Dental pharmacology (1)
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  • Pulp tissue may die from the action of caustic drugs or from infection associate with caries. At first there is necrosis means local death of cells soon followed by gangrene where puterificaiotn is added to necrosis. When gangrene sets in there is a rapid break down of the dead tissue by puterifcation bacteria & foul smelling nitrogenous substanes. The tissues are liquefied and gas is often evolved the gangrene spreads rapidly without a line of demaraction and very soon the whole pulp is involved. If pulp cavity is not opened the increased pressure in pulp chamber may force bacteria through the apical foramen where they will cause the peridontitis or alveolar abbesses if they are violent or numerous.

Dental pharmacology (1) Presentation Transcript

  • 1. July 26, 2013July 26, 2013 11 DentalDental PharmacologyPharmacology
  • 2. July 26, 2013 2 Dental PharmacologyDental Pharmacology  Oral HygieneOral Hygiene  ObtudentsObtudents  Mummifying agentsMummifying agents  Drugs used for cavity toilets &Drugs used for cavity toilets & periodontal diseaseperiodontal disease
  • 3. July 26, 2013 3 Oral hygieneOral hygiene  Oral hygiene means care of oral mucousOral hygiene means care of oral mucous membrane & teeth it includesmembrane & teeth it includes a)a) SialagougeSialagouge b)b) DentrifricesDentrifrices c)c) Mouth washesMouth washes d)d) Bleaching agentsBleaching agents
  • 4. July 26, 2013 4 SialagougeSialagouge  It increases the salivary secretion, itIt increases the salivary secretion, it includesincludes 1.1. BitterBitter 2.2. Autonomic Cholinergic drugsAutonomic Cholinergic drugs 3.3. Autonomic Ganglion blocking drugsAutonomic Ganglion blocking drugs 4.4. Stimulant substancesStimulant substances
  • 5. July 26, 2013 5 DentrifricesDentrifrices  Therapeutic mechanicalTherapeutic mechanical aids meant foraids meant for cleansing the teeth with the help of acleansing the teeth with the help of a brush.brush.  Available as toothAvailable as tooth powderpowder or toothor tooth pastepaste,,  IdealIdeal tooth paste or powder contains thetooth paste or powder contains the following ingredients.following ingredients. 1.1. Abrasive agentsAbrasive agents 2.2. DetergentsDetergents 3.3. AntisepticsAntiseptics 4.4. Sweetening agentsSweetening agents
  • 6. July 26, 2013 6 Abrasive agentsAbrasive agents  Dental abrasives areDental abrasives are fine powderfine powder preparationspreparations  They are used,They are used, 1.1. to help the scouring action of tooth brushto help the scouring action of tooth brush mechanically andmechanically and 2.2. for cleaning, polishing and filling the teethfor cleaning, polishing and filling the teeth  Most commonly used dental abrasives areMost commonly used dental abrasives are pumicepumice andand precipitated calciumprecipitated calcium carbonate.carbonate.
  • 7. July 26, 2013 7 Abrasives (contd….)Abrasives (contd….)  PumicePumice consists of silicates of aluminum,consists of silicates of aluminum, potassium and sodium.potassium and sodium.  To polish, fill and clean teeth pumice withTo polish, fill and clean teeth pumice with glycerin is employed.glycerin is employed.  Precipitated calcium carbonatePrecipitated calcium carbonate is a mildis a mild abrasive which is employed to give theabrasive which is employed to give the final polish to silver amalgam fillings. It isfinal polish to silver amalgam fillings. It is also used to prepare tooth paste and toothalso used to prepare tooth paste and tooth powderspowders
  • 8. July 26, 2013 8 DetergentsDetergents  These are cleaning agents.These are cleaning agents.  Sodium bicarbonateSodium bicarbonate: it is mild alkali, acts by: it is mild alkali, acts by dissolving proteinsdissolving proteins  Hydrogen PeroxideHydrogen Peroxide: acts by liberating oxygen: acts by liberating oxygen  Hard SoapsHard Soaps::  act by dissolving fatty substances mucous plaques andact by dissolving fatty substances mucous plaques and lowering surface tension.lowering surface tension.  causes loosening of debris adhering to teethcauses loosening of debris adhering to teeth  acts as lubricants when scrubbed over the teeth and gumsacts as lubricants when scrubbed over the teeth and gums  proportion in most tooth paste varies from 5 – 25%.proportion in most tooth paste varies from 5 – 25%.
  • 9. July 26, 2013 9 AntisepticsAntiseptics  Value is limitedValue is limited  Volatile Oils:Volatile Oils: Thymol,Thymol, MentholMenthol,, EugenolEugenol,, CinnamonCinnamon up to 1%up to 1%
  • 10. July 26, 2013 10 Sweetening AgentsSweetening Agents  SaccharineSaccharine commonly usedcommonly used  Other agents:Other agents: SucroseSucrose andand LactoseLactose  Sucrose causes less fermentation.Sucrose causes less fermentation.
  • 11. July 26, 2013 11 Coloring AgentsColoring Agents  Make preparations more attractive andMake preparations more attractive and acceptableacceptable  Red colorRed color: Azorubri, Liquor rubri, liquor: Azorubri, Liquor rubri, liquor caramini or tincture coci.caramini or tincture coci.  Blue colorBlue color: Methylene Blue.: Methylene Blue.
  • 12. July 26, 2013 12 Dentrifrices-Ideal dentrificeDentrifrices-Ideal dentrifice  An Ideal preparation should beAn Ideal preparation should be  Non-causticNon-caustic to the mucous membraneto the mucous membrane  Non-decalcifyingNon-decalcifying and non-over abrasive to the teethand non-over abrasive to the teeth  Non-poisonousNon-poisonous to the body as a wholeto the body as a whole  Not inhibit the secretionNot inhibit the secretion and alter the reaction ofand alter the reaction of salivasaliva  NotNot destroydestroy the ferments of salivathe ferments of saliva  Have pleasantHave pleasant taste,taste, odorodor andand consistencyconsistency  Have sufficient cleaning action.Have sufficient cleaning action.
  • 13. July 26, 2013 13 MOUTH WASHMOUTH WASH  These are mechanical agents used forThese are mechanical agents used for gargles.gargles.  Types:Types:  Therapeutic:Therapeutic: to reduce plaque, gingivitis,to reduce plaque, gingivitis, dental caries and stomatitis.dental caries and stomatitis.  Cosmetic:Cosmetic: are used to reduce bad breathare used to reduce bad breath
  • 14. July 26, 2013 14 THERAPEUTIC MOUTH WASHTHERAPEUTIC MOUTH WASH HYDROCORTISONE,HYDROCORTISONE, NYSTATIN,NYSTATIN, ANTIHISTAMINE ANDANTIHISTAMINE AND TETRACYCLINETETRACYCLINE StomatitsStomatits PilocarpinePilocarpine xerostomaxerostoma Tranexamic acidTranexamic acid prevention of bleedingprevention of bleeding after oral surgeryafter oral surgery Amphotericin BAmphotericin B oral candidiasisoral candidiasis Chlorhexidine gluconateChlorhexidine gluconate plaque controlplaque control
  • 15. July 26, 2013 15 TypesTypes 1.1. AntisepticsAntiseptics: H: H22OO22, KMnO, KMnO44, Phenol and, Phenol and KClOKClO33, Thymol, Menthol and, Thymol, Menthol and Sodiumpercholate.Sodiumpercholate. 2.2. AstringentAstringent: ZnO: ZnO22, Alcohol and ZnCl. These, Alcohol and ZnCl. These make a protective layer over the mucosa ofmake a protective layer over the mucosa of oral cavity.oral cavity. 3.3. DemulcentDemulcent:: Glycerin, liquoron. They form aGlycerin, liquoron. They form a protective layer and prevent attack ofprotective layer and prevent attack of bacteria.bacteria.
  • 16. July 26, 2013 16 Moth wash (contd…)Moth wash (contd…)  Generally they contain four groups ofGenerally they contain four groups of excipients:excipients:  AlcoholsAlcohols: used as solublizing agent for some: used as solublizing agent for some flavoring agents as well as preservatives.flavoring agents as well as preservatives.  SurfactantsSurfactants: used to reduce debris by providing: used to reduce debris by providing foaming agentsfoaming agents  FlavorsFlavors  Coloring agentsColoring agents
  • 17. July 26, 2013 17 Ideal Mouth washIdeal Mouth wash  Non-causticNon-caustic to the mucous membraneto the mucous membrane  Non-decalcifyingNon-decalcifying and non-over abrasive to theand non-over abrasive to the teethteeth  Non-poisonousNon-poisonous to the body as a wholeto the body as a whole  Not inhibit the secretionNot inhibit the secretion and alter the reactionand alter the reaction of salivaof saliva  NotNot destroydestroy the ferments of salivathe ferments of saliva  Have pleasant taste, odor and consistencyHave pleasant taste, odor and consistency  Have sufficient cleaning actionHave sufficient cleaning action
  • 18. July 26, 2013 18 BLEACHING AGENTSBLEACHING AGENTS  They remove the coloring pigments from theThey remove the coloring pigments from the teeth and these are,teeth and these are, 1.1. Oxidizing AgentsOxidizing Agents: like perhydrol, pyrozone, sodium: like perhydrol, pyrozone, sodium peroxide hyderogenperoxide.peroxide hyderogenperoxide. 2.2. Chlorinating AgentsChlorinating Agents: like chlorinated Soda lime.: like chlorinated Soda lime. 3.3. Reducing AgentsReducing Agents: like Sodiumthiosulphate.: like Sodiumthiosulphate.  Boric acid, Sodiumthiosulphate and chlorinatedBoric acid, Sodiumthiosulphate and chlorinated soda lime are packed in the oral cavity insoda lime are packed in the oral cavity in powder form and to hasten the evolution ofpowder form and to hasten the evolution of chlorine drop of acetic acid is used.chlorine drop of acetic acid is used.
  • 19. July 26, 2013 19 Special StainsSpecial Stains StainStain Bleaching agentBleaching agent usedused Iodine stainsIodine stains Weak ammonia orWeak ammonia or Sodium thiosulphateSodium thiosulphate solution.solution. Silver stainsSilver stains Hypochlorite or IodineHypochlorite or Iodine solutionsolution Iron stainsIron stains HypochloriteHypochlorite Stains of manyStains of many daysdays Chlorinated lime andChlorinated lime and Acetic acidAcetic acid
  • 20. July 26, 2013 20 OBTUDENTSOBTUDENTS  Agents used toAgents used to diminish the dentinediminish the dentine sensitivitysensitivity so that excavation may becomeso that excavation may become painlesspainless..  Classification is according to mode of action.Classification is according to mode of action. 1.1. By paralyzing sensory nerve endingsBy paralyzing sensory nerve endings: Phenols,: Phenols, Camphor, Thymol, Clove oil & Alcohol.Camphor, Thymol, Clove oil & Alcohol. 2.2. By precipitating proteinBy precipitating protein: Silver nitrate and Zinc: Silver nitrate and Zinc chloride.chloride. 3.3. By destruction of nerve tissueBy destruction of nerve tissue: Alcohol 70%.: Alcohol 70%.  At present the use of obtundents has declinedAt present the use of obtundents has declined due to the availability of local anesthetics (e.g.due to the availability of local anesthetics (e.g. xylocainexylocaine))
  • 21. July 26, 2013 21 Properties of good ObtudentsProperties of good Obtudents  Should not produce any irritation or pain.Should not produce any irritation or pain.  Should not stain the denture.Should not stain the denture.  Should penetrate the dentine sufficientlyShould penetrate the dentine sufficiently to remove the sensitivity.to remove the sensitivity.  CLOVE OIL is an ideal obtudentCLOVE OIL is an ideal obtudent
  • 22. July 26, 2013 22 Draw backsDraw backs  Irritative agents may cause the formationIrritative agents may cause the formation of secondary dentine If applied for longof secondary dentine If applied for long periods.periods.  The pulp may shrinkThe pulp may shrink
  • 23. July 26, 2013 23 MUMMIFYING AGENTSMUMMIFYING AGENTS  Used toUsed to harden & dryharden & dry the tissue of pulp andthe tissue of pulp and root canal so that tissue may maintain anroot canal so that tissue may maintain an asepticaseptic conditions resistant to infection,conditions resistant to infection, especially in cases where it is impossible toespecially in cases where it is impossible to remove the pulp and contents of the root canalremove the pulp and contents of the root canal completely.completely.  To accomplish the desired goal more than oneTo accomplish the desired goal more than one drug will be employed in the form of a paste.drug will be employed in the form of a paste.  Mainly Astringents and antiseptics are used inMainly Astringents and antiseptics are used in the form of paste.the form of paste.  ParaformParaform,, Liquor formaldehydeLiquor formaldehyde,, CresolCresol,, Amino-silver nitrateAmino-silver nitrate andand IodoformIodoform, T, Tannicannic AcidAcid can also be used.can also be used.
  • 24. July 26, 2013 24 Peridontal DiseasesPeridontal Diseases  Peridontal disease can refer to any conditionPeridontal disease can refer to any condition that affects thethat affects the gums and other structuresgums and other structures supporting the teethsupporting the teeth..  The most common forms of periodontal diseaseThe most common forms of periodontal disease are caused byare caused by bacterial infectionsbacterial infections..  The mildest form of infection isThe mildest form of infection is gingivitisgingivitis, which, which affects only the gums.affects only the gums.  More severe disease damages the otherMore severe disease damages the other supporting structures of the tooth. This can leadsupporting structures of the tooth. This can lead toto tooth losstooth loss..
  • 25. July 26, 2013 25
  • 26. July 26, 2013 26 Peridontal Diseases- AntibioticsPeridontal Diseases- Antibiotics  Tetracycline antibiotics, which includeTetracycline antibiotics, which include tetracycline hydrochloridetetracycline hydrochloride,, doxycyclinedoxycycline, and, and minocyclineminocycline, are the primary agents used., are the primary agents used.  They not only have anti-bacterial actions, butThey not only have anti-bacterial actions, but also, theyalso, they reduce inflammationreduce inflammation and help blockand help block collagenasescollagenases, even in low doses., even in low doses.  In fact, it is theseIn fact, it is these two actionstwo actions, rather than their, rather than their antibacterial properties, which seem toantibacterial properties, which seem to contribute most to periodontal protectioncontribute most to periodontal protection
  • 27. July 26, 2013 27 Peridontal Diseases- AntibioticsPeridontal Diseases- Antibiotics  MacrolideMacrolide antibiotics (e.g.,antibiotics (e.g., roxithromycinroxithromycin).).  QuinoloneQuinolone antibiotics (e.g.,antibiotics (e.g., moxifloxacin,moxifloxacin, ciprofloxacinciprofloxacin) may specifically target) may specifically target A.A. actinomycetemcomitansactinomycetemcomitans, an important bacteria, an important bacteria in periodontal disease.in periodontal disease.  MetronidazoleMetronidazole in combination with tetracyclinein combination with tetracycline or amoxicillin. Such combinations may be usedor amoxicillin. Such combinations may be used for severe and chronic periodontal disease.for severe and chronic periodontal disease.
  • 28. July 26, 2013 28 ROOT CANAL THERAPY (RCT)  It is the treatment of non vital tooth in which pulp is damaged & exposed due to trauma injury or caries. In this pulp is removed & canal is sealed with suitable drugs. July 26, 2013 28
  • 29. July 26, 2013 29July 26, 2013 29 Pulp tissue dies due to caustic drugs or infection Necrosis -> Gangrene -> Putrefaction tissues liquefied and gas often evolves, the gangrene spreads rapidly involving the whole pulp If pulp cavity is not opened the increased pressure in pulp chamber may force bacteria through the apical foramen where they will cause the peridontitis or alveolar abbesses
  • 30. July 26, 2013 30 STEPS FOR CARRAYING RCT  Removal of micro organism form the cavity  Use of obtudent  Use of mummifying agents  Use of filling material  Prophylaxis July 26, 2013 30
  • 31. July 26, 2013 31 REMOVAL OF MICROORGANISM FROM PULP CAVITY  For this patient must take antibiotic course pirior to pulpectomy cavity. Drugs of choice are penicillin, sulphonamide these are used to prevent the growth of microorganism, reduces pain & irritation & stimulates perapical repair H2O2 is also used it is an antiseptic but not potent one. July 26, 2013 31
  • 32. July 26, 2013 32 ANTISEPTIC USED TO STERILIZE ROOT CANAL  The ideal drug used for root canal therapy should.  Germicidal to all organism  Rapidly effective  Capable of deep penetration  Effective in presence of organic matter  Non injurious to peripecial tissues  Non staining to the teeth July 26, 2013 32
  • 33. July 26, 2013 33 THE PHENOL GROUP  Beech wood, cresol, tricresol, cresatine, paramonochlorphenol, paramonochlorophenol is dissolved in portion of three part with 7 parts of camphor. July 26, 2013 33
  • 34. July 26, 2013 34 POLYANTIBOTIC PASTES POLYANTIBIOTIC PASTE  Consist of penicillin bacteriacin chlorophenicol, strephtomycin & sodium caprylate. The antibiotic used are sulfonamide used are baetercostatic, Penicillin alone or combination of penciling & Streptomycin have limited effects on the organism of root canal so the polyantibiotic pastes was introduced in 1955 by Grossman this paste contain many antibiotics. It consists of July 26, 2013 34
  • 35. July 26, 2013 35  10,0000 units of Penicillin G (Effective against gram +ve organism  )  10000 units of bacteriacim Effective against gram +ve organism RESISTANCE TO PENCILLIN  1 G of Streptomycin Effective against gram +ve organism  1 G of Sodium Caprylate destroy fungi  3 cc D. C fluid silican  A similar paste supplied by the Boots drug comp  Penicillin G. 0.2 mega units  Streptomycin 0.2 mega unitsJuly 26, 2013 35
  • 36. July 26, 2013 36  Chloromphenicol 0.2 g  Sodium capryltate 0.2 g  Silicon DC 200.6 millions July 26, 2013 36
  • 37. July 26, 2013 37 QUATERNARY AMMONIUM COMPOUND  Compounds such as certimide non injurious to tissues act in the presence of organism  Monaern is active against gram –ve & gram +ve bacteria but not against ps pyocyanus slight active aginst candida  cetrimide belongs to quaternary ammonium compound, detergent active ataisnt gram –ve the & gram +ve organism as well as ps pyocyanus but it has only limited effect on Candida. July 26, 2013 37
  • 38. July 26, 2013 38July 26, 2013 38   HALOGEN DERIVATIVES There are two salts of (a)Chloramine (b)Chloramide in a strength of 1 in 125.
  • 39. July 26, 2013 39 Root Canal Filling Materials  Root Canal filling material should be aseptic, non-irritant and able to seal the apex of the root, the dentine foramina and tubules  They act as firm barrier against moisture, and bacteria.  They are  Permanent filling e.g Gold, silver, copper amalgam  Semi permanent filling e.g cements composits  Temporary filling e.g gutta-percha points, calium hydroxide cements
  • 40. July 26, 2013 40 Root Canal Filling MaterialsRoot Canal Filling Materials  Root Canal filling material should beRoot Canal filling material should be aseptic, non-irritant and able to sealaseptic, non-irritant and able to seal the apex of the root, the dentinethe apex of the root, the dentine foramina and tubulesforamina and tubules  They act as firm barrier againstThey act as firm barrier against moisture, and bacteria.moisture, and bacteria.
  • 41. July 26, 2013 41 Prophylaxis  Stanous flouride 80% after every six months to avoide formation of caries  Fissure sealents applied on over the occlusal surface to prevent food particals ot an other narcotic material into dangerous zone.
  • 42. July 26, 2013 42 Drugs for local haemostasisDrugs for local haemostasis  StypticsStyptics:: These are local haemostaticThese are local haemostatic agents.agents.  The preparation used is,The preparation used is, 1.1. Human FibrinogenHuman Fibrinogen 2.2. Human fibrin foamHuman fibrin foam 3.3. Human Thrombin.Human Thrombin.  AdrenalineAdrenaline 1:1000 parts, a1:1000 parts, a vasoconstrictor can be used locally.vasoconstrictor can be used locally.
  • 43. July 26, 2013 43 DRUGS USED FOR CAVITYDRUGS USED FOR CAVITY TOILETTOILET  Alcohol, HAlcohol, H22S and Tricresol.S and Tricresol.  HH22S is an oxidizing agent and hasS is an oxidizing agent and has antiseptic properties.antiseptic properties.  Not a very strong antiseptic as it liberatesNot a very strong antiseptic as it liberates OO22 very quickly.very quickly.  But it inhibits the growth of anaerobicBut it inhibits the growth of anaerobic bacteria.bacteria.
  • 44. July 26, 2013 44 AlcoholAlcohol  Distinct smell and burning taste.Distinct smell and burning taste.  Ethyl AlcoholEthyl Alcohol, 70% solution is used for, 70% solution is used for dental procedures.dental procedures.  It penetrates rapidly but not deeply and isIt penetrates rapidly but not deeply and is not toxic to pulp.not toxic to pulp.  It acts by precipitating protein in the dentalIt acts by precipitating protein in the dental tubule.tubule.  Benzyl alcoholBenzyl alcohol can also be used alone orcan also be used alone or with Chloroform and Ethyl Alcohol , in ratiowith Chloroform and Ethyl Alcohol , in ratio 5:3:2.5:3:2.