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PD Ch6 Plaque control chemical (Mouthrinse (Active ingredients (Quaternary…
PD Ch6 Plaque control chemical
Introduction
Plaque bioform on the tooth surface will cause
caries
Periodontal disease
High level oral hygiene
reduced the incidence of dental caries and periodontal infections
Biofilm Agglomeration生物膜集聚
Subsequently, Actinomycetes and Fusobacteria bind by co- aggregation to these pioneer species
Depending largely upon the effectiveness of dental hygiene, other organisms joining the biofilm have little ability to co-aggregate with the pioneers, but do bind with the intermediates such as Fusobacterium
The fusobacteria梭菌 are therefore called bridging species
Early colonisers, predominantly Streptococci
attach to a film composed of
cervical proteins
salivary
Dentifrices(toothpaste)
Types
toothpowder's
liquid
gels
tooth paste
Background
some have therapeutic agent
cosmetic products
(to clean and polish the teeth清潔和拋光牙齒)
removing extrinsic stains
Do not remove intrinsic stains (Whitening systems do)
Ineffective in altering the yellowing color of teeth seen with aging, so manufacturers cannot state ‘makes your teeth whiter or colour lighter’
most of these “whitening” toothpaste may be quite aggressive in removing excessive tooth hard tissues (abrasions) if not used with an appropriate toothbrush/technique.
reduce caries ,gingivitis.plaque.tooth sensitivity
Ingredients
Abrasive
depend on the inherent hardness of abrasive, size of particles, and the shape of particle
most common abrasives 磨料
calcium carbonate
economical and effective abrasive
usually found in combination with Na-mono-fluorphosphate
sodium carbonate
baking soda
calcium pyrophosphate
used as anti-calculus.
silica
chemically inert化學惰性
most commonly used abrasive found in dentifrices.
Further polishing agent added
small-sized particles of aluminium
magnesium
calcium
zirconium compound
blended with the abrasives in order to achieve better results in terms of stains removal
RDA higher, more easily to injure the enamel
Humectant
Incorporated to the composition to maintain the moisture and prevent hardening.
most common
Sorbitol
Manitol
Glycerol
Propylene glycol.
Carboxymethyl cellulose
Sodium benzoate (to avoid bacterial growth inside the toothpaste).
Soaps and detergents
antibacterial properties
facilitates the flow of the dentifrice over the teeth促進潔牙劑在牙齒上的流動
sodium lauryl phosphate
can be irritating to the mucous membrane
incompatible with other components such as calcium.與鈣等其他成分不相容。
Flavoring
Flavour, smell, colour and consistency important for public acceptance of dentifrices
Spearmint, peppermint, and essential oils such as thymol or menthol that provide a medicinal taste
Sweeteners
sorbitol山梨糖醇
manitol (humectants)
saccharin糖精
cyclamate甜蜜素
recently introduced xylitol (this interfere with the metabolism of bacteria)
Therapeutic Dentifrices
Background
Therapeutic dentifrices on prescription, could contain up to 5000 ppm of fluoride.
The level of active fluoride adequate and must be maintained over the shelf life of the dentifrice, to demonstrate anti-caries activity.
Today combination of calcium-phosphate with fluoride is widely accepted.
Combination of a stabilised stannous fluoride with sodium hexametaphosphate has demonstrated efficacy in antimicrobial effect, calculus control, and reducing gingivitis
The most commonly therapeutic agent added to dentifrices is fluoride (1000-1100 ppm fluoride).
Treatment Amino-fluoride
Amino-flouride
Can rapidly distributed in the oral cavity due to
surface activity
slightly acidic pH
form a long-lasting, stable calcium fluoride precipitate on the enamel
acts as a pH-dependent fluoride reservoir and exerts a long-term protective action under cario-genic conditions.
CARIES PROTECTION toothpaste gives superior protection against caries for permanent teeth
Reduction of enamel solubility溶解度
A remarkable fluoride uptake of dental enamel surface after amine fluoride application has been observed in several studies.
Antiglycolytic action
Amine fluoride also inhibits the metabolic activity of bacteria,
resulting in an effective reduction of their acid production
Triclosan
broad spectrum antibacterial agent
Combined with zinc citrate檸檬酸鋅
effective in reducing acid production, plaque formation and preventing gingivitis.
may produce cell death
Anti-calculus dentifrices
Soluble pyrophosphates are crystal growth inhibitors, which retard the formation of calculus.
etra-sodium pyrophosphate is the most common, and it has demonstrated a significant reduction of calculus formation.
Anti-hypersensitivity products
when roots are exposed, pain while eating or drinking hot and cold food or beverages.
Potassium nitrate
commonly used to desensitize the nerves by depolarisation of sensory nerve endings 使感覺神經末梢去極化(penetrating through the length of the dentinal tubules).
Strontium chloride or Ca/Na Oxalates or bioglasses
occlude exposed 阻塞暴露(block)dentinal tubules
Mouthrinse
Used daily along with brushing and flossing→ more effective in reducing plaque and gingivitis
Active ingredients
Quaternary ammonium compounds(QAC)
Sanguinarine血紅素
Clorhexidine(CHX)
Benzalconium chloride苯甲膽鹼
Phenolic compounds.
Traditional purpose
Comestic
Pleasant taste
halitosis control
Therapeutic
Reduction in bacterial plaque; gingivitis and dental caries control.
Bacterial proliferation on the surface of the tongue as main factor responsible for halitosis.
90% of halitosis: oral cavity
. 10% non-oral causes.
Contain
Flavoring
Pleasant taste
Astringent
Refreshes the mouth.
Ethyl alcohol and Water
Solvent.
Antibacterial component
CHX
sanguinarine
cetylpiridinium十六烷基吡啶
chloride
triclosan三氯生
essential oils
Phenolic component
QAC
Benzalconium chloride
Types of mouth rinse
Halitosis control
Zinc chloride
reducing malodour (good oral health)
Neutralises volatile sulphur compounds揮發性硫化合物 (VSC) and kills the gram- bacteria (VSC production)
combined with eucalyptus oil, thymol.
Expensive
Xerostoma
Cause
Damage to the salivary glands (radiotherapy)
Sjögren syndrome.
Drug use of
anticholinergic 抗膽鹼藥
antihypertensives
antihistamines 抗組胺
tricyclic antidepressants，三環類抗抑鬱藥
Fluoride, calcium, phosphorus (similar concentrations than saliva).
Dry mouth - oral mucosa membrane continually dry and get affected by lesions (uncomfortable/pain).
Mouthrinse used
Biotene mouthwash
Combination of (can stimulate the saliva dense )
salivary enzyme
lactoperoxidase
lysozyme
proteins
15ml (1 tablespoon) 30 seconds 2-3 times a day
Oasis mouthwash(Sensodyne)
-Moisturise the mouth (muco-adhesive formula),
-Keep moisture (xhantum gum and carboxymethilcellulose) -
Rinse in the morning and at bedtime.
Protects from dryness (glycerine coating of the mucosa).
Clorexidine gluconate
types
Spray
0.2-0.5%
Bottle of 40 ml
Used in patients with cerebral palsy, mentally deficient
Sometimes in oral surgery.
Gel
0.5-1.0%
50ml
Used in oral surgery and inside periodontal pockets and for high risk patients.
Mouthrinse
with a concentration of 0.12% (10 ml/ 2 times
a day, for one minute.
does not work properly in periodontal pockets >3 mm.
Reduces gingival inflammation and plaque growth.
Varnish
1%
High risk patients - application every 3-6 months
Side effects
Yellow-brown stain
External stains, easy to remove with polishing paste and rubber cups.
In retentive surfaces, like margin of fillings, calculus, pits... more frequent in tobacco ,tea ,coffee consumption
Intolerance in oral mucosa
pain
irritation
desquamation脫屑
Loss of taste
Very usual more than 2 weeks.
Lesions and Cancer ???
When to use?(When we need a quick and significant antiplaque effect當我們需要快速而顯著的抗斑效果)
Gingivitis. Mechanical control is not enough.
Periodontitis. Maintenance period.
Preparation and irrigation in scaling and root planing
After oral surgery, especially in periodontal surgery.
To reduce the number of bacterias in the aerosols during procedures such as scaling, polishing....93,6%
Not use MORE than 2 weeks.
Periodontal surgery.
Essential oils
can alter the bacterial cell walls.
Active ingredient combination of
thymol 百里香酚
menthol薄荷醇
methyl salicylate水楊酸甲酯...in a hydro-alcoholic vehicle (21.6 to 26.9% alcohol)在水-酒精媒介物中
eucalyptol桉樹油
Listerine has shown 34% reduction in plaque accumulation and severity of gingivitis.
Burning sensation
is unlikely to be effective in treating periodontitis (>5mm pockets depths),
Quaternary ammonium compound季銨化合物
most common: cetylpiridinium chloride十六烷基吡啶鎓氯化物.
Background
It weakens and disrupts the bacterial cell membrane.
Effects up to 12 hours.
It reduces plaque biofilm and gingivitis 14-24%.
Recommended usage: rinse with 20ml. Twice daily (30 seconds).
Absence of alcohol content
little-to-no burning sensation
High concentration QAC as an Anti-MMP as well as CHX
Phenolics: Triclosan酚類：三氯生
It is combined with zinc citrate to increase effects.
Low side effects, but less antiplaque action.
It can be used for long periods of treatment
the longer we use, the better results we reach
(the opposite in CHX)
. Maintenance treatment.
Only soluble in alcohols or organic substances.
Anti-inflammatory effect, it is useful in gingivitis.
Non-fluoride caries preventive agents
Xylitol
a five-carbon sugar polyol
has been found to be promising in reducing dental caries disease
reversing the process of early caries.
MOA
reduces the adhesion of these microorganisms to the teeth surface
reduce their acid production potential
reduce the levels of mutans streptococci(MS) in plaque and saliva by disrupting their energy production process--> futile無用
energy cycle--> cell death
promotes mineralization by increasing the salivary flow when used as chewing gum or large xylitol pastille
practically nonfermentable by oral bacteria
decrease the amount of plaque, when there is habitual consumption of xylitol.
but bacteria will adapt(won't bind anymore)
Probiotics益生菌consisting of
food-grade microorganisms
genetically-modified bacteria轉基因細菌
naturally-occurring oral bacteria
means to promote healthier plaque ecologies.
Non fluoride agents may serve as adjunctive therapeutics for preventing, arresting or even reversing dental caries非氟化物可以用作預防，阻止甚至逆轉齲齒的輔助治療劑
Risk assessment
In preventive dentistry it is important to carefully
factors to personalize
recommendation
assess oral health and disease risk
These risk factors include oral self-care practices and past and current oral health status (in relation to all oral diseases and conditions).
The process of care model is used to determine the most appropriate products and practices for supplemental oral self-care.
Phase include
Assessment
Collecting data of general and oral health status.
Diagnosis
Data are analysed to formulate a diagnosis.
Planning
Design of the oral self-care practices and products on the individual.
Implementation實作
Preventive procedures to promote/maintain oral health and therapeutic procedures to control disease.
Evaluation
Analysis of achievement of oral health gaols
C.A.M.B.R.A. - Caries Management By
Risk Assessment
➢ Caries disease factors (Examination)
➢ Caries risk factors (Interview)
➢ Caries protective factors (Interview)
fluoride
chewing gum
➢ Caries risk level
➢ Bacteria and saliva testing
➢ Treatment plan for caries intervention and prevention
It focus on caries rather the periodontology
For Patient Use
Over-the-counter(OTC)fluoridated toothpaste NaF varnish for excessive root exposure or sensitivity .Sealants optional per ICDAS(LOW RISK)
Xylitol gum or mints(6-10gm/day)(MODERATE RISK)
Calcium Phosphate Supplement--> Optional: Apply calcium phosphate paste several times per day(HIGH RISK)
1.Apply calcium phosphate paste several times per day.2.Saliva substitutes as needed(EXTREME HIGH RISK)
Antibacterials--> 1.CHX0.12% rinse(10mL daily for 1 week each month), 2.Chlorine-based rinse(BID*2 week)(HIGH RISK)
1.CHX0.12% rinse(10mL daily for 1 week each month), 2.Chlorine-based rinse(BID*2 week),3.Xylitol(as above)
Topical Fluoride-->1.OTC fluoridated toothpaste2.OTC 0.05%floride rinse3. NaF varnish(MODERATE RISK)
RX1.1%NaF dentifrice twice per day OTC 0.05% fluoride rinse NaF varnish(HIGH RISK)
RX1.1%NaF dentifrice twice per day OTC 0.05% fluoride rinse NaF varnish at each recur(EXTREME HIGH RISK)
Protocol For Caries Risk Management
ppt P9
Toxicity of fluoride
Ingested in excessive quantities, fluoride can be toxic.
The American Dental Association
has recommended that no more than 120 mg fluoride (264 mg sodium fluoride) be dispensed at any one time.
Association of Poison Control Centers
indicated that of all reported cases of fluoride intoxication, were related to
fluoride dentifrice ingestion
fluoride mouth rinse
fluoride supplement
Children younger than 6 years of age account for more than 80% of reports of suspected over ingestion.
Dosage
should trigger therapeutic intervention and hospitalization for fluoride intoxication
5 mg/kg body weight.
Lethal dose of fluoride
15 mg/kg
Infant lethal dose
250 mg