Ch 23 Flashcards
(32 cards)
1
Q
what are the 2 classifications of oral rinses
A
- therapeutic rinses: treat diseases (gingivitis, NUG)
2. cosmetic rinses: freshen breath
2
Q
what are indications for oral rinses
A
- in addition to home care for supragingival biofilm reduction and gingivitis
- as an addition to periodontal instrumentation
- following surgical procedures when brushing and flossing are generally not practical
- maintenance of dental implants
3
Q
how do mouthrinses work
A
- supragingival only
- suppress the pathogenicity of existing biofilm(s)
- does not reach subgingivally
4
Q
contents of mouthrinses and their purposes
A
- alcohol: enhances flavour, solubilizes flavour component, antibacterial
- flavour: taste, refreshing cool quality
- humectant (glycerin): adds body, inhibits crystallization around closure
- surfactant (sodium lauryl sulfate): solubilizes flavour, foams, removes debris by lowering surface tension
5
Q
what is substantivity
A
- binds to tissues or tooth surfaces and slowly releases over time
- ideal for rinse to have high substantivity
- major requirement for the success of antimicrobial therapy
- 3 “generation” agents for substantivity
6
Q
what are first generation agents of substantivity
A
- ex. colgate
- low substantivity
- limited therapeutic value in reducing biofilm and gingivitis
- phenolic compounds: listerine
- quaternary ammonium compound: scope, cepacol
7
Q
what are second-generation agents of substantivity
A
- ex. chlorhexidine
- antibacterial properties in addition to high substantivity
- bisbiguanide (0.12% chlorhexidine gluconate) – best percentage for substantivity
- peridex
- periogard
- fluorides
8
Q
what is chlorhexidine gluconate 0.12%
A
- binds to salivary proteins, bacteria cell wall, mucous membranes, tooth enamel
- enters the bacterial cell wall and causes death of the bacteria
- concentration of alcohol is 11.6%
- GUM makes alcohol-free chlorhexidine
- chx binds to fluoride and sodium lauryl sulfate in toothpaste, thus, rinse for 30 secs with chx either 30 mins before or after toothbrushing (8-12 hour substantivity)
9
Q
what are examples of phenolic compounds and what are their contents
A
- listerine (low substantivity)
- essential oils: eucalyptol, thymol, methyl salicylate, menthol. first generation agent
- percentage of alcohol in original listerine: 26.9%
- percentage of alcohol in newer listerine products: 21.6%
- there is a 0 alcohol as well
10
Q
what are quaternary ammonium compounds
A
- positively charged
- readily bind to oral surfaces and are released more rapidly or lose their activity upon binding to the surface
- approximately 3 hours substantivity
- cetylpyridinium active ingredient
- same as chx don’t brush for 30 mins before or after
11
Q
what are oxygenating agents
A
- peroxides and perborates
- used for acute necrotizing ulcerative gingivitis and pericoronitis
- provides a cleaning action and gentle effervescence for oral wounds
- <3% deemed safe
- long term studies do not demo any benefit over home care
12
Q
what is povidone iodine
A
- broad spectrum: bacteria, viruses
- binds to proteins: deliver at site of debridement
- can stain
13
Q
what is povidone iodine
A
- broad spectrum: bacteria, viruses
- binds to proteins: deliver at site of debridement
- can stain
14
Q
what are fluorides
A
- the only fluoride with antibacterial/antibiofilm activity is stannous fluoride
15
Q
what are indications for alcohol free mouthrinses
A
- pregnant women
- former alcoholics
- patients taking medications
- patients who prefer to avoid alcohol
16
Q
what do we use for oral irrigation
A
- no inflammation: water
- inflammation: medicament
17
Q
what was the goal of oral irrigation in the 60s, 70s and 90s
A
- 60s: remove food debris
- 70s: unattached of loosely adherent biofilm
- 90s: flush out and detoxify
18
Q
where can we conduct supragingival irrigation
A
- home supplied
19
Q
where can we conduct subgingival irrigation
A
- home applied
- office applied
20
Q
what is the purpose of oral irrigation
A
- disruption of biofilm
- decreases toxicity
- slows down recolonization
21
Q
what are the pros and cons to oral irrigation
A
- limitations
- mixed results
- maintenance patients
- single irrigation: 1 week
- 14-28 days
- prolonged – longer time (up to 8 weeks)
22
Q
what is supragingival irrigation
A
- adjunct to mechanical removal or biofilm/calc
- removes debris
- flushes out loosely adherent biofilm
- reduces inflammation
- detoxifies bacteria
- pockets up to 3-4 mm
- pulsating (jet) stream of water
- plastic jet tips
- tip placed at right agnle
- removes debris
23
Q
what is water irrigation
A
- minimal decrease in biofilm
- improved inflammation
- alters bacteria toxicity
24
Q
what devices can be used for subgingival irrigation
A
- squeeze containers
- push syringes
- powered devices: via jet, water pik
- non-electric: max-i-probe
- ultrasonic devices: piezon master 400
25
what is a disadvantage of subgingival irrigation in office
- there is reinfection of the pocket with bacteria
26
what is home irrigation
- 1-2 mm subgingival (pik pocket) for 5 seconds results in penetration of:
- 90% in < 6 mm PD
- 64% in > 7 mm PD
27
how many clinicians perform chair-side subgingival irrigation
- 43.4%
28
how does calculus in pocket affect penetrability of subgingival oral irrigation
- reduces penetrability
29
what are some cautions for oral irrigation
- 60 PSI pressure
- tissue trauma
- transient bacteremia
- periodontal abscess; ulceration
30
how can we make irrigation more affective
- remove calculus deposits prior to irrigation
- supragingival irrigation as an adjunct to OH, may be of value in treatment of gingivitis
- professional subgingival irrigation takes time, is done infrequently, and shows no advantage to scaling and root planing alone
31
what solutions can be used for irrigation
- water
- chx 0.02%
- hydrogen peroxide
- povidine iodine
- fluorides
- antibiotics
32
what is the solution for supragingival irrigation with chx
- chx 0.02%
| - 1-1/4 glass of water + 4 capfuls
