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Flashcards in chemical agents in plaque biofilm control Deck (47):

define systemic delivery

administering chemical agents such as antibiotic, in the form of tablet or capsule


define local delivery? example?

placing a chemical agent into the mouth or even into a perio pocket
example is toothpaste that contains a chemical agent that can kill bacteria such as stannous fluoride


what inhibits calculus formation



examples of chemical agents used in perio patients

1. therapeutic mouth rinses
2. therapeutic dentifrices
3. subgingival irrigation
4. controlled-release delivery devices


what could cause resistance of biofilm to delivery of chemical agents

1. surface of plaque biofilm is covered by an extracellular slime layer
2. slime layer acts as a natural barrier to protect organized bacterial colonies living in plaque biofilm
3. slime layer prevents chemical from contacting and killing bacteria


what is a microbial reservoir

secure place that allows periodontal pathogens to live undisturbed during routine periodontal therapy and subsequently repopulate periodontal pockets quickly.


is there a chemical agent that can control perio?



examples of chemical agents

antibiotics, fluorides, metal salts, antimicrobial, phenolic compounds, and antiseptics


examples of antibiotics studied for use in perio care

1. penicillin and amoxicillin
2. tetracyclines
3. clindamycin
4. erythromycin


T/F: routine use of systemic antibiotics for plaque-induced gingivitis and chronic perio is recommended

false; not recommended


why is antibiotics not recommended

bacterial antibiotic resistance and good response to plaque-induced gingivitis and chronic perio can come from NSPT


how often would antibiotics need to be taken to control bactiera in mouth?

many many years


when is antibiotics indicated?

for patients with aggressive perio and other rarer forms of perio


what is microbiologic analysis used for?

used to identify the antibiotic that is effective against the bacterial pathogens present in patient's biofilm


use of tetracyclines

1. higher concentrations of the drug concentrate
2. effective against A.A.
3. inhibit action of collegenase


how is controlled-release delivery device used in the mouth

1. an antibacterial chemical embedded in a carrier material
2. device is placed directly into perio pockets
3. material dissolves slowing producing a steady release of antimicrobial agent over a period of several days within the perio pocket


benefits of controlled-release delivery device

1. result in a small increase in attachment level in perio pocket
2. when used with perio instrumentation they can result in both an improvement in probing depth reduction and a clinical attachment gain


mechanisms of controlled-release delivery

1. tetracyclin hydrochloride-containing fibers
2. minocycline hydrochloride microspheres
3. doxycycline hyclate gel
4. chlorhexidine gluconate chip


features of tetracycline fibers

-no longer available in US
-gingival retraction cord impregnated with tetracyclin
-fiber laid back and forth all around tooth


minocyclin hydrochloride microspheres features

-cannula tip is used to expel microsphere into perio pocket
-within 5-7 days the microspheres dissolve so nothing to remove from pocket


reactions from minocyclin

-oral candidiasis
-allergic reaction
-don't use in women who are pregnant or nursing


doxycycline gel features

-tetracycline derivate
-antibiotic is delivered in a gel to perio pocket with cannula
-gel solidifies into a waxlike substance
-gel dissolves


reactions from doxycycline

-oral candidiasis
-allergic reactions
-do not use in pregnant or nursing mothers


chlorhexidine gluconate chip features

-tiny gelatin chip containing the antiseptic chlorhexidine
-can be used in pockets with 5 mm or greater in depth
-chip dissolves
-no risk of antibiotic resistance with the use of gelatin chip


what must you have to use gluconate chip? why?

5 mm pocket because if not then the chip will fall out of the pocket


uses of cosmetic mouth rinses

used to cover up or mask odors of halitosis
-do not control oral disease such as gingivitis


therapeutic mouth rinse purposes

-decrease dental plaque enough to also decrease the severity of gingivitis
-can decrease the risk of dental caries


characteristics of an ideal mouth rinse

efficacy, stability, substantivity, safety


define efficacy

inhibits or kills perio pathogens


define stability

stable at room temp and have a reasonable shelf life


define substantivity

retained in the oral cavity and released slowly over several hours with continued effect


define safety

does not produce any harmful effects on local tissues


define active ingredient

component that produces a benefit for the patient


define inactive ingredient

component added to give color or taste, preserve, or keep in a liquid state


3 ingredients that have some effect on gingivitis are....

1. chlorhexidine gluconate
2. essential oils
3. cetylpyridinium chloride


how much can chlorhexidine reduce the overall severeity of gingivitis by?

by 50 % when used as directed


what is chlorhexidine effective against?

gram positive and negative bacteria, very low level of toxicity and shows no permanent retention in the body


why is the primary mechanism of action for chlorhexidine

disruption of the integrity of the cell walls of bacteria


patients who would benefit from using chlorhexidine

special needs, patients with dental caries, oral piercings, candida infections, and patients in nursing homes


chemical agents included in essential oils

thymol, menthol, and methyl salicylate


features of mouth rinses containing essential oils

reduces gingivitis by 35%
-less effective than chlorhexidine
-less expensive than chlorhexidine
-pre-procedural rinses reduces bacteria in aerosols by more than 90%


quaternary ammonium compounds features

-released so rapidly that is has very little substantivity, limiting its effectiveness
-less effective than chlorhexidine and essential oils


povidone iodine as a mouth rinse features. who shouldn't use this?

-used in medical practice as a presurgical scrub for skin disinfection
-safety concerns
-shouldn't be used with patients who have sensitivity to iodine, allergies to shellfish, thyroid dysfunction, or women who are lactating or pregnant


what ingredient inactivates chlorhexidine

sodium laurel sulfate


side effects of essential oils

burning sensation in mouth, bitter taste, drying out mucous membranes


ADA classificiation of dentifrices

-antitartar activity, caries prevention, whitening, gingivitis reduction, plaque formation reduction, tooth sensitivity reduction


what ingredients reduce supragingival calculus

pyrophosphates, triclosan, and zinc citrate