1. Periodontology Pharmacology
Weinberg, chapter 11

2. Learning Objectives
Discuss the rationale for the use of chemical agents in the treatment of periodontal diseases
Describe the various types of drug delivery systems
Understand how to select the optimum intervention for individual clients
Research on the internet specific types of controlled release systems
Understand the need to stay current regarding use and delivery of chemical agents

3. 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

4. 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

5. Client Considerations
Site specific or general application
Client sensitivity
Appropriate follow-up evaluation
Response of tissues
Client compliance
Discuss with client
Name of agent & method of use
Anticipated outcomes
Side effects

6. Chlorhexidine Available CHX (0.12%) products: ProSol CHX (Dentsply)
Peridex (P&G)
PerioGard (Colgate)
OraCleanse (Germiphene)

7. 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  releases cytoplasm contents
Reduces adherence capacity of P.g.

8. 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

9. 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)

10. 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

11. Chlorhexidine Instructions for use: Rinsing: Irrigation:
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

12. Chlorhexidine Clinical efficacy:
2 months & 8 months following debridement & full mouth disinfection
Reduction in spirochetes & motile rods
Some probing depth reduction in deep pockets

13. Chlorhexidine Re-assessment:
Re-evaluate at 4-6 weeks & again at 3 months
Outcomes met?
Re-treatment required?
Discontinue use?

14. PerioChip

15. 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

16. PerioChip Mechanism of action: 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

17. 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

18. 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)

19. PerioChip Adverse reactions:
Approx. 40% of teeth associated with chip insertion experience tooth sensitivity – dissipates as chip dissolves
Slight pressure for 24 hours
Mild-moderate swelling, gingival sensitivity
Likelihood of reaction increases with repeated administration

20. PerioChip Client information: Brush as usual
Avoid flossing around teeth with inserted PerioChip for 10 days
Contact dental office if:
Chip dislodges
Pain intensifies
No bacterial resistance (studies conducted over 2 year period)
No tooth staining or altered taste perception

21. 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

22. 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 mm – 2.0 mm or greater

23. Listerine
1920s ad
Current

24. Essential Oils Available products: Mechanism of action:
Listerine (Warner & Lambert)
Mechanism of action:
Formulation includes:
Thymol & eucalyptol with menthol & methylsalicylate
Low substantivity
Disrupts bacterial cell wall & inhibits bacterial enzyme production

25. 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

26. Essential Oils Use of Essential Oil mouthrinse: Clinical efficacy:
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%

27. Quaternary Ammonium Compounds
Breath Fresheners

28. QAC Available products: Active ingredient: Cetylpyridinium chloride
Scope (P&G)
Cepacol (J.B. Williams)
Viadent Oral Rinse Advanced Care (Colgate)
Oral-B Antiplaque Rinse
Active ingredient: Cetylpyridinium chloride

29. QAC Mechanism of action: Marketed more as breath freshener
Increased bacterial cell wall permeability (favours lysis)
Alatered cell wall metabolism
Decreased ability for bacterial to adhere to oral surfaces
Low substantivity (about 3 hours)
Marketed more as breath freshener

30. 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

31. Periodontal Pharmacology
QAC
Use of products:
Anti-plaque (up to 14%)
Anti-gingivitis (up to 24%)
Short term studies only
Activity altered by abrasives, flavoring agents
Rinse  wait 30 minutes  brush
Soft Tissue Management DEN4361