Download Chemotherapeutic Agents

Chemotherapy
Chemotherapeutic Agents
Treatment of disease by means of chemical
substances or pharmaceutical agents
Four General Local Methods for
Chemotherapy
Irrigation (at home use)
Local delivery of a slow-release agent to a
periodontal pocket (at home or professional)
Mouth rinse
Use of dentifrice
Oral Irrigation
Oral Irrigation
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Also known as “hydrotherapy” or “lavage”
What are the benefits? P. 409 - 410 Perio
What are the shortcomings? P. 184 H
What does current research say? Over 60
studies
 Bacteremia risk?
Oral Irrigation
Suggested use for “Home Irrigation:”
Types of Irrigators:
 Before brushing and flossing to remove debris or retained
food particles OR after to deliver antimicrobials; what
kind? See H p. 184; Perio 411
 Debridement of recessed areas of fixed prosthetic or
orthodontic appliances or implants
 Flushing of periodontal pockets with a controlled, low
intensity stream of antimicrobial agent
 Can use specialized tips (w/or w/o cannula- standard,
ortho, sub, filament) p. 412 Perio
• *Most are power driven now
• Water pressure driven devices
Types of Tips:
• Microjet
• Monojet
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Technique and Delivery
Methods:
• Adjust the water stream (low settings are recommended for
sub; moderate for supra)
• Lean over sink or basin; close lips around
• Direct tip at right angle to the tooth surface; turn on
• Follow a pattern around the mouth; applying for 5-6
seconds at each interdental area
Specialized Tips
• Angulation- for application at or below
gingival margin
cannula
* very important patient understands irrigator is an “adjunct” and not a
substitute for regular tooth brushing; but more effective than floss;
29% more effective than brushing/flossing– so why keep
recommending flossing to patients?!?
Filament or ortho “trace around margins”
Most Commonly Recommended
Medicaments
 Essential oils
full strength
 Chlorhexidine Diluted OK
 Stannous Fluoride
 Povidone- iodine
 Hydrogen peroxide
 Sodium hypochloride
What about just water alone? Still significantly reduces bleeding
Benefits of Irrigation: Review
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Reduction of gingivitis & bleeding
Reduction or alterations of microbial flora
Periodontal maint. patients, special needs, those non- compliant; ortho
Penetration of the pocket deeper (esp. if using cannula)
Enhances delivery of antimicrobial agent (better than rinsing)
Substitute for flossing but NOT for brushing
Professionally Administered
Irrigation
See p. 415 perio
 Supplemental irrigation may be
administered as an adjunct to
non-surgical periodontal
therapy
 Use SLOW/Gentle
 Controversial as to benefits?!
Can use with an
ultrasonic/piezo reservoir
Other Advantages of Home
Irrigation
 Patients participate “co-therapy” (more
partnership)
 Improved plaque removal difficult to reach areasloosely attached & problem areas
 Care for special need areas
 Always use what is proven &
evidence-based (who did research?)
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Purposes of Mouth rinses
(“supra-gingival”)
Dental Office
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Pretreatment rinse
Fluoridated
Antimicrobial
Other
At home
• Reduce pathogens
• Post surgical
• After periodontal therapy
• Anticaries
• Cosmetic
• Reduce gingivitis/biofilm
Chemotherapeutic Agents
o
o
o
o
o
o
o
Antimicrobial
Oxygenating
Astringent
Anodyne
Buffering
Deodorizing
Oxidizing
*See Wilkins p. 492/ notes
Some only cosmetic—
if no value; no ADA seal*
Where does halitosis come from?
See Harris p. 155
Why alcohol added? See p. 155 H
Dry tissues? See article
Oral cancer? See article
Types of Mouth rinses
Chlorhexidine Gluconate
Types of Mouth rinses
• Phenol-related essential oils
.12%
ADA Approved
Know instructions for use, side effects &
indications!
Directions
Rinse full strength for 30 seconds with 20 ml (1/2- 2/3 fluid ounce or 4 teaspoonfuls) morning and night. If bad breath persists,
see your dentist.
Types of Mouth rinses
• Fluoridated
Ingredients
Active Ingredients: Thymol 0.064%, Eucalyptol 0.092%, Methyl Salicylate 0.060%, Menthol 0.042%.
Also Contains: Water, Alcohol (21.6%), Sorbitol Solution, Flavoring, Poloxamer 407, Benzoic Acid, Sodium Saccharin, Sodium
Benzoate and FD&C Green #3.
Warnings
Do not administer to children under twelve years of age. Keep this and all drugs out of reach of children. Do not
swallow. In case of accidental ingestion, seek professional assistance or contact a Poison Control Center immediately.
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Types of Mouth rinses
Other Mouth rinses
• Oxygenating See W p. 494
(Antiseptic)
• CPC (Quaternary Ammon Compounds)
H p. 157 & Wilkins *Does stain/supra/ sloughing
Black Hairy Tongue
• Pre-brushing rinses
why triclosan free???? What about the safety?
http://www.colgatetotal.com/health-benefits/colgate-total-triclosan
Short term use! What does data show about plaque?
Other Mouth rinses
Other- Aids for Xerostomia
• Other- alcohol free
MUCOADHESION
Indications for Mouth rinses
 Inability to achieve acceptable oral self-care
 Fixed splinting, prosthesis, dental implants, and
overdentures (lots past dental work)
 Orthodontic appliances
 Post periodontal treatment or surgery
 Immunosuppression
 High caries risk
 Other….
Dentifrices
What is it?
Substance used with a toothbrush on accessible tooth
surfaces to remove biofilm; generally available in
gel, paste, or powder form
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Guidelines for Dentifrice
Selection
Guidelines for Dentifrice
Selection
See Harris p. 150 – most common are calcium carbonate, phosphates
& silicas; abrasive testing (RDA); usually dull enamel (so add polishing agents)
ADA Seal of Acceptance (see Wilkins/website)
Safe levels of abrasives
 Voluntary
 5- years
 Tells consumers/professionals
product claims reviewed &
why approval
V-shaped notch
Dentifrices Basic Ingredients
Therapeutic Agents
See handout (know agents) & W.
 Det/surfactants (may react to)
 Abrasives
 Preservatives
 Binding agents
 Flavoring/sweetner
agents
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(non-cariogenic; careful with
cinnamon)
 Humectants
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Total ‘97
Plaque-inhibiting/gingivitis agents Triclosan/zinc citrate/stannous (Pro-health)
Oral malodor (Essential oils, chlorine, triclosan, stannous, hexametaphosphate,
chlorhex, CPC & zinc)
Anti-calculus (tartar control) Pyrophosphates, hexametaphosphate, triclosan &
zinc
Anticaries FLUORIDE most common
Remineralization/erosion ACP/CPP Recaldent
Desensitizing/antisensitivity PN, citrate, chloride, stannous
Other- whitening- carbamide/hydrogen perox
 Coloring agents
 Water
Reviewing Motivational Interviewing
Techniques
 Asking permission (do you mind if we talk about…)
 Evoking change talk (what would you like different? What makes you want to
change? What would be the good things if you change?)
 Using open-ended questions
(What do you know about..? What brought you
“but….you need to floss everyday, Mrs. Johnson”
 Patients will forget 30-60% of health information provided with
in an hour and >50% of recommendations are not followed; do they
even hear you?
 Hand-outs great for references later; another person in the room
 Motivational interviewing is collaborative, person- centered –
meant to “guide & strengthen” motivation for change….
here today? What have you been taught before about MR’s? What products have you used or have
considered?)
 Reflective listening (“it sounds like… what I hear you saying…”) *gives you
information; allow patient to share with you– be sure to REALLY LISTEN!
If patients do not want to talk– why?
What are the consequences?
 Affirmations (avoid statements that sound overly excited- needs to be genuine; show
understanding… “I know it is hard for you financially- I appreciate your commitment”
“It looks like you are really trying…”)
**Patient’s freedom, timing, empathy, WORDS
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