initial therapy pt 3

lecture given 9/24/2026

what are the options for local administration?

actisite (not resorbable, no longer available in US), atridox, periochip, arestin

periochip

2.5mg chlorhexidine gluconate

can be used in pregnancy

how is a periochip used?

are isolating the periodontal pocket and drying the surrounding area…

grasp periochip at flat end with forceps

insert periochip, curved end first, into the pocket to its max depth

further maneuver into position as necessary

atridox

equivalent to 42mg doxycycline

bacteriocidal

expensive if only used in a few sites, more cost effective as more sites are used

2 syringes- 1 liquid (vehicle) and 1 powder (doxycycline)

arrestin

minocycline HCl microspheres

microspheres are bioadhesive, bioresorbable polymer in powder form

sustain release, administered as a powder, easy to use, no reconsititution, no refrigeration

2 year stability

active for up to 14 days

minocycline

potent, broad spectrum antibiotic

semi-synthetic derivative of tetracycline

effective against p. gingivalis, p. intermedia, and a. acintomycetemcomitans

how effective is arrestin?

arrestin + SRP had significantly greater pocket depths reduction than SRP alone

27% greater pocket depth reduction in molars

numbers of reduction (-0.16, -0.31) are similar to periostat

does arrestin work the same way as periostat?

no- arrestin kills bacteria in the pocket because it has a high concentration of antibiotic

who is arrestin contraindicated for?

children and pregnant or nursing women (tetracycline)

who should you use arrestin on?

according to manufacturer- anyone you do an SRP on

according to flyfly- depends on the provider but he uses it on ppl who surgery is contraindicated on, and ppl with targeted issues (failing bridge bc of perio issue)

what mouthrinses are chemical inhibitors of plaque and calculus (ADA accepted)?

chlorhexidine (peridex, periogard)

essential oils (listerine)

FDA also recently approved CPC (found in crest pro health) but not as effective as above

chlorhexidine gluconate

ADA seal of acceptance

available by prescription

high level of substantivity

proven long term efficacy

adverse effects- staining of teeth and restorations, increased calculus deposition, unpleasant taste

interaction with common dentifrice detergent

what interactions does chlorhexidine gluconate have with dentifrice?

it is cationic and forms salts with anions, toothpaste has anionic detergents like SLS

even w a 30 min interval between SLS toothpaste and chlorhexidine rinsing resulted in a significantly reduced antiplaque effect of chlorhexidine

listerine antiseptic

ADA seal of acceptance

disrupts cell wall and inhibits enzymes

reduces gingival inflammation

adverse effects- initial burning sensation, bitter taste, occasional minimal staining

is listerine or chlorhexidine better to enhance postsurgical healing?

listerine enhanced wound healing in pts who underwent periodontal flap surgery

chlorhexidine increased wound healing up to 28 days following gingivectomies

products considered safe for enhancement of postsurgical wound healing

is listerine or chlorhexidine better to reduce peri-implantitis?

both have been shown to be effective in reducing inflammation around implants

used in powered irrigators considered for implant pts

is listerine or chlorhexidine better to use preprocedure?

anaerobes and aerobes reduced following preprocedural rinse

cool mint listerine reduced CFU by 92.1% compared to hydroalcohol control

30 sec 0.12% chlorhexidine rinse confirmed bacterial reduction in saliva

is listerine or nystatin better to for xerostomia related candidiasis?

xerostomia induced oral candidiasis associated w full or partial dentures and side effects of meds

listerine was show to be as effective as nystatin in treatmetn of oral candidiasis in pts with prosthetic appliances

is listerine or chlorhexidine better to inhibit dental plaque and gingivitis?

chlorhexidine reduced gingival plaque better, but listerine reduced gingivitis better