PerioPharmacology

7/29/2019 PerioPharmacology

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Periodontology Pharmacology

Weinberg, chapter 11


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Learning Objectives

1. Discuss the rationale for the use of chemicalagents in the treatment of periodontal diseases

2. Describe the various types of drug deliverysystems

3. Understand how to select the optimumintervention for individual clients

4. Research on the internet specific types ofcontrolled release systems

5. Understand the need to stay current regarding use

and delivery of chemical agents


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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


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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


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Client Considerations

1. Site specific or general application

2. Client sensitivity

3. Appropriate follow-up evaluation

Response of tissues

Client compliance

4. Discuss with client Name of agent & method of use

Anticipated outcomes

Side effects


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Chlorhexidine

Available CHX (0.12%) products:

ProSol CHX (Dentsply) Peridex (P&G)

PerioGard (Colgate)

OraCleanse (Germiphene)


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Chlorhexidine

Mechanism of action:

Broad spectrum bactericidal agent

High substantivity

Binds to oral tissues

Released in active form for up to 5 hours

Ruptures bacterial cell membrane

releasescytoplasm contents

Reduces adherence capacity ofP.g.


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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


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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)


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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


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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


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Chlorhexidine

Clinical efficacy:

2 months & 8 months following debridement &full mouth disinfection

Reduction in spirochetes & motile rods

Some probing depth reduction in deep pockets


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Chlorhexidine

Re-assessment:

Re-evaluate at 4-6 weeks & again at 3 months Outcomes met?

Re-treatment required?

Discontinue use?


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PerioChip


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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


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PerioChip


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


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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


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PerioChip

Recommended dose:

One PerioChip into one periodontal pocket

Not recommended to place more than 2 chips around

one tooth at one time

Can be administered once/3 months (PD 5 mm)


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PerioChip

Adverse reactions:

Approx. 40% of teeth associated with chip

insertion experience tooth sensitivity

dissipatesas chip dissolves

Slight pressure for 24 hours

Mild-moderate swelling, gingival sensitivity Likelihood of reaction increases with repeated

administration


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PerioChip

Client information:

Brush as usual

Avoid flossing around teeth with inserted PerioChipfor 10 days

Contact dental office if:

Chip dislodges

Pain intensifies

No bacterial resistance (studies conducted over 2 yearperiod)

No tooth staining or altered taste perception


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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


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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 mm2.0 mm or greater


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Listerine

1920s ad

Current


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Essential Oils

Available products:

Listerine (Warner & Lambert)


Formulation includes:

Thymol & eucalyptol with menthol & methylsalicylate

Low substantivity Disrupts bacterial cell wall & inhibits bacterial enzyme

production


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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


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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%


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Quaternary AmmoniumCompounds

Breath Fresheners


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QAC

Available products:

Scope (P&G)

Cepacol (J.B. Williams)

Viadent Oral Rinse Advanced Care (Colgate)

Oral-B Antiplaque Rinse

Active ingredient: Cetylpyridinium chloride


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QAC


Increased bacterial cell wall permeability

(favours lysis)

Alatered cell wall metabolism

Decreased ability for bacterial to adhere to oralsurfaces

Low substantivity (about 3 hours)

Marketed more as breath freshener


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QAC

Side effects:

To be effective, must be used 4+ times/day

With this frequency of use expect:

Burning, staining

Soft tissue irritation

Increased calculus formation


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