Exam 5

Question 1

Use chemical agent to control disease

Answer 1

Chemotherapeutics

Question 2

Used currently with conventional periodontal therapy

Answer 2

Adjunct therapy

Question 3

 Biofilm in furcation area
 Bacteria in residual calculus deposits, epithelial layers, connective tissue, or dentinal tubules

Answer 3

Microbial reservoirs

Question 4

What are the 3 factors for chemotherapeutics to be effective?

Answer 4

 Reach site of disease activity
 Be delivered at bacteriostatic or bactericidal concentration
 Remain in place long enough to be effective

Question 5

Kill or inhibit growth of bacteria

Answer 5

Systemic antibiotics

Question 6

What are the systemic antibiotics studied for use in periodontal disease?

Answer 6

o Penicillin and amoxicillin
o Tetracyclines
o Azithromycin
o Erythromycin
o Metronidazole
o Clindamycin

Question 7

o Broad spectrum bacteriostatic antibiotic
o Often concentrated in gingival crevicular fluid
o Effective against most strains of pathogen associated with more aggressive periodontitis
o Inhibit action of collagenase

Answer 7

Tetracyclines

Question 8

Slows progress of tissue breakdown

Answer 8

collagenase

Question 8

o Broad spectrum bacteriostatic agent
o Rapid absorption, high tissue concentration, long half-life, once a day doing

Answer 8

Azithromycin (Z-pak)

Question 9

o Antibacterial mediator embedded in carrier material
o Placed in pockets, attached to tooth, dissolves slowly

Answer 9

Controlled-released chemotherapeutic agents

Question 10

o Controlled-release mechanism delivers drug in powdered biodegradable microsphere form
o Broad spectrum, semisynthetic tetracycline derivative that is bacteriostatic

Answer 10

Arestin

Question 11

 Cannula tip expels microspheres into pocket
 Powdered microspheres binds to tooth surface
 Dissolve over 5-7 days

Answer 11

Arestin

Question 12

 Into pocket with cannula
 Solidifies into wax-like substance

Answer 12

Atridox

Question 13

o Biodegradable
o Treating chronic periodontitis
o May cause oral candidiasis, allergic responses

Answer 13

Atridox

Question 14

o Tiny biodegradable gelatin chip containing chlorhexidine
o Insert tip into pocket 5mm or greater
o Significantly reduces alveolar bone loss when used as adjunct to instrumentation
o No risk of antibiotic resistance
o May reduce periodontal surgical needs at little cost

Answer 14

PerioChip

Question 15

What are the two types of non-controlled-release chemotherapeutic agents?

Answer 15

Povidone-iodine (PVP-I)
Sodium hypochlorite

Question 16

o Water-soluble
o Broad-spectrum bactericidal chemotherapeutic agent
o Dilute PVP-I has potential to neutralize major periodontal pathogens
o Naturally golden-brown in color, no permanent staining

Answer 16

Providone-Iodine

Question 17

o Colorless or slightly yellow liquid with bleach color
o Generates highly reactive hypochlorous acid when mixed with water
o Highly potent against bacteria, fungi
 Can cause hemorrhage, edema in high concentration

Answer 17

Sodium hypochlorite

Question 18

o Decrease dental biofilm enough to resolve gingival inflammation when used with daily self-care regimen
o Bacteriostatic or bactericidal
o Substantivity

Answer 18

Therapeutic mouth rinses

Question 19

-add color, enhance flavor, and act as preservatives
-Have potential to provoke unintended side effects

Answer 19

Inactive ingredients in therapeutic mouth rinses

Question 20

o Demonstrated to reduce severity of gingivitis
o Most effective antimicrobial agent for long-term reduction of biofilm and gingivitis
 Effective against gram positive & negative bacteria
 Releases slowly over time, low toxicity

Answer 20

Chlorhexidine mouth rinses

Question 21

o Disrupts the integrity of the cell walls of bacteria
o Useful adjunct to biofilm control for many patients

Answer 21

Chlorhexidine mouth rinses

Question 22

What patients should be considered to use chlorhexidine mouth rinse?

Answer 22

o Special needs
o Postsurgical
o Candida infections
o High caries risk
o Oral piercings/dental implants
o Xerostomia

Question 23

What are the chemicals in essential oil mouth rinses?

Answer 23

Thymol
menthol
eucalyptol
methyl salicylate

Question 24

o Reliable alternative to chlorhexidine rinse for reducing plaque and gingival inflammation o Disrupts cell wall integrity, inhibits bacterial enzymes o Less expensive

Answer 24

Essential oil mouth rinses

Question 25

What are the side effects of essential oil mouth rinses?

Answer 25

Staining Taste alteration

Question 26

o Kills bacteria by disrupting bacterial cell walls o Binds to oral tissues, but releases rapidly o Reduced severity of gingivitis and supragingival biofilm

Answer 26

Quaternary Ammonium mouth rinses

Question 27

o Forms barrier preventing biofilm from adhering to tooth surface and gingiva o Interferes with enzymes responsible for forming biofilm o May cause tooth and tongue staining o Effectively reduces severity of gingivitis and biofilm when used as adjunct to mechanical biofilm removal

Answer 27

Delmopinol mouth rinses

Question 28

Contain no fluoride, may damage teeth and gingiva

Answer 28

Charcoal products

Question 29

o Ancient Indian fold remedy believed to prevent gingival bleeding, caries, malodor o Limited scientific trials to support to refute practice

Answer 29

Oil pulling

Question 30

- Targets inflammation - Neither leads to nor contributes to antibiotic resistance - Intent is to manipulate status, function of host inflammatory response to bacterial challenge *Does not directly target pathogens - Controls inflammation to control infection

Answer 30

Host modulation therapy

Question 31

What are the two categories of treatment for HMT in medicine?

Answer 31

Antiresorptive Bone-forming

Question 32

What are the pro-inflammatory mediators that can cause periodontium damage?

Answer 32

Prostaglandin E Interleukin 1 alpha & beta Interleukin 6 & 8 Tumor necrosis factor-alpha

Question 33

Altered host defense responses can cause what?

Answer 33

-Breakdown of connective tissue fibers -Resorption of alveolar bone

Question 34

o Tetracycline-class antibiotic o Used to treat a wide variety of bacterial infections

Answer 34

Doxycycline - Periostat

Question 35

What are the antibacterial doses of doxycycline?

Answer 35

50-100mg every 12 hours

Question 36

At what dose does sub-antimicrobial doxycycline function as a host modulating agent?

Answer 36

20mg

Question 37

Studies involving the use of SDD in periodontitis patients have shown what?

Answer 37

-Reduction in probing depths -Gains in clinical attachment levels -Prevention of periodontal disease progression

Question 38

o Can inhibit elevated MMPs, pro-inflammatory cytokines o Can suppress bone resorption by reducing effects of inflammation

Answer 38

Chemically modified tetracyclines

Question 39

o Reduce inflammation by inhibiting prostaglandin action o Can reduce inflammation and inhibit osteoclast activity o Some shown to slow rate of alveolar bone loss

Answer 39

NSAIDS

Question 40

What can long term use of NSAIDS lead to?

Answer 40

GI problems Hemorrhage Kidney & liver impairment Bone loss

Question 41

What is not approved to treat periodontal disease?

Answer 41

NSAIDS

Question 42

Proteins released by immune cells to influence other cells such as phagocytes

Answer 42

Anticytokine therapy

Question 43

 Neutralizing monoclonal antibody  Suppresses osteoclastic-mediated bone resorption by blocking binding of osteoblast-produced RANKL to osteoclast-receptor RANK

Answer 43

Denosumab - Prolia

Question 44

Block action of pro-inflammatory mediators such as TNF-a

Answer 44

Receptor antagonist

Question 45

What are the common TNF-a antagonists recently approved?

Answer 45

 Etanercept  Adalimumab  Infliximab

Question 46

o Prescribed to prevent cardiac and cerebrovascular events o Primary mechanism of action mediated by ability to inhibit key enzyme in endogenous cholesterol production

Answer 46

Statins

Question 47

Dietary substances containing good microorganisms that keep body healthy and in homeostatic balance when consumed or applied to body

Answer 47

Probiotics

Question 48

What are the beneficial bacterias?

Answer 48

 Lactobacillus  Streptococcus  Bifidobacterium  Enterococcus

Question 49

o Derivative of omega-3 fatty acids o Include resolvins and protectins o Promotes resolution phase of inflammation by limiting further neutrophilic infiltration to target site

Answer 49

Specialized proresolution mediators SPMs

Question 50

What is the only agent approved for adjunctive use during periodontal surgery?

Answer 50

Emdogain

Question 51

What constitute a positive clinical outcome?

Answer 51

Less inflammation Reduction in pocket depths No BOP

Question 52

o Cannot efficiently remove existing plaque o Chlorhexidine molecule reacts with anionic surfactants present in certain toothpastes, reducing effectiveness

Answer 52

Chlorhexidine mouth rinse