Chemical plaque control /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
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  • 1. Chemical plaque control INDIAN DENTAL ACADEMY Leader in Continuing Dental Education
  • 2. PLAQUE CONTROL Plaque control is the regular removal of dental plaque and the prevention of its accumulation on the teeth and adjacent gingival surfaces. Since plaque control is an effective method of treating as well as preventing periodontal disease,it forms an important aspect of all procedures involved in the management and prevention periodontal disease. It is the primary level of prevention of periodontal diseases and caries.
  • 3. Objectives of plaque control To reduce the number of micro organisms on the teeth. This reduces factors of irritation and inflammation. One of the causes of halitosis may be removed. Gingival stimulation.
  • 4. Disclosing agents Used for identification of the bacterial plaque,which might otherwise be invisible to naked eye. It is a preparation in liquid, tablet or lozenge form which contains a dye or other colouring agent,which when applied to teeth imparts colour to soft deposits but can be rinsed easily from clean tooth surfaces.
  • 5.  Solutions and wafers are available commercially. Solutions are applied to teeth as concentrates on cotton swabs or diluted as rinses. These can be used as educational and motivational tools to improve the efficacy of plaque control procedures.
  • 6. MethodsMechanical plaque control aids: Tooth brushes Manual tooth brush Electrical tooth brush Inter dental aids Dental floss Triangular tooth picks Inter dental brushes
  • 7. Aids for gingival stimulation Rubber tip stmulator Balsa wood edge Aids for denture wearers Denture and partial clasp brushes Cleansing solutionsChemical plaque control aids: Mouth rinses dentifrices
  • 8.  Mechanical plaque control seems to be the most dependable form of plaque control. Chemical plaque control is used only as an adjunct to mechanical means and not a substitute even tough various chemicals are widely used nowadays.
  • 10. Chemical plaque control agents have been proven as an adjunct to mechanical plaque control procedures especially in individuals with a defective host defence mechanism, mentally or physically handicapped and in patients who have undergone surgery.
  • 11. While evaluating antimicrobials thefollowing criteria are consideredDoes it reach the site?Is it present in adequate concentration?Is it effective against target organisms?Is it in the oral cavity for long enough?Does it have minimal or controllable side effects?
  • 12. Ideal requisites Should significantly reduce plaque and gingivitis Prevent growth of pathogenic bacteria. Prevent development of resistant bacteria. Be compatible with the oral tissues. Should not stain teeth or alter taste. Should exhibit good retentive properties. Should be inexpensive and easy to use.
  • 13. Classification of chemical plaque control agents. First generation anti plaque agents They are capable of reducing plaque scores by 20-50%. Exhibit poor retention. ex:antibiotics,phenols,quaternery ammonium compounds and sanguanaire Second generation Upto 70% and are better retained by the oral tissues and exhibit slow release properties ex:bisbiguanides Third generation Donot exhibit good retentive properties as CHX ex:delmopinol
  • 14. Modes of action of antiplaque agents Inhibition of bacterial growth and metabolism Inhibition of bacterial colonisation Disruption of established plaque Modification of plaque biochemistry Alteration in plaque ecology
  • 15. ANTIBACTERIAL AGENTS Effective only supragingivally Agents with complementary modes of actions are being combined to increase their antibacterial effectiveness. Their long term use should not  Disrupt the natural balance of the oral microflora  Lead to colonisation by exogenous organisms  Lead to the development of microbial resistance
  • 16.  Bisguanide antiseptics Quaternary ammonium compounds Phenolic antiseptics Triclosan Povidone iodine Metal ions Sanguanarine Oxygenating agents Enzymes Delmopinol Prebrushing rinses
  • 17. Bisguanide antisepticsChlorhexidine ,alexidine,octenidine. Chlorhexidine gluconate is most commonly used It is a salt of chlorhexidine and gluconic acid Containing 0.12%chx gluconate in a base containing 11.6%alcohol,FD&C blue no.1,glycerine,peppermint flavour,purified water,and saccharine sodium. ph 5-7.
  • 18. Pharmacology Effective against both gram positive and gram negative bacteria including aerobes and anaerobes 30%of the active ingredient is retained in the oral cavity following rinsing.this retained drug is slowly released into oral fluids. The ability of the drug to adsorb onto and bind to soft tissues and hard tissues is known as substantivity.
  • 19.  Mechanism of action: Mechanism of plaque inhibition: • Based on the interaction of its positive charge with negatively charged sites in the oral cavity • CHX molecules adsorb to salivary glycoproteins and prevent their adsorption to the tooth surface and the formation of acquired pellicle. • Bacteria coated with CHX—adsorption of bacteria to tooth surface is prevented • By displacing calcium ions—prevents plaque maturation • CHX is retained • The bactericidal action of CHX would thus render the established plaque less
  • 20. Mechanism of antibacterial action:• The bacterial wall contains many negatively charged groups—sulphite and phosphates…to which the CHX+ adsorbs• On the cell wall CHX causes irreversible damage to its integrity and disturbs the permeability mechanism..vital cell elements leak out and harmful substances may gain entry into the cell.this occurs at low concentrations..this accounts for bacteriostatic action.• At higher conc..CHX+ enters into the cell and causes coagulation of cytoplasmic proteins..rendering the bacteria dead
  • 21. Clinical usage:• 0.2%...10 ml per rinse with equal amount of water…• After 30-45 mins after brushing using a flourinated tooth paste• Difficult to incorporate in toothpastes.
  • 22. Side effects: Unpleasant taste,Staining,Mucosal erosion and parotid swellingAdverse reactions: stomatitis,glossitis,ulcers,dry mouth,hyperaesthesia,desquamation.Advantages: o Wide spectrum of action o Immediate action o Prolonged action after a single use o Lack of aquired bacterial resistance o No risk of sensitization o Safe,non toxic
  • 23. Quaternary ammonium compounds Cetylpyridium chloride(CPC 0.1%), benzathonium chloride CPC have moderate plaque inhibitory activity. it has low substantivity. The positively charged molecules react with the negatively charged cell membrane phosphates— disrupts cell wall of micro organisms Adverse effects—staining of teeth and burning of oral tissues.
  • 24. Phenolic antiseptics Used alone or in combination. Listerine (26.9%alcohol,ph-5.6),contains the essential oils-thymol ,menthol,eucalyptal oil, methylsalicylate in an hydroalcohol vehicle. Acts by alteration of the bacterial cell wall as well as reduction in bacterial endotoxins.Also have an anti inflammatory action which contributes to the inhibitory effect on gingivitis
  • 25.  Listerine is uncharged compound and has low substantivity. Adverse effects include burning sensation of tongue, oral mucosa and bitter taste. They produce less stain than CHX.
  • 26. Triclosano It is a non-ionic antiseptic with hydrophobic and hydrophilic properties, a broad spectrum of antimicrobial activity and low toxicity, low substantivty.o It may adsorb to lipids of the bacterial membrane thus effecting mechanisms of transport ,cause leakage of intracellular compounds and cell lysiso It can delay plaque maturation and also inhibit formation of prostaglandins and leukotrienes
  • 27. o Formulations containing triclosan(0.15%) and zinc citrate(0.4%) have been developed to improve the antiplaque and antigingivitis affects observed with each agent alone.o Other attempt—addition of polyvinyl methyl ether and maleic acid(PVM-MA) known as gantrez, in an attempt to increase the oral retention of triclosano However, unlike CHX&CPC it is compatible with conventional dentifrices and does not cause tooth staining.
  • 28. Povidone iodineo It does not appear to have significant plaque inhibitory activity.o Besides, a significant amount of iodine is absorbed through the oral mucosa making it unsatisfactory for prolonged use.
  • 29. Metal ionso Zn,Cu,Sno Zn is retained by the dental plaque and inhibits its regrowth without disrupting the oral ecologyo Metallic salts reduce the glycolytic activity in micro organisms and delay bacterial growth.o Stannous ion also interferes with bacterial biochemical synthesis ,metabolism,and aggregation.o SnF has moderate substantivity.(conc-0.63% rinse,0.4%gels)o Adverse effects include metallic taste,short shelf life and formation of black lines
  • 30. Sanguinarineo Alkaloid derived from rhizomes of Sanguinaria candensis. it contains chemically reactive iminiumo It acts by alteration of bacterial cell attachmento Low substantivity, has moderate plaque inhibitory effect and less anti gingivitis effecto Acts synergistically with zinco Causes burning sensation of the oral tissues.
  • 31. Oxygenating agents Such as hydrogen peroxide and buffered sodium peroxy borate and peroxy carbonate in mouth rinses have a beneficial effect on acute ulcerative gingivitis ,probably by inhibiting aerobic bacteria. Adverse effects---tissue injury, delayed wound healing, potential carcinogenic effects as well as candida albicans overgrowth
  • 32. Enzymes• Enzymes have been used as active agents in antiplaque preparations due to the fact that they would be able to breakdown already formed matrix of plaque and calculus.• Besides, certain proteolytic enzymes are bactericidal Ex: mucinase , mutanase, dextranase.
  • 33. Delmopinol• It is an morpholinoethanol derivative.• It acts by interfering with plaque matrix formation and reduction of bacterial adherence…therefore can be used as pre brushing mouthrinse.• Conc of 0.1-0.2%• Adverse effects include transitory numbness of the tongue,tooth and tongue staining,taste disturbance and rarely mucosal soreness and erosion.
  • 34. Pre brushing rinses Plax is currently available It enables the mechanical action of brushing and flossing to remove the plaque more easily. The active ingredient is sodium benzoate and that combined with detergents may have surfactant action on plaque.
  • 35. Delivery vehicles for antiplaque agents Locally delivered It should ensure user compliance and have a compound that allows for stability, bioavailability, solubility of the chemoprophylactic agent  Mouthrinses  Dentifrices  Gels  Sprays  Chewing gums
  • 36. Mouth rinsesTypes:• Fluorides mouthrinses• Antiplaque mouthrinses• Plaque control mouthrinses• Desensitizing mouthrinses
  • 37. Uses:To replace mechanical tooth brushing when it is not possible in following situations  After oral or periodontal surgery during healing  After IMF  Acute oral mucosal or gingival infectionsAs an adjunct to normal tooth brushing in situations where this may be compromised by discomfort or inadequacies  Following subgingival scaling and root planing  Following scaling in situations where the patients oral hygiene remains inadequate
  • 38. Assessing the mouthwashes:  Range of antibacterial activity  Substantivity  Possible anti inflammatory effect  Acceptable taste  Ability to promote fresh mouth sensation
  • 39. DentifricesA dentifrice is a substance used with a toothbrush for the purpose of cleaning theaccessible surfaces of teeth.
  • 40. Composition:INGREDIENTS % FUNCTION CHEMICALMild abrasives 15-45 Mechanically CaCO3,Ca2(PO clean the teeth 4)3,SiO2,Al2O3water 20-38 Vehicle and Double solvent medium distilled waterhumectants 25-40 reduces loss of Sorbitol,manni surface moisture tol,propylene glycoldetergents 1-5 Anti microbial Na lauryl properties sulphate,Na N- lauryl sarcosinateBinding agents Upto 2 Controls Synthetic stability&consist cellulose ency
  • 41. Flavouring Upto 1 Pleasant taste Peppermintagents oil,spearmint oil,oil of winter greenSweetening Upto 2 Sweet taste Sorbitol,mannitagents ol,saccharinTherapeutic Upto 2 Specific Tetraagents therapeutic act Napyrophosphat e,Zn chloridepreservatives upto0.5 Prevent Benzoic acid microbial growthColouring agents Upto 0.5 Pleasing colour Manufacturer’s choice
  • 42. Other agents- • Antimicrobial agents: triclsan, delmopinol,metallion ions,zinc citrate trihydrate. • Anticaries agents: Na monofluorophosphate, Na fluoride, stannous flouride. • Anticalculus agents: pyrophosphate ,Zn citrate, Zn chloride ,gantrez. • Desenstizing agents: Na flouride, potassium nitrate, strontium chloride.
  • 43. Types of toothpastes:  Fluoride toothpaste  Desensitizing toothpaste  Anti calculus toothpaste  Antiplaque toothpaste  Whitening toothpaste  Ayurvedic medicated toothpastes
  • 44. CONCLUSIONThere currently exists no one procedure or agent that meets the stringent demand of clinicians, absolute plaque control and that of patients ease and negligible adverse effects. At present it is necessary to selectively apply the cumulative effects of various mechanical and chemical modalities,individualised according to the patient need. Adjustments based on disease process and charecteristics as well as on patient compliance should be made as needed.