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Where do biofilms form in the office?
- Dental water lines
- Air/water syringe
- Cavitron water lines
- Drinking water reservoirs
- Medical implants
- Stents
- On teeth
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Specifis Plaque hypothesis
Quality of the plaque is more important then quantity
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About how many species of bacteria contribute to plaque biofilm and how many specifically seen in perio disease?
700/20
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What 3 bacteria are specifically seen in active perio pockets with bone loss?
- Pophyromonas gingivalis
- Tannerella forsynthesis
- Treponema denticola
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What are the four stages of plaque formation
- Initial adherence
- Lag phase
- Rapid growth
- Steady state
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At what phase does a colony of gram + cocci begin to form a community of bacteria
Lag phase
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What three properties does rinses posses
- Selectivity
- Sunstantivity
- Penetrability
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Substantivity
Ability of the rinse to bind and be released from the binding sites, How long it last
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Selectivity
Ability of the rinse to affect specific bacteria within a mixed bacterial population
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Penertrbility
Ability of the rinse to go into the biofilm
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The 3 major therapeutic mouthrinses
- Chlorhexidine
- Essential Oils
- CPC (Cetlypyridinium chloride)
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Patients taking what 2 medications shouldn't use alcohol containing mouthrinse
- Antabuse (disulfiram)
- Flagyl (metronidazole)
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What is the make up of EO?
- Combination of
- Eucalyptol 0.092%
- Menthol 0.042%
- Methyl Salicylate 0.060%
- Thymol 0.064%
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What are the components of CPC?
Quaternary Ammonium compounds
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What are the components of 0.12% CHX
A bacerial bisbiguanide antiseptic
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What is coaggregation and what stage does it occur in
Different bacterial species in the matrix & adhere to early colonizers
Rapid growth
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What are the phenolic-related therapeutic mouthrinsed for perio disease
- Triclosan (Bisphenol)
- Essential oils
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What are some of the properties of Chlorhexidine Gluconate 0.12% rinse
- Highest level of substantivity
- 11.6% pharmaceutical alcohol
- Available by prescription
- Not approved by the ADA
- Gold standard
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Mechanisms of action of CHG
- Bactericidal or bacteriostatic
- Active against gram + n - bacteria as well as yeast, aerobes, anaerobes, HIV, Herpes Hep B
- 30% absoprtion in oral cavity
- Selectivity Sunstantivity & Penetrability
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Indications for usage of CHG Rinse
- Antiplaque Antigingivitis & Anticaries
- Oran fungal infection
- Immunosuppressed patients
- Post surgical healing
- Implant maintenance
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CHG Rinse is commercially available as
- Peridex
- Periogard
- GUM (Alcohol free)
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What are some potential interactions with CHG Rinse
Use rise 30 minutes after brushing because toothpaste containing sodium lauryl sulfate 0.4% Stannous fluoride can minimize the effects of CHG
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What are the adverse effects of CHG rinse
- Altered taste perception
- Staining of the teeth, tongue & anterior composite restorations
- Increase in supragingival calculus
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What are the mechanisms of action of Triclosan
- Antibacterial agent: Bisphenol & nonionic germicide
- Substantivity
- Therapeutic effects against gingivitis
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Indications for usage for Triclosan
- Management of gingivitis and plaque
- Contains sodium fluoride so has anti caries potential
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What is Triclosan commercially available as
- Toothpaste form: Colgate Total
- Rinse: In Europe and Canada
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What are the mechanisms of action for EO
- Phenolic related compound with antiseptic properties
- Disrupts cell membrane and inhibits bacterial enzymes
- Exhibits anti-inflammatory properties
- Poor substantivity due to neutral elecrical charge
- Good selectivity and penetrability
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What is the alcohol content of EO
Previously 26.9% now 21.6%
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What is the antiseptic component of the EO
Thymol
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What is the cleaning agent of the EO
Methyl salicylate
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What are the indications of usage for EO
- Pre-procedural rinse
- Antiplaque and anti-gingivitis
- Implant maintenance
- Post operative healing
- Can kill candida on dental prosthesis
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What are the adverse effects for using EO
- Tissue sloughing with excessive use
- Initial burning sensation
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What are the mechanisms of action for QAC
- No ADA seal
- 6-14% alcohol content
- Low substantivity
- Bactericidal and decreases bacteria to adhere to biofilm on teeth
- Cationic surface active agents bind to oral tissues
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What are the indications of usage for QAC
- Antiplaque
- May be used 2-3 times/day
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What are the QAC commercially available as in a cosmetic rinse
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What are the QAC commercially available as in a therapeutic rinse
- Crest Pro Health 0.07%
- Discus Breath Rx 0.05%
- Colgate Viadent 0.05%
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What are the two adverse effects of using QAC
Staining and increased supragingival plaque
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