DH270 Antimicrobial rinses/irrigation/plaque control

trends in antimicrobial therapy used for caries management

Chlorhexidine Gluconate (CHX) Fluoride Povidone-Iodine Xylitol

what products are used fir professional oral irrigation?

-CHX gluconate (GCF overturns too quickly for it to be effective) -povidone-iodine -tetracycline/distilled water -sodium hypochlorite

whitening agents containing hydrogen peroxide

-Crest -listerine pre-brushing rinse

what are brand names for chlorhexidine gluconate?

-Peridex -Perioguard -Oris -PerioRX -Others

what are indications for supragingival irrigation?

-adjunctive aid for gingivitis, poor OH, inadequate home care -adjunctive for clients after orthognathic surgery or who are in active ortho treatment -addition of chemotherapeutic agents such as listerine or CHX -adjunctive aid for clients who do not comply with interproximal aids, or if the client prefers it

what are the 5 general categories for chemical plaque control agents?

-agents that interfere with the attachment of bacteria to the pellicle surface or to each other -antibiotics capable of inhibiting or killing a specific group of bacteria -antiseptics w/ a broad spectrum of antibacterial activity -non-enzymatic, dispersing, denaturing or modifying agents that can alter the structure or metabolic activity of plaque -single or combination enzymes that can break up or disperse the plaque biofilm or modify activity

what are benefits of pre-treatment rinsing?

-can reduce the number of microorganisms in the oral cavity -reduces aerosol contamination occurring during professional care -highly recommended when using ultrasonics -clients also appreciate the provision of a rinse after the completion of care

what are indications for subgingival irrigation by the clinician?

-clients with C or D microscope risk -clients with site specific deep pocketing, with signs of active inflammation, exudate, furcations etc

what are the antimicrobial effects of fluoride?

-effects bacterial metabolism -may contribute to reduced levels of S. Mutans NOT lactobacilli

what factors should be considered then selecting antimicrobial agents for plaque and gingivitis reduction?

-efficacy -safety -specificity -stability -substantivity

what are some indications for use of CHX?

-helps to control gingival inflammation and bleeding following periodontal scaling and surgery -enhances surgical outcomes by controlling plaque and gingivitis -can also be used in the treatment for oral candidiasis, aphthous stomatitis, ANUG or ANUP, mouth breathing, and for patients with inadequate home care due to physical/mental limitations -pre-procedural rinse to lower oral bacterial count -short-term adjunct following oral surgery or periodontal surgery that limits client plaque removal because of healing tissues, dressings, or accessibility -used pre-procedurally a day or two prior to surgery -Implants, overdentures, extensive fixed prosthetics, orthodontic appliances

what agents are used to reduce VSC (volatile surface compounds)?

-oxidizing agents and zinc chloride are recommended treatment (neutralize VSC) -substantial evidence that use of sodium bicarbonate products should be considered as an effective method for controlling mild to moderate oral malodor -routine use of CHX for oral malodor alone is discouraged due to taste alteration, staining, and alcohol content

what are the causes of oral malodor?

-primarily dental diseases -multifactorial -extrinsic or intrinsic -the tongue: papillae and crevices on dorsum of tongue harbor gram- bacteria; combined with dead cells, saliva and food products produce VSCs -denture wear/other appliances -tonsillitis -sinusitis -xerostomia

what benefits to oral health does home irrigation produce?

-removes unattached plaque and dilutes toxins -controls gingivitis -good for clients who do not receive the desire result with traditional self care methods

Concentrations greater than 3% hydrogen peroxide for more than ___days is discouraged because of reports of adverse tissue effects

30

how long does stannous fluoride cause anti-mutans streptococci activity for?

8 hours

what essential oils and other antiinflammatory agents are found in STELLALIFE?

Aconitum, Azadirachta, Arnica, Calendula, Chamomilla, Echinacea, Gelsemium, Hepar, Hypericum, Ignatia, Mercurius, Plantago, and Ruta

what is the controversy with the use of povidone-iodine?

Appears safe for short-term use but potential adverse effects from long-term usage have not been evaluated. P-I should be avoided in pregnant and nursing women, clients with thyroid conditions, and those sensitive to the agent

-0.12% -disrupts cellular osmosis and cell wall integrity, resulting in cell death -high substantivity-remains in active form for 8-12 hours in the mouth

CHX gluconate rinse

what is the most successful antibacterial therapy agent against cariogenic bacteria?

CHX rinse or gel

what paste and rinse systems are oxidizing agents/chlorine dioxide?

Closys II, Oxyfresh

types of stannous fluoride gels (.4%)

Gel Kam, Fluoridex

are there any mouth rinses accepted by the ADA for the treatment of periodontitis?

NO

types of stannous fluoride rinse

PerioMed (Omnii) Gel Kam (Colgate) Fluoridex (Discus Dental)

Studies show that a daily dose of CHX rinse for 2 weeks can markedly reduce what type of bacteria?

S. Mutans (Recolonization takes place in 3-6 months (rather than immediately), clients with high levels should have these 2-week treatments at 3 month intervals)

- ½-1 tsp/300ml water two times per week (NOT DAILY!). -Overuse can result in overgrowth of strep and enamel erosion -HOT water (as hot as the patient can stand it) kills bacteria!

Sodium hypochlorite (household bleach) as a daily irrigant

types of homeopathic oral care products

StellaLife® VEGA® Oral Care Rinse, Gel, Oral Hydration Mist

how does fluid pulsation work?

The cycles of compression and decompression are capable of expelling subgingival bacteria and debris, in addition to stimulating gingival tissues, pulsating is more effective than a stream

what is chlorhexidine bactericidal against/how does it work?

a broad range of G- and G+ microorganisms and fungi, it alters the cell wall to lysis occurs and the cell is destroyed

how long must CHX and povidone-iodine be applied to be effective?

a minimum of 5 minutes (can be used during ultrasonic scaling)

-method of plaque removal or disruption is used with other methods of therapy -considered supportive treatment (therapy in addition to other self care methods)

adjunctive therapy

what is a major limitation of mouthrinses?

agents only penetrate a few mm subgingivally

what are some considerations of mouthrinses?

alcohol content, pH, and sodium content

what is STELLALIFE indicated for?

aphthous ulcers, lichen planus, mucositis, post-surgical management, chronic inflammation

-the ability of an agent to destroy bacteria

bactericidal

-the ability of an agent to inhibit the growth of bacteria without destruction

bacteriostatic

why was sanguinarine removed from viadent?

because studies over 20 years ago suggested that users were 8-11 times more likely to develop oral leukoplakia (supported by a grant from the american cancer society)

-a widely used cationic quaternary ammonium compound with a broad antimicrobial spectrum -mostly effective against Gram-positive bacteria and yeast -should be used as a 20-ml rinse twice a day -weaker than CHX or EO -side effects include increased calculus formation, staining, and occasional burning sensation

cetylpyridinium chloride

-chemical compounds used as rinses, dentifrices, irrigants, sustain/controlled release agents, or systemic drug therapies (oral antibiotics or host modulation agents)

chemotherapeutic agents

-only agent commercially available with high substantivity -rapidly ADSORBED to the teeth and ABSORBED to the oral mucosa and pellicle, and is released slowly [prolonging the bactericidal effect]

chlorhexidine gluconate

what are the only 2 mouth rinse products with the ADA seal of acceptance as having a therapeutic effect on gingivitis?

chlorhexidine gluconate .12% and listerine

-effective agains S. Mutans -used as a mouthrinse once daily for 2 weeks every 2-3 months -regimen should be continued for about 1 year and should be monitored -parents/caregivers with children 3yrs and younger with high bacterial levels should use this

chlorhexidine gluconate rine

what is the key ingredient of closys II and oxyfresh toothpastes?

chlorine dioxide

what are contraindications for supragingival and subgingival irrigation?

clients with a high risk of infective endocarditis during initial/active therapy

key ingredient is chlorine dioxide. Does NOT contain sodium lauryl sulfate (SLS), an ingredient in most dentifrices said to contribute to recurrent aphthous ulcers

closys II and oxyfresh toothpastes

-Cetylpyridium Chloride, ZYTEXTM (essential oils and zinc chloride) -Antibacterial properties; reduces volatile sulfur compounds (VSC) -Alcohol-free, sugar free (when Discus Dental marketed this it had xylitol, now marketed by Philips Sonicare) Available OTC. -low substantivity -used for oral malodor

combined essential oils, CPC, zinc chloride, and xylitol

explain the protocol for hydrogen peroxide based rinses for use during covid?

concentration should be at least 1.5%, patient should rinse for at least 1 minute, over the counter rinse should be diluted 1:1, effectiveness varies, concentration is increasing so time decreases

Most OTC mouthrinses are considered _______, not therapeutic [for plaque and gingivitis], even though many claim antibacterial activity

cosmetic

-creates a barrier that prevents bacteria from adhering to tooth surfaces -interferes with bacterial aggregation and colonization -NOT bactericidal -used to be RX only, now available OTC

delmopinol HCL 0.2% barrier rinse

the dental water jet reduces what

dental water jet reduces plaque biofilm, bleeding, and gingivitis, changes the composition of plaque/removes the protective layer on biofilms

Most common cause of oral malodor (halitosis) is what?

elevated levels of volatile sulfur compounds (VSC) the production of these gases result from the action of gram - anaerobic bacteria on protein matter

-irrigant is deflected from the tooth surface away from the main spray, aids in sulcular access and subgingival delivery of the solution

flushing zone

"Brush, Scrape, Rinse"

fresh breath system

-one-stage SRP entire dentition within 24 hours -studies indicate no difference with this treatment vs. quadrant scaling with anesthesia in 2-4 appointments -popular in those states where hygienist are not allowed to administer local anesthesia

full mouth disinfection

-leads to reduction of pro-inflammatory cytokines -demonstrates significant reduction in bleeding, gingivitis, periodontal pathogens and probing depths

home irrigation

-irrigant makes contact, direct impact of the spray against the tooth surface results in the removal of plaque and debris

impact zone

-what is irrigations roll in disease prevention?

it is inconclusive, there is no evidence that it changes CAL, blood and crevicular fluid levels can deactivate the agent

what is CHX NOT effective against?

lactobacilli

-a single method of plaque removal -NOT effective

monotherapy

is CHX approved for the reduction of periodontitis?

no

does evidence support therapeutic use of oxygenating agents as part of a self care program?

no, short term and long term studies found no added value using peroxide or baking soda over mechanical oral hygiene

-involves swishing an oil or combination of oils in the mouth for 20 minutes -common oils are sesame oil, sunflower oil, and coconut oil

oil pulling

-a targeted application or delivery of a pulsated or steady stream of water or other irrigant for cleansing and/or therapeutic purposes

oral irrigation

Home preparations with hydrogen peroxide Colgate Peroxyl Amosan Glyoxide

oxygenating agents

-reaches 90% of 4-6mm pockets -reaches 64% of 7mm or above pockets

pik pocket tip attachment for the waterpik

-pre-brushing rinse -no effect on plaque reduction when compared to placebos -HIGH sodium content

plax: sodium benzoate

-effective antibacterial -reduces levels of lactobacilli AND s.mutans -reduce incidence of early childhood caries in high risk children when applied 1x/every 2 months

povidone-iodine

-should be administered by a dental professional only -1 part betadine to 9 parts water for ultrasonic use -equal parts betadine to water for subgingival irrigation with a cannula

povidone-iodine

-equal parts Betadine and H20 -solution should fill up and remain in pocket for at least 5-10 minutes (may require repeated subgingival application to retain the solution in the pocket)

povidone-iodine: subgingival irrigation with a thin cannula

-live microorganisms that have health benefits for the host -long term effects have not demonstrated efficacy for plaque and gingivitis

probiotics

Cetylpyridium Chloride (CPC) Scope, Cepacol, Crest Pro-Health Rinse, Viadent

quaternary ammonium compounds

-once a key ingredient in viadent line of toothpaste and mouthrinse -0.03% sanguinarine and 0.02% zinc chloride -a natural antibacterial agent -interferes with bacterial glycolysis preventing adherence

sanguinarine

an ingredient in most dentifrices said to contribute to recurrent aphthous ulcers

sodium lauryl sulfate

Anti-inflammatory and anti-microbial properties that are shown to accelerate healing, temporarily relieve pain, and reduce swelling and bruising

stellalife (homeopathic oral care product)

-the ability of an antimicrobial agent to be retained in the oral cavity for extended periods with subsequent slow and sustained release of the active ingredient at effective levels

substantivity

mechanical methods of delivering antimicrobials have limitations, they are primarily _______ plaque removers

supragingival

what are the 2 zones in oral irrigation?

the impact zone and the flushing zone

what causes the antimicrobial action of stannous fluoride?

the stannous/tin ion rather than the fluoride itself

what is the greatest benefit of mouthrinses?

to augment the mechanical efforts of those clients who are not effective with their home care (they do not replace the need to properly brush and floss)

what is the primary purpose of home irrigation?

to reduce harmful bacteria, therefore the risk and severity of periodontal disease

-an ingredient in mouthrinses outside the US (used to be the key ingredient in colgate total) -moderate substantivity -antimicrobial and anti-inflammatory properties

triclosan

________ that used to be in Colgate Total toothpaste had the ADA Seal of Acceptance as anti-gingivitis, decay prevention, and reduction in plaque and calculus. It was [sadly] taken off the market and reformulated with Stannous Fluoride

triclosan

key ingredient is now zinc citrate (a "breath freshening" agent that is also reported to have anti- 'tartar' properties —prevents buildup by preventing plaque from calcifying

viadent

types of waterpik dental water jets

waterpik ultra, waterpik cordless

- a natural sweetner that bacteria cannot feed on -limits the transfer of decay causing bacteria from the caregiver/parent to baby/toddler -becoming a popular ingredient in several professional and OTC products

xylitol

a "breath freshening" agent that is also reported to have anti- 'tartar' properties —prevents buildup by preventing plaque from calcifying

zinc citrate

what is the key ingredient of viadent?

zinc citrate

-an ingredient in products that are popular for oral malodor/halitosis -Zinc Chloride (Breath Rx) and Zinc Citrate (Viadent Toothpaste) -Marketing claims effective against VSC's to freshen breath, and studies have been performed claiming reduction in plaque and gingivitis.

zinc compounds