaps, detergents

Oxygenating mouth rinses

-Peroxyl and Prevention brands -some contain carbamide peroxide, hydrogen peroxide, and alcohol -short term use recommended esp. if hydrogen peroxide -effects are negligable

Fluoridated mouth rinses

-Phos-flur -ACT

Chlorhexidine gluconate (Peridex/Perioguard)

-Rx only CHG or CHX -0.2% not legal in U.S. -0.12% concentration containing 11.6% alcohol, pH5.5 -active with gram + and - org and fungi -reduces mutan streptococci -alters cell wall -rapidly absorbed, binds to pellicle, released slowly -antimicrobial and antigingivitis

Technique and delivery for oral irrigation

-adjust water stream to low setting -lean over sink -direct tip at a right angle to the tooth surface; stream should move in a horizontal direction through the gingival embrasure -can increase pressure slightly over time depending on tissue condition -follow a pattern around the mouth; 4-6 sec at each interdental area

Oral irrigation

-aka hydrotherapy or lavage -oral irrigating devices force a steady or pulsating stream of water over the gingival tissue and teeth -devices also used to deliver antimicrobial agents such as chlorhexidine

Therapeutic effects of dentifrices

-antibiofilm/gingivitis (triclosan, SnF2, zinc citrate) colgate total 1997 -anticalc (pyrophosphates) -remineralization (ACP-Recaldent) -antisensitivity (potassium nitrate, citrate, chloride, SnF2) -whitening is cosmetic

Characteristics of chemotherapeutic agents in mouth rinses

-antimicrobial -oxygenating -astringent -anodyne -buffering -deodorizing -oxidizing

Reviewing motivational interviewing

-asking permission -evoking change talk -open ended questions -reflective listening -normalizing -affirmation

Use for "home irrigation"

-before brushing and flossing to remove debris or after to deliver antimicrobials -debridement of recessed areas of fixed prosthetic or ortho appliances/implants -flushing of perio pockets with a controlled, low intensity stream of antimicrobial agent

Possible side effects of Chlorhexidine

-brownish-yellow stain that rubs off easily -supracalculus formation -unpleasant taste or temp loss of taste -minor irritation to lips, tongue, burning/soreness

abrasive

-clean and polish -Calcium, biocarbonate, salts, aluminum oxide, silica -account for 20-40%

Most commonly recommended medicaments

-essential oils -chlorhexidine -stannous fluoride

flavor and water

-flavoring from essential oils: peppermint, spearmint, cinnamon, etc. and menthol -sweetening from xylitol, sorbitol, glycerol -water maintains formulation

surfactants/detergents

-foam and cleanse -SLS: sodium lauryl sulfate; most widely used

Indications for mouth rinses

-inability to achieve acceptable oral self care -fixed splinting, prosthesis, implants, overdentures -orthodontics -post perio surgery -immunosuppression -high caries risk

Four local methods for chemotherapy

-irrigation -local delivery of a slow-release agent to a perio pocket -mouth rinse -dentifrice

Inexpensive mouth rinses

-isotonic saline solution: 1/2 tsp salt in 8oz water -hypertonic saline solution: 1/2 tsp salt in 4oz water (for edema/swelling) -sodium bicarbonate solution: 1/2 tsp sodium bicarbonate in 8oz water

Studies about chlorhexidine show...

-it is a stable, safe, and effective rinse in preventing and controlling bacterial plaque and reducing and inhibiting gingivitis/caries -may be effective in controlling inflammation following scaling and root planning, prophylaxis, or perio surgery

Precautions for oral irrigation

-keep fluid at low pressure; esp. sub g -only an adjunct NOT a substitute for brushing -can cause tissue punctures and reduce height of papilla if pressure too great or for too long -transient bacteria can be a concern for patients who have pre med prior to treatment

Phenol-related essential oils

-listerine and "antiseptic" brands -available without Rx -reduces mutan streptococci -preprocedural rinse (94% reduction) -short acting; company claims 12 hours -microorganisms do not develop resistance -not for kids <12 or alcoholics

Professionally administered irrigation

-may be administered as an adjunct to NSPT -benefits are controversial/debated over systemic effect -can use with ultrasonic/reservoir

Other advantages of oral irrigation

-patient participation: co-therapy -improved palque removal of difficult to reach areas -care for special need areas

Patients following recommendations

-patients will forget 30-60% of information provided within an hour and 50% of recommendations are not followed

Contraindications for oral irrigation

-physician should review patients who previously require antibiotic pre med for treatment prior to introducing oral irrigation -patients with periodontal abscesses or ulcerative lesions

Purposes of mouth rinses in dental office

-pretreatment rinse -fluoridation -antimicrobial

humectant

-prevent drying or hardening -retains moisture -20-40% -xylitol, glycerol, sorbitol

preservative

-prevent microbe growth -alcohol, benzoates, phenols

Benefits from irrigation

-reduce gingivitis and bleeding -reduce or alter microbial flora -penetrates pocket beyond toothbrush alone -enhances delivery of antimicrobial agents better than rinsing -oral disinfection -alternative to flossing -small benefit from medicaments -perio maintenance/ortho patients

Purposes of mouth rinses at home

-reduce pathogens -post surgical -after perio therapy -anticaries -cosmetic -reduce gingivitis and biofilm

Patient applied sub g irrigation

-soft rubber tip for sub g -tapered plastic tip for gingival margin -thorough instruction must be given to the patient prior to home use -most common antimicrobials are essential oils (full strength) or chlorhexidine (dilute)

Side effects of essential oils

-strong or bitter taste -burning

Ingredients in dentifrices

-surfactants/detergents -abrasive -binder -humectant -preservative -flavor -water

binder

-thicken and stabilize -colloids, cellulose, alginate

types of irrigators and tips

-types: most are power driven, others are water pressure driven -tips: microjet or monojet

How to use Chlorhexidine

-wait 30 min after brushing and flossing bc inactivated by surfactants/detergents -use 1/2oz 2 times a day for 30-60 sec -for short term use only - limit to 6 months

specialized tip

Angulation tip for application below gingival margin via cannula

Do not recommend products with alcohol for patients currently taking which medication?

Flagyl (metronidazole), an antibiotic; can cause nausea or vomiting

Alcohol free chlorhexidine

GUM brand

Substantivity of Chlorhexidine

Has a prolonged effect of 8-12 hours

Dentifrices - what is it?

Substance used with a toothbrush on accessible tooth surfaces to remove biofilm; generally avalable in gel, paste, or powder

Natural dentifrice

Tom's of Maine was purchased by Colgate-Palmolive and became the first natural tp to receive the Seal of Acceptance from the ADA

What do phenol related essential oils contain?

active ingredients: menthol, thymol, eucalyptol, and methyl salicylate also contains: alcohol, sorbitol, flavoring, benzoic acid, sodium saccharin, sodium benzoate, water, poloxamer 407

oxygenating agents

agents to cleanse, debride, and release oxygen ex: hydrogen peroxide/carbamide peroxide

anodynes

alleviate pain and soothe sore spots ex: phenol derivatives

Newer brands of essential oils

contain zinc chloride, whitening agent, and less alcohol - "less intense"

Prebrushing rinses

efficacy not documented; ex: Plax

oxidizing agents

neutralize VSC ex: chlorine dioxide and zinc chloride

deodorizing agents

neutralize odors ex: chlorophyll and zinc chloride

who sees the greatest benefit form oral irrigation?

patients who perform inadequate interproximal cleansing

First OTC antiplaque and antigingivitis mouth rinse to be approved by ADA?

phenol related essential oils (listerine)

buffering agents

reduce acidity and relieve soft tissue pain ex: sodium bicarbonate

antimicrobial agents

reduce or inhibit microbial activity ex: quaternary ammonium cmpds and phenol

Directions for essential oils (listerine)

rinse twice daily with 1/2 - 2/3 oz (20ml) of listerine for 30 sec

astringents

shrink tissues ex: zinc citrate

Goal of oral irrigation

to remove unattached debris, loosely attached biofilm, and reduce the concentration of bacteria, periodontal pathogens, and cellular end products that could be present

Chemotherapy

treatment of disease by means of chemical substances or pharmaceutical agents