Mouthwashes Lecture Notes PDF

Mouthwashes Module: Founda0ons for Clinical Skills and Prac0ce Tutor: Rhona Mann Aim: To gain an insight into the range of mouthwashes and their poten3al role in oral health. 3 Learning Outcomes Acknowledge the range of the various constituents found in mouthwashes. A...

Mouthwashes Module: Founda0ons for Clinical Skills and Prac0ce Tutor: Rhona Mann Aim: To gain an insight into the range of mouthwashes and their poten3al role in oral health. 3 Learning Outcomes Acknowledge the range of the various constituents found in mouthwashes. Appreciate the potential benefits of the constituents on patient’s oral health. Have an understanding of the potential disadvantages of certain constituents on patient’s oral health. Be able to analyse the information gained in order to advise patient’s accordingly.  GDC Learning outcomes 1.1.1, 1.1.8, 1.2.3., 1.9.1, 1.10.2, 1.10.3, 1.10.4, 1.10.5, 6.1, 6.2, 6.3 4 6 What is a mouthwash? A mouthwash or mouth rinse is a chemotherapeutic agent used as an adjunct to a patient’s home care system in their oral care regime. Google images 2021 Before we begin it is important to remember that no chemical adjunct e.g. mouthwashes are meant as a REPLACEMENT for MECHANICAL plaque removal. Google images 2021 8  When may a mouthwash be recommended? When good oral hygiene/toothbrushing may be difficult to achieve e.g. medically, physically or mentally compromised. When there is oral ulceration and/or certain oral conditions e.g. Lichen planus, Aphthous ulcers. After oral surgery. Xerostomia sufferers. Caries control (Fluoride component) Cosmetic: Fresh taste, fresh breath Can you think of anything else? ‘x 9 So what are the general constituents of a mouthwash? Water Alcohol (acting mainly as a preservative) Flavouring Colouring Sweeteners Active Ingredients ………we will discuss these in more detail Ac0ve Ingredients 1 1 As the consumer, what are you thinking? Bad breath , What is my problem? gums bleeding What is the solution? Remember: people are influenced by advertising claims that may be misleading! 1 2 As a Clinician delivering care……… What are hoping to achieve by recommending a mouthwash? What does the patient need? Can you justify it? 1 3 Actions of Active Ingredients 1 4 Oxygenating agents Their action is as a cleansing effervescent, introduction of O2 E.g. Sodium Perborate, Hydrogen Peroxide. Will have some antibacterial effect on anaerobic bacteria but are not broad spectrum. What will the bubbles do? Bubble introduce oxygen 1 5 Astringents Tissue shrinkage Soft tissue shrinkage to some extent E.g. Zinc Chloride, Zinc Acetate, Citric acids Google images 2021 1 6 Anodynes Help alleviate pain e.g. Phenol derivatives, Essential oils images 2021Google 1 7 Buffering Agents Reduce acidity, reduce soreness e.g Sodium Perborate, Sodium Bicarbonate Google images 2021 1 8 Deodorising agents Neutralize odours from e.g decomposing food Example: Chlorine Dioxide Google images 2021 They masking underlying disease possibly Challenge with these products?  Fluoride The addition of Fluoride in mouthwashes has the benefit of caries prevention, prevention and management of demineralisation, patients with certain conditions such as Xerostomia and dental sensitivity. Amounts vary and certain products e.g. Duraphat Google images 2021 Mouthwash contain a higher percentage. Refer to Fluoride and tooth surface lecture 2 0 Pain relief There are products (for example ELUDRIL) that not only contain an an3microbial (in the case of Eludril this is Chlorhexidine) but also contain a mild local anaesthe0c. * In Eludril this is CHLOROBUTANOL 0.5% This makes it poten3ally useful in the management of certain oral condi3ons that are painful, e.g. Apthous ulcers  mar Antimicrobials most Bisbiguanides (e.g. Chlorhexidine ) Bispyridines (e.g. Ocetedine) Pyrimidines (e.g. Hexetidine) Halogens (e.g. Fluoride and Iodine) Phenols/Phenolic : Phenol, Thymol Quaternary Ammonium Compounds (eg Cetylpyridium Chloride) Herbal: Sanguinarine Oxidising agents Fluoride 21 General considerations Active ingredient Indication (when would you recommend it?) Duration of use Side effects Cost Access Google images 2021 2 3 Chlorhexidene Chlorhexidine is broad spectrum Well evidenced usage comba3ng periodontal disease related bacteria Absorbed onto ALL oral surfaces Good substan0vity….released slowly and stays ac3ve for up to 24 hours, binding onto surfaces, pellicle, etc 2 4 Effects of Chlorhexidine Bactericidal – High Concentration Bacteriostatic – Low Concentration Causes cell lysis Causes cell content leakage loss of Incorporates into bacteria potassium & phosphates Extreme leakage loss of potassium Reduces replication & phosphates But can recover Impacts cell membrane & thus lysis 2 5 Chlorhexidine – Indications of use Gingivitis Periodontal disease Extra help if required 2 6 Potential side effects Staining can be a significant problem and increases with prolonged use Taste can be disturbed Reported cases of tongue discomfort and burning Oral Desquamation Shedding of oral epithelium Swelling of the Parotid ( rare side effect) Two weeks use maximum Can effect certain constituents of toothpastes Google images 2021 2 7 What is available in the Corsodyl mouthwash range? Daily range contains Chlorhexidine 0.06% GSK Website 2021 2 8 Corsodyl original contains 0.2% Chlorhexidine Gluconate GSK website 2021 2 9 Phenolic compounds Not as effective as Chlorhexidine Poor oral retention Has some anti inflammatory effects Reduction of plaque by up to 30% Works by altering the bacterial cell wall Works in association with essential oils Common products – Listerine Google images 2021 3 0 Essential Oils Menthol , a natural antibacterial Eucalyptus , a natural anti inflammatory Thymol, a natural antiseptic Google images 2021 Tend to be incorporated into a phenolic compound in many products. 3 1 Triclosan Triclosan is a derivative of Phenol and is used in toothpastes but can also be found in some mouthwashes. Has a broad spectrum anti bacterial effect as well as some anti inflammatory effects. Originally was used as a Hospital scrub in the 1970s and then expanded and now found in a variety of products, toothpastes, mouthwashes, soaps shampoos etc Has been some concern over it’s safety/toxicity in recent years Google images 2021 3 2 CETYLPYRIDIUM CHLORIDE (Quaternary Ammonium Compounds) Moderate plaque inhibitory effect Has greater initial oral retention and equivalent antibacterial activity to Chlorhexidine but less effective on inhibiting plaque and preventing Gingivitis. Dentyl is an oil &water based product mixed before use. Lifts and absorbs bacteria & debris( including food particles, epithelial cells etc) Google images 2021 3 3 Hexetidine………… ORALDENE antimicrobial found in e.g. Oraldene Google images 2021 Sanguinarine Plant based, appears to have effective anti plaque properties Google images 2021 34 Oxygena0ng agents Eg Hydrogen peroxide Beneficial in certain conditions, for example AUG as it inhibits anaerobic bacteria. Google images 2021 35 Mouthwashes and alcohol content Many mouthwashes on the market contain alcohol, this may be as high as 26% This is a significant if accidently( or otherwise!) swallowed and caution is needed. There have been studies linking alcohol in mouthwashes and possible oral malignancies but the evidence is not strong, However the alcohol content may cause soft tissue discomfort in certain individuals and there is evidence that it can effect certain types of materials used in restorative work  Recommended Reading https://onlinelibrary.wiley.com/doi/full/10.1111/j.1834- 7819.2008.00070.x https://www.nature.com/articles/sj.bdj.2009.1014 https://www.nature.com/articles/s41598-020-61912-4.pdf? origin=ppub http://www.bsdht.org.uk/FINAL%20Dental%20Health%20May%20for %20WEB.pdf  Image references: https://nypost.com/2018/10/24/salem-man-attacks-victim- with-witchs-cauldron-police/ https://www.vectorstock.com/royalty-free-vector/antibacterial- and-antiviral-defence-icon-stop-vector-22991863 https://drbrucesilva.com/using-mouthwash-correctly/ https://en.wikipedia.org/wiki/Oral_candidiasis Thankyou for your aTen0on! Short forma0ve assessment to follow. Any ques0ons feel free to contact me. [email protected] 39  Mouthwashes QUIZ Which of the following are used in mouthwashes A) Anaesthe;cs B) Fluoride C) Phenols D) Oxygena;ng agents E) All those listed - Which of the following is not a component of mouthwashes A) Astringent - B) BuFering agent C) Binding agent D) Anodynes E) Water - Chlorhexidine is only eFec;ve against gram+ bacteria A) TRUE B) FALSE Which of the following mouthwashes contain a mild local anaesthe;c A) Corsodyl daily B) Eludril C) Dentyl D) Listerine ~ E) Peroxyl - Listerine is an example of a phenol based mouthwash A) TRUE B) FALSE Bactericidal is deNned as slowing the rate of bacteria growth A) TRUE B) FALSE - A) TRUE B) FALSE - Bacteriosta;c is deNned as slowing the rate of bacteria growth The concentra;on of chlorhexidine gluconate in original Corsodyl mouthwash is A) 2.0% ~ B) 0.1% C) 0.06% D) 0.2% E) None of those listed  Mouthwashes QUIZ All pa;ents should be advised to use a mouthwash - A) TRUE B) FALSE Which the following is not a side eFect of overuse of chlorhexidine? A) Staining B) Taste disturbance C) Oral Desquama;on D) Whitening E) Burning tongue -