Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
• Mouthrinses
• Toothpaste
• Toothbrushes
• Irrigators
Mouthrinsing
Chinese 2700 BC
Toothbrushes
Dentifrice
ADA Seal
Romans 50BC
Chinese 1498 (Hog)
Nylon Bristles 1930
Hippocrates 400 BC
1960
Council on Scientific Affairs
•Safety
•Efficacy
•Promotional Claims
Guidelines for acceptance of
Chemotherapeutic Products for the
Control of Supragingival Plaque and
Gingivitis
United States Residents 2008
$$/year spent (Total 6 billion)
• Toothpaste
• Toothbrushes
• Mouthwashes
• Dental Floss
• Breath Freshener
• 2.4 billion
• One billion
• One billion
• 200 million
• 150 million
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Periodontal diseases are bacterial infections and antimicrobials have been shown to be useful in their treatment and prevention
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Types of Chemotherapeutic Agents
• Chlorhexidine
• Cetylpyridium
Chloride
• Enzymes
• Iodine
• Fluoride
• Oxygenating Agents
• Essential Oils
• Triclosan
• Other Agents
Gingivitis
ADA Guide to Dental
Therapeutics
• Cationic
• Absorbed to Oral Tissue
• Substantivity/Reservoir
• Broad Spectrum
• Decrease Plaque
• Decrease Gingivitis
Chlorhexidine
Substantivity
• Binds to oral surfaces 30% retained
• Inhibits bacterial regrowth
• Released over time, binds for prolonged effect
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Indications for Chlorhexidine
Rinse
• Following Oral/Perio Surgery
• Gingivitis Associated with
Prosthodontics
• Physically Handicapped
Person
• Rampant Caries Control
• Other
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
One stage full-versus partial mouth disinfection in the treatment of chronic or generalized early onset periodontitis
I.
Long-term clinical observations
II. Long-term impact on microbial level
One Stage Full
Mouth Disinfection to Treat Periodontitis
Partial Traditional
Mouth Disinfection to
Treat Periodontitis
• RP 4 quadrants in 24 hours
• Chlorhexidine Rinse
2x/day
• Chlorhexidine Spray
Tonsils for 2 months
• RP each quadrant with 1-2 week interval
• No disinfection
One Stage Full VS Partial
Mouth Disinfection
Full Stage Gave:
• Greater PD !
• Greater AL "
Chlorhexidine
Staining
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Cetylpyridium Chloride
• Increase cell wall permeability
• Cationic
• Some effect in reducing plaque and gingivitis
• Minimal substantivity

Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Fluorides
• Stannous Fluoride, Acidulated
Phosphate Fluoride, Sodium Fluoride
• Some antiplaque properties
• Some effect on gingivitis
• SnF
2
ADA accepted for anticaries, reduce tooth hypersensitivity
Stannous
Fluoride
Staining
Oxygenating Agents
• Anaerobic bacteria
• Anti-inflammatory
• Little effect on plaque reduction
• Little effect on gingivitis reduction
• Co-carcinogen/delay wound healing
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Long-term use of hydrogen peroxide > 3% or 10% carbamide peroxide is discouraged
(especially in patients at risk for cancer)

• Listerine and others: Thymol,
Menthol, Eucalyptol,
Methylsallicylate
• Alter bacterial cell wall
• Uncharged/low substantivity
• Reduces Plaque and
Gingivitis
• ADA Accepted
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Pre-Procedural Rinsing
Reduction of aerosolized bacteria during ultrasonic scaling
• Non-cationic
• In Dentifrices 0.2 - 0.3%
• Combine with zinc citrate, pyrophosphate or gantrez
• Reduce plaque and gingivitis
Triclosan/Copolymer Dentifrice
Long-Term Clinical Studies (6 months)
Investigator Plaque Gingivitis
Reduction Reduction
Mankodi 12 20
Bolden
Garcia-Godoy
Cubells
Deasy
Denepitiya
Paloma
Triratana
Lindhe
17
59
25
32
18
13
33
31
29
30
20
25
32
24
19
27
Triclosan
Antimicrobial Combined with:
• Zinc Citrate - greater anticalculus/antiplaque potential
• Vinylmethylether maleic acid increases substantivity
• Anticalculus
• Fluoride - caries control
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Viadent
Listerine
Scope
Peridex
Cepacol
Mouthrinse pH Alcohol (%)
4.5
11.5
5.0
5.5
5.6
6.0
26.9
18.5
11.6
14.0
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Chlorhexidine
Cetylpyridium
Essential Oils
Stannous Fluoride
Triclosan
Anti-plaque/Anti-gingivitis
BID
BID
BID
BID
Daily
Use
BID
% Plaque
Reduction
50
% Gingivitis
Reduction
50
15
30
0-75
30
25
30
0-70
30
Adapted from Ciancio
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Adverse Tissue
Reactions Due to Tartar
Control Toothpaste

Pyrophosphate Toothpaste
• Pyrophosphate: " Alkalinity
• " Flavoring Agent
• " Detergent
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Summary of Topical Agents Used
• Safety/efficacy children - not established
• Chlorhexidine + Stannous fluoride - no
• Alcohol mouthrinse in recovering alcoholic - no
• Mouthrinse - no rinsing for 30 min after use
• Mouthrinse - use just before bed
• Do not double dose
• Sodium Lauryl sulfate - apthous ulcer
• Pyrophosphate - tooth sensitivity
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Manual
Toothbrushes
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Where Use Electric/Sonic
Toothbrushes
• Poor plaque control
• Orthodontic patient
• Handicapped patient
Should Plaque Control Agents be
Used in Irrigation Devices?
Supragingival?
Subgingival?
Patient?
Professional?
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Supragingival Irrigation in
Reducing Gingivitis
0.12% Chlorhexidine >
0.06% Chlorhexidine >
Water
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
Oral Irrigation with Water
Improved Clinical Signs of
Periodontitis After 2 Weeks
Probing Depth
Bleeding
Gingival Index
Plaque Index
Cytokines (IL-I # , P g
E
2
)
!
!
!
!
!
Cutler et al 2005
Mechanical Irrigators
• Viajet
• Water Jet
• Water Pik
• Hydrofloss
• Oxycare 3000
(Oratec)
(Interplak)
(Water Pik)
(Hydrofloss, Inc.)
(OxyFresh)
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Peri-Implant Tissue Health
Improved with Sub-
Gingival Irrigation using
0.06% Chlorhexidine
Felo et al. 1997

Reaching Subgingivally
• Mouthrinsing
• Manual brushing
• Flossing
• Supragingival irrigation
0 mm
1-2 mm
2-3 mm
2-4 mm
(40% of PD)
• Subgingival irrigation
- Patient 4-5 mm
(70% of PD)
- Professional Full PD
(100% of PD)
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
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