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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 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 1 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 • • • • • • 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?) 2 Purposes of Mouth rinses (“supra-gingival”) Dental Office • • • • 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. 3 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 4 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 • • • (non-cariogenic; careful with cinnamon) Humectants • • • • 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 5