ABX - Part I - Chemotherapy and Plaque Control

Question 1

The goal of hygiene is to provide an environment that encourage normal _______ and prevent _______ of pathogenic flora.

Answer 1

Flora

Growth

Question 2

What are the two ways to achieve oral hygiene?

Answer 2

Mechanical means

Chemical means

*Or a combination of means

Question 3

Mechanical plaque control is the __________ method used to prevent dental disease and maintain oral health.

Answer 3

Primary

Question 4

T/F - Just by brushing, even with just water, can be just as effective as brushing with toothpaste or other products.

Answer 4

TRUE

Question 5

What are some issues with mechanical means of plaque control?

Answer 5

Lack of motivation or understanding

Impaired manual dexterity

Systemically compromised

Inaccessible
-Deep pockets or furcations

Recent surgery

Question 6

T/F - Toothbrushing can only get down into the socket 1-2 mm.

Flossing can only get down into the 2-3 mm.

Answer 6

TRUE

TRUE

Question 7

What is a chemotherapeutic agent?

Answer 7

Chemical substance that provides clinical therapeutic benefit

Benefits

• Antimicrobial actions
• Ability to increase the host’s resistance

Question 8

What are some chemotherapeutics in periodontal tx management?

Answer 8

Systemic abxs

Drugs that modulate host response

• Periostat
• NSAIDS

Topical antimicrobial agents

• Toothpaste
• Rinses

Drug delivery systems
-Arrestin

Question 9

What are 5 desirable characteristics of local chemotherapeutics?

Answer 9

Substantivity

Low toxicity

High potency

Good permeability

Intrinsic efficacy

Question 10

What is substativity?

Answer 10

Product sticks to the teeth and slowly releases chemicals (chlorhexidine)
-Product has to get into the biofilm and disrupt it from within

Question 11

1st generation products?

Answer 11

Agents that have antimicrobial activity

• Phenolics
• H2O2

NO SUBSTANTIVITY

Question 12

2nd generation products?

Answer 12

Agents that have antimicrobial activity and proven SUBSTANTIVITY
-Chlorhexidine

Question 13

3rd generation products?

Answer 13

Target specific bacteria or bacterial products that are essential to disease development and have substantivity

Question 14

What are 4 antimicrobial activities?

Answer 14

Cidal

Static

Substantivity

Inhibitory dosage

Question 15

T/F - To make a plaque control, benefit MUST demonstrate significant effects against gingivitis.

Answer 15

TRUE

Question 16

How is data efficacious?

Answer 16

2 independent, well-designed trails
-Minimum of 4 weeks

Placebo control

Assess plaque qualitatively and quantitatively

Statistically significant

References must be published

One study of US-like population

Typical product users

Use ADA-sealed products

Question 17

What about safety data of products?

Answer 17

Soft/hard tissues
-No deleterious effects

Oral flora
-No development of opportunistic or pathogenic organisms

Toxicology

• Toxic/adverse effects
• Document any mutagenic/carcinogenic effects

Question 18

Do mouth rinses effect the sub-gingival plaque?

Answer 18

NO

Question 19

What are some popular topical antimicrobial

Answer 19

Chlorhexidine

Essential oils

Question 20

What products can the pts get OTC?

Answer 20

Rinses

Rx rinses

Home irrigation

Toothpaste

Question 21

T/F - Chlorhexidine is the “Gold Standard.”

Cationic bisbiguani

Answer 21

TRUE

Question 22

What is the most common concentration of chlorhexidine in the US?

Answer 22

0.12%

11. 6% alcohol
    - pH 5.5
    - For shelf-life

ADA/FDA approved

High effects

Question 23

What is chlorhexidine’s mechanism of action?

Answer 23

Ruptures cell membranes

Good substantivity

• Binds to soft tissue
• Detectable in saliva 8-12 hrs later

Broad spectrum
-G+ and G- and yeast

Question 24

Side effects of chlorhexidine?

Answer 24

Staining*

Increased suprgingival calculus*

Altered taste sensation

Reversible desquamation

Transient swelling of salivary glands

Rare hypersensitivity

Question 25

What is the chlorhexidine concentration outside of the US?

Answer 25

0. 2% | - No significant difference in antimicrobial or clinical effects

Question 26

By how much does chlorhexidine reduce plaque? By how much does chlorhexidine reduce gingivitis?

Answer 26

50-55% 45%

Question 27

What are the pt instructions for CHX (Chlorhexidine)?

Answer 27

2x/day for 30 seconds with 1/2 ounce

Question 28

T/F - Pts should allow 30 minutes b/t rinsing with CHX and rushing teeth. Why?

Answer 28

TRUE Sodium lauryl sulfate and fluoride ion in toothpaste can reduce the effectiveness of CHX

Question 29

T/F - Periodontitis (or dead tissue) is the most common cause of halitosis.

Answer 29

TRUE

Question 30

T/F - Enhanced wound healing has been shown when CHX was used as a pre-rinse for extractions.

Answer 30

TRUE

Question 31

T/F - 30-60 second pre-rinse can reduce bacterial load by >/= 90-95% and significantly decreasing aerosol contamination/bacteremia.

Answer 31

TRUE

Question 32

What are uses of CHX?

Answer 32

Gingivitis rampant caries Candida infections - Dentures - Immunocompromised Post-operative

Question 33

T/F - The supragingival plaque influences the subgingival plaque.

Answer 33

TRUE

Question 34

T/F - CHX does kills fibroblasts.

Answer 34

TRUE

Question 35

What is the oldest phenolic product?

Answer 35

Listerine - 1865 | -ADA approved

Question 36

Listerine used to have ______% ethanol, and since 1992 has ______% EtOH.

Answer 36

26. 9% | 21. 6%

Question 37

What is the pH of listerine?

Answer 37

4. 2 - 30 second rinse 2/3 ounce 2x/daily - Alcohol can range from 22-27% depending on the brand

Question 38

What is Listerine’s mechanism of action?

Answer 38

Cell wall disruption and inhibition of bacterial enzymes

Question 39

T/F - Published research shows with essential oils: - 20-34% plaque reduction - 28-34% gingivitis reduction - Anti-candida effect - Decreases plaque and increases wound healing 7 days - Used as a pre-rinses for SRP >90% reduction of bacteria in aerosols.

Answer 39

TRUE

Question 40

Phenolic “essential oils” (Listerine), can __________ LPS, have anti-inflammatory properties, _____________ is the principal antibacterial component, and have low substantivity (effectiveness related to _________ or contact)

Answer 40

Extract THYMOL Duration

Question 41

3 side effects of listerine-type products?

Answer 41

Burning Bitter taste Possible staining

Question 42

T/F - Listerine does NOT take the place of floss.

Answer 42

TRUE Used as adjunct only

Question 43

What 2 mouthwashes meet the ADA approval stating that it req’s the product be able to demonstrate a 20% reduction of gingivitis?

Answer 43

Chlorhexidine Listerine

Question 44

What is one quaternary ammonium compound?

Answer 44

Cetylpyridinium (CPC) - Viadent - Scope - Cepacol - Clear choice - Crest Pro-Health Rinse

Question 45

Tell me about CPC.

Answer 45

0.045-0.07% CPC 0-18% EtOH 5.5 - 7.0 pH Dentifrice alters activity 30 minutes b/t rinsing and brushing

Question 46

What is the MOA for quartenary ammonium compounds?

Answer 46

Rupture cell walls *Bind surface, but release rapidly, and that limits substantivity - 14% reduction in plaque and gingivitis for Cepacol - 24% reduction in plaque and gingivitis for Scope

Question 47

CPC MOA?

Answer 47

- Strong initial attachment - Increases cell wall permeability - Decreases cell metabolism - Decreases ability to attach to tooth * -Released from binding site more rapidly than CHX

Question 48

T/F - CPC’s do NOT have the ADA seal.

Answer 48

TRUE

Question 49

What pts should be considered for alcohol-free rinses?

Answer 49

Children Pts with dry mouth Diabetics Alcoholics Pts with sensitive soft tissue Pts of certain religious faiths

Question 50

What is sanguinarine?

Answer 50

Herbal blood root extract Mouthwashes and dentrifices *Claimed to reduce plaque by 17-42% and gingivitis by 18-57% **Research found mixed results ***Data supported increased leukoplakia in pts and increased risk for cancer***