Individual Drug Carrier

An individual medication carrier is a plastic splint made for one or both jaws that is loaded with fluoride or chlorhexidine gel and placed in the mouth. This medication carrier is designed to provide a longer residence time for the active ingredient on the tooth surface or gingiva (the gums).

Indications (areas of application)

The application (the application) of an active ingredient by means of a splint has the advantage that its dilution by saliva does not occur or occurs much more slowly than with splintless application. An individual drug carrier is used in intensive prophylaxis when conventional applications of the drugs do not seem feasible due to certain restrictions. The following are usually used:

The indications are as follows:

  • Bacterial gingivitis (inflammation of the gums).
  • Temporarily limited oral hygiene: for example, after surgery that limits manual dexterity.
  • Permanently restricted oral hygiene, for example, in patients with mental or physical limitations that make effective dental care impossible
  • Intensive reduction (lowering) caries-relevant germs.
  • Xerostomia: age-related dry mouth, triggered by gradually declining function of the salivary glands.
  • Radio-xerostomia: therapy with X-rays in the jaw and thus salivary glands also leads to hyposalivation (decreased saliva production) due to their damage.

Contraindications

There is nothing against the use of an individual drug carrier as such. Limitations arise from improper handling and composition of the drugs applied with the splint:

  • Incompatibility of an active substance or additive.
  • The patient is not able to rinse the gel after application, giving the possibility of overdose.

The procedure

Splint fabrication:

After taking impressions of the upper and lower jaw in the dental office, plaster models are made in the dental model using the impressions. A thermoplastic foil (e.g. Erkoflex, 2 mm thick) that remains soft (deformable when heated) is vacuum-formed over these models so that it fits closely to the tooth contours and retains this shape after cooling. The edges of the vacuum-formed tray are adjusted to the tooth contour by grinding or trimming so that the gingiva is not irritated. The deep-drawing splint usually serves as a carrier for the following active ingredients:

I. Chlorhexidine digluconate (chlorhexidine, CHX) in gel form 1% to 2%:

CHX has a direct bactericidal (germicidal) effect on the main caries-causing germ, streptococcus mutans, et al, both in saliva and in the plaque layer (layer of germs and organic material) adhering to the teeth. CHX is also deposited and stored in the pellicles (an extremely thin layer of organic matrix that reappears on the tooth surface immediately after tooth cleaning) and thus has a long-term effect. The reduction of mutans streptococci can be detected up to three months after application. The application can be made

  • In the form of a shock therapy: wearing time 5 min, rinse, 5 min break, repeat application twice more,
  • As a time-limited intensive treatment or
  • For radio-xerostomia permanent therapy: daily wearing time in the evening 5 to 10 min. in combination with fluoride gel.

II. Sodium fluoride or amine fluoride in gel form 1.25 %-ig:

Serve to improve the enamel structure by remineralization (re-deposition of fluoride in the crystal lattice of the enamel so as replacement of hydroxyl ions). As a result, the enamel surface is less susceptible to acid and thus less prone to caries, since acid is a metabolic product of caries-relevant mutans streptococci. It is applied according to the caries risk:

  • In radio-xerostomia: daily in combination with CHX gel.
  • In case of increased caries risk: once a week.
  • For prophylaxis in dental practice: semi-annually / annually.

An advantage resulting from the application of medication by means of individual splint is up to 90% more economical medication dosage compared to a ready-made splint. When simply brushing in the gel, only a small amount of active ingredient is used, assuming proper handling, similar to the individual medication tray. Due to the nevertheless high fluoride concentration in fluoride gels (12,500 ppm), patients must be instructed in detail in advance in the case of self-application; in the case of restricted patients, application must be carried out by appropriately trained persons. Procedure for application:

  • Uniform and sparing charging of the drug carrier with the gel.
  • Insertion of the splint on the maxilla and mandible for 2 to 3 min. (radio-xerostomy 5 min.)
  • The final rinse must be mastered by the patient.
  • Cleaning the splint with toothbrush under clean water.
  • Dry storage of the splint

Possible complications

  • The most important complication is the overdose of the applied active ingredient due to improper handling, in particular the overdose of fluoride. Prolonged overdose in the growing age can lead to dental fluorosis, with several years of overdose to mineralization disorders of the bones.
  • Fluoride should not be used in patients with severe renal or hepatic dysfunction.