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Periodontology Pharmacology
Weinberg, chapter 11
Learning Objectives
1. Discuss the rationale for the use of chemical agents in the treatment of periodontal diseases
2. Describe the various types of drug delivery systems3. Understand how to select the optimum intervention
for individual clients4. Research on the internet specific types of
controlled release systems5. Understand the need to stay current regarding use
and delivery of chemical agents
Qualities of the Ideal Chemical Agent
Bacterial specificity Inhibit overgrowth of other organisms Low drug induced resistance Nontoxic to oral tissues High substantivity Limited systemic absorption
Selection of a Chemical Agent
Ideal: determine specific type of pathogen select antimicrobial
Reality: evidence based selection In-office testing: takes little time, improves
selection knowledge improves outcomes Costly to client
Client Considerations
1. Site specific or general application2. Client sensitivity3. Appropriate follow-up evaluation
Response of tissues Client compliance
4. Discuss with client Name of agent & method of use Anticipated outcomes Side effects
Chlorhexidine
Available CHX (0.12%) products: ProSol CHX (Dentsply) Peridex (P&G) PerioGard (Colgate) OraCleanse (Germiphene)
Chlorhexidine
Mechanism of action: Broad spectrum bactericidal agent High substantivity
Binds to oral tissuesReleased in active form for up to 5 hours
Ruptures bacterial cell membrane releases cytoplasm contents
Reduces adherence capacity of P.g.
Chlorhexidine
Not all clients exhibit undesirable side effects Side effects may include:
Extrinsic brown staining Increase in supragingival calculus accumulation Alteration in taste perception (temporary) Bitter taste
If client rinses with water right after rinsing with CHX Mucosal desquamation
Chlorhexidine
Side effects: Interacts with positively charged detergents
30 min. between brushing & rinsing with CHX Japanese race prone to CHX allergies 30 min. time lapse between rinsing with CHX & rinsing
with fluoride (SnF) High alcohol content (11.6%)
Dehydrates mucosa & may intensify pain Increased risk of oropharyngeal cancer (possible)
Chlorhexidine
Use of CHX: Inhibits dental plaque & gingivitis Full mouth disinfection Oral mucositis Site specific professional irrigation
Furcations, deep pockets Home irrigation or rinsing Post-periodontal surgery Some therapeutic value in treating candida infections
Chlorhexidine
Instructions for use: Rinsing:
15 ml for 30s bid Short term therapy (1-2 weeks up to 3 months))
Irrigation: Professional: 0.12% At-home: 0.06% daily
Pre-procedural rinse 10 ml for 60s
Chlorhexidine
Clinical efficacy: 2 months & 8 months following debridement &
full mouth disinfectionReduction in spirochetes & motile rods
Some probing depth reduction in deep pockets
Chlorhexidine
Re-assessment: Re-evaluate at 4-6 weeks & again at 3 months
Outcomes met?Re-treatment required?Discontinue use?
PerioChip
PerioChip
Description: Rectangular chip, supplied in boxes of 10 chips Contains 2.5 mg Chlorhexidine D-gluconate Biodegradable matrix of hydrolyzed gelatin Store in refrigerator until use 2 year shelf life
PerioChip
Mechanism of action: Bactericidal antiseptic agent Binds with tissue – no need for surgical dressing Chip gradually biodegrades releasing CHX Sustained release over period of 7-10 days GCF concentrations vary among clients
Peaks at (2-4) hours after insertion Peaks again at approx. 72 hours Concentrations gradually decline over 7-10 day period
PerioChip
Indications: Adjunctive therapy to debridement Clients with adult periodontitis
Bleeding/nonbleeding pockets 5 mm Where maintenance is preferred choice for care
Surgical care is contraindicated
PerioChip
Recommended dose:One PerioChip into one periodontal pocketNot recommended to place more than 2 chips around
one tooth at one timeCan be administered once/3 months (PD 5 mm)
PerioChip
Adverse reactions: Approx. 40% of teeth associated with chip
insertion experience tooth sensitivity – dissipates as chip dissolves
Slight pressure for 24 hours Mild-moderate swelling, gingival sensitivity Likelihood of reaction increases with repeated
administration
PerioChip
Client information: Brush as usual Avoid flossing around teeth with inserted PerioChip
for 10 days Contact dental office if:
Chip dislodges Pain intensifies
No bacterial resistance (studies conducted over 2 year period)
No tooth staining or altered taste perception
PerioChip
Administration: Keep chip refrigerated until ready to use Thorough debridement of area to be treated Irrigate area to flush out debris Dry area Grasp chip with non-serrated cotton pliers Entire chip must be submerged – use probe to
maneuver chip to pocket base
PerioChip
Clinical efficacy: Depends on study read Expected outcomes:
Reduction in PD depths, increased CAL, less bleeding Greater PD reduction when chip used in
conjunction with debridement Reductions in probing depths reported anywhere
from 1.0 mm – 2.0 mm or greater
Listerine
1920s ad
Current
Essential Oils
Available products: Listerine (Warner & Lambert)
Mechanism of action: Formulation includes:
Thymol & eucalyptol with menthol & methylsalicylate Low substantivity Disrupts bacterial cell wall & inhibits bacterial enzyme
production
Essential Oils
Side effects: Alcohol levels high (original formula: 26.9%;
Cool Mint: 21.6%)Carcinogenic potential (insufficient evidence to link
oral cancers with mouthrinses containing alcohol) Slight extrinsic staining Drying effects Temporary burning sensation, unpleasant taste
Essential Oils
Use of Essential Oil mouthrinse: Anti-plaque & anti-gingivitis 20 ml full strength for 30s bid More frequent use may lead to desquamation of oral
tissues Clinical efficacy:
About 50% as effective as CHX Plaque reductions range from 20-40% Gingivitis reductions range from 25-35%
Quaternary Ammonium Compounds
Breath Fresheners
QAC
Available products: Scope (P&G) Cepacol (J.B. Williams) Viadent Oral Rinse Advanced Care (Colgate) Oral-B Antiplaque Rinse
Active ingredient: Cetylpyridinium chloride
QAC
Mechanism of action: Increased bacterial cell wall permeability
(favours lysis) Alatered cell wall metabolism Decreased ability for bacterial to adhere to oral
surfaces Low substantivity (about 3 hours)
Marketed more as breath freshener
QAC
Side effects: To be effective, must be used 4+ times/day With this frequency of use expect:
Burning, stainingSoft tissue irritation Increased calculus formation
QAC
Use of products: Anti-plaque (up to 14%) Anti-gingivitis (up to 24%) Short term studies only Activity altered by abrasives, flavoring agents
Rinse wait 30 minutes brush