W3-Chemical Biofilm Control.pdf

17.10.2023 PERIODONTOLOGY Chemical Biofilm Control Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources 2 1 17.10.2023 Chemical Biofilm Control Ø Unable to properly control supragingival biofilm with mechanical devices Ø Adjunctive to mechanica...

17.10.2023 PERIODONTOLOGY Chemical Biofilm Control Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources 2 1 17.10.2023 Chemical Biofilm Control Ø Unable to properly control supragingival biofilm with mechanical devices Ø Adjunctive to mechanical devices Ø Mechanical devices à reduce the biofilm disturb its structure Chemical formulations more effective 3 Chemical Biofilm Control Ø Adjunctive use >>> sole use Most chemical agents are only able to act against the most external parts of the biofilm 4 2 17.10.2023 Chemical Biofilm Control !!!! some agents have demonstrated some capacity for penetration Chlorhexidine (CHX) Essential Oils 5 Chemical Biofilm Control Ø Mechanism of action: 1. Preventing bacterial adhesion 2. Avoiding bacterial growth and/or co-aggregation 3. Eliminating an already established biofilm 4. Altering the pathogenicity of the biofilm. 6 3 17.10.2023 Chemical Biofilm Control Ø Formulations for chemical plaque control can be classified according to their effects: • Antimicrobial agents: bacteriostatic or bactericidal effects in vitro • Plaque-reducing/inhibitory agents: quantitative or qualitative effect on the plaque that may or may not be enough to affect gingivitis and/or caries • Antiplaque agents: affect the plaque sufficiently to show a benefit in terms of gingivitis and/or caries control • Antigingivitis agents: reduce gingival inflammation without necessarily affecting dental plaque, including anti-inflammatory drugs. 7 Delivery formats of Chemical agent for biofilm control: Ø Dentifrices Ø Oral rinses* Ø Gels Ø Chewing gums Ø Varnishes Ø Lozenges (pastil) Ø Irrigators Ø Sprays Ø Sustained-release devices 8 4 17.10.2023 Indications for Chemical Biofilm Control To decrease bacterial load To decrease the risk of bacteremia As a pre-rinse to reduce aerosolisation of microbes during dental procedures To decrease the risk of infection of the surgical area (postoperative) Patients with intermaxillary fixations Patients with mucosal or gingival acute infections Patients carrying fixed or removable orthodontic appliances Disabled patients Predisposed patients, with high risk of suffering oral infections 9 Ideal features of Chemical agent for biofilm control: Specifity Stability Safety Efficacy Substantivity 10 5 17.10.2023 Bisguanides Ø Chlorhexidine digluconate Ø Alexidin dihydrochloride Ø Octenidine dihydrochloride 11 Chlorhexidine (CHX) Ø CHX is active against Gram (+), Gram (-) bacteria, yeast, and viruses(incl. HIV,HBV). Ø Low concentrations: CHX increases the permeability of the plasmatic membraneà bacteriostatic effect Ø High concentrations: it induces precipitation of ANTIMICROBIAL EFFECT cytoplasmic proteins and cell deathà bactericidal effect Ø CAN PENETRATE BIOFILM! 12 6 17.10.2023 Chlorhexidine (CHX) Ø CHX molecules adhere to the tooth surface and interfere with bacterial adhesion Ø CHX also interacts with salivary glycoproteins à reduced salivary pellicle formation. Ø CHX affects the activity of bacterial PLAQUE INHIBITORY EFFECT enzymes involved in glucan production 13 Chlorhexidine (CHX) Ø CHX molecules bind reversibly to oral tissues, with a slow release that SUBSTANTIVITY allows for sustained antimicrobial effects 14 7 17.10.2023 CHX CHX DENTIFRICES ORAL RİNSES %0.12 %0.2 15 CHX- Side Effects Ø Brown staining of the teeth, tongue, and silicate and resin restorations Ø Transient impairment of taste perception. Ø Mucosal erosion Ø Increase in calculus formation 16 8 17.10.2023 CHX-Side Effects 17 CHX-Side Effects Ø Burning sensations (glossodynia) Ø Desquamation of the oral mucosa Less common Ø Swelling of the parotid gland and oral paraesthesia 18 9 17.10.2023 CHX-Alcohol Ø The preparation contains 12% alcohol, which may be of interest to clinicians and patients with regard to concerns that alcohol increases the risk of oropharyngeal cancer. However, an extensive review of the available epidemiologic evidence associating alcoholcontaining oral rinse preparations with cancer concluded that existing data do not support this association. A nonalcoholic form of chlorhexidine mouthrinse is also available. It has been shown to be equally effective for microbial plaque biofilm control and it may be preferred by patients. 19 Essential Oils Ø Essential oil mouthrinses contain thymol, eucalyptol, menthol, and methyl salicylate Cell wall disruption, Inhibition of bacterial enzymes, Extraction of endotoxins derived from lipopolysaccharide (LPS) of Gram negative bacteria Anti-inflammatory action based on antioxidant activity 20 10 17.10.2023 Essential Oils Ø Have demonstrated plaque biofilm reductions of 20% to 35% and gingivitis reductions of 25% to 35% Ø ADA (American Dental Association) ØAlcohol %24!!! à burning sensation (side effect) Ø Tooth staining – side effect 21 Other products Ø Triclosan: Antibacterial (dentifrices, rinses) Ø Quarternary ammonium compounds (cetylpyridinium chloride) : affects bacterial cell Wall permeabilityà bacterisidal Ø Herbal extracts (Sanguinarine) !!!Evidence suggests that these and other available mouthrinse products do not possess the antimicrobial potential of either chlorhexidine products or essential oil preparations 22 11 17.10.2023 Thank you for listening… 23 12