Periodontology Fifth Year First semester Al Azhar University Gaza Palestine By Lama El Banna

1. Periodontology
DR. RAWAND SAMY MOHAMED ABU NAHLA
ORAL MEDICINE, PERIODONTOLOGY&ORAL RADIOLOGY
DEPARTMENT.
DR. HAYDAR.A.SHAFY FACULTY OF DENTISTRY.
EL AZHAR UNIVERSITY.
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2. Lecture 3
Chemical Plaque
Control
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3. CHEMICAL PLAQUE
CONTROL
PLAQUE
 Dental plaque is defined as a highly specific
variable structural entity formed by sequential
colonization of microorganism on the tooth surface,
epithelium and restorations.
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4. Plaque control
 It is the removal of microbial plaque and the
prevention of its accumulation on the teeth and
adjacent gingival tissues. It also deals with the
prevention of calculus formation.
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5. Properties of ideal plaque control material:
 Should decrease plaque & gingivitis
 Prevent pathogenic growth
 Should prevent development of resistant bacteria
 Should be biocompatible
 Should not stain teeth or alter taste
 Should have good retentive properties
 Should be economic
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6. CLASSIFICATION
CHEMICAL PLAQUE CONTROL AGENTS
FIRST GENERATION
Eg: antibiotics, phenol,quarternary ammonium compounds & sanguinarine
SECOND GENERATION
Eg: Bisbiguanides,(chlorhexidine)
THIRD GENERATION
Eg: delmopinol
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7. 1-FIRST GENERATION AGENTS
1-TRICLOSAN
 Phenol derivative
 Is synthetic and ionic
 Used as a topical antimicrobial agent
 Broad spectrum of action including both gram
positive and gram negative bacteria's
 It also includes mycobacterium spores and Candida species
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8. MECHANISM OF ACTION
Triclosan
Act On Cytoplasmic Membrane
Induce Leakage Of Cellular Constituents
Bacteriolysis
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9.  Triclosan is included in tooth paste to reduce plaque
formation
 Used along with Zinc citrate or co-polymer Gantrez to
enhance its retention within the oral cavity
 Triclosan delay plaque formation
 It inhibits formation of prostaglandins & leukotrienes there
by reduces the chance of inflammation
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10. 2. METALLIC IONS
Ex. Zn & Cu ions
MECHANISM OF ACTION
 It reduces the glycolytic activity in bacteria
&delays bacterial growth
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11. 3.QUARTERNARYAMMONIUM
COMPOUNDS
 Cationic antiseptics & surface active agents
 Effective against gram positive organisms
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12. MECHANISM OF ACTION
 Positively charged molecule reacts with negatively
charged cell membrane phosphates and thereby
disrupts the bacterial cell wall structure
ex. Benzanthonium chloride, Benzalleonium chloride
and cetylpyredinium
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13. 4.SANGUINARINE
 It is a benzophenanthredine alkaloid
 It is most effective against gram –ve organisms
 Used in mouth rinse
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14. 5-ANTIBIOTICS
 Different types as vancomycin, erythromycin,
Niddamycin and Kanamycin
 Due to bacterial resistance problems the use of
antibiotics has been reduced
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15. Systemic administration of
antibiotics:
1-Tetracyclines:
 Bacteriostatic agent act by inhibition of protein synthesis.
 Used in case of refractory periodontitis and localized
aggressive periodontitis.
 Tetracyclines are unique in their ability to concentrate in
gingival crevicular fluid achieving levels 2-4 times higher than
serum levels following multiple dosage.
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16.  Tetracycline's have non antimicrobial
properties that have therapeutic applications
related to host modulation:
1- They can promote the attachment of fibroblasts
and connective tissue to root surface thus promoting
regeneration of lost periodontal attachment.
2- They appear to have:
Anti inflammatory properties, suppress PMN activity,
blocking synthesis of PGE2, scavenger for relative
oxygen metabolites.
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17. 3- Tetracycline in low doses as 20mg doxycycline
(periostat) directly inhibit collagenase enzymes and
other collagenolytic enzymes produced by host tissues.
4- Chemically modified tetracyclines can inhibit
parathyroid hormone induced bone resorption.
Specific agents:
Tetracyclines, minocyclines, doxycyclines.
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18. 2-Metronidazole:
1- It is effective against obligate anaerobic bacteria as
prophoromanas gingivalis, provetella intermedia.
2-Used in treatment of gingivitis, ANUG, Adult
periodontitis.
3-Used in acombination with amoxcilline in
treatment of aggressive periodontitis.
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19. 3-Ciprofloxacin:
1-It is active against gram negative rods including
facultative and some anaerobic putative periodontal
pathogens.
2- It is the only antibiotic against all strains of A.a
3- It is used in a combination with metronidazole.
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20. 4-Amoxiclline:
1- It is a semisynthetic penicillin.
2- It is abroad spectrum antibiotic work against gram + and gram _
bacteria.
3-Used for treatment of aggressive and refractory periodontitis.
4- Amoxicillin and calvulanate potassium (Augmentin) are not
susceptible to pencillanase enzyme.
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21. 5-Clindamycin:
1- It is a chloroderivative of lincomycin.
2-It is bacteriostatic and penetration well in gingival
crevice.
3- Work against gram +and gram _ bacteria.
4-Used in treatment of refractory periodontitis.
5- A serious side effect is pseudomembranous colitis.
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22. 6-Spiromycin:
 It is amacrolide antibiotic that is active
against gram + bacteria and it is excreted in
high concentration in saliva.
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23. 2-Second generation
Bisbiguanides
Chlorhexidine Gluconate(0.2%)
 It is a cationic bisbiguanide
 Effective against gram +ve, gram –ve
organisms, fungi, yeasts and viruses
 Exhibit antiplaque & antibacterial properties
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24. Mechanism Of Action
Antiplaque action of chlorhexidine
1. Prevents pellicle formation by blocking acidic
groups on salivary glycoproteins thereby reducing
glycoprotein adsorption on to the tooth surface
2. Prevents adsorption of bacterial cell wall on to the
tooth surface
3. Prevents binding of mature plaques
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25. Antibacterial action of chlorhexidine It shows two actions
1. Bacteriostatic at low concentrations
Bacterial cell wall(-ve charge)
Reacts with +ve charged chlorhexidine molecule
Integrity of cell membrane altered
CHX binds to inner membrane phospholipids &
increase permeability
Vital elements leak out & this effect is reversible
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26. 2. Bacteriocidal action
increased concentration of chlorhexidine
Progressive greater damage to membrane
Larger molecular weight compounds lost
Coagulation and precipitation of cytoplasm
Free CHX molecule enter the cell & coagulates proteins
Vital cell activity ceases
cell death
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27. Adverse Effects Of Chlorhexidine
1. Brownish staining of tooth or restorations
2. Loss of taste sensation
3. Rarely hypersensitivity to chlorhexidine has been
reported
4. Stenosis of parotid duct has also been reported
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28. 3-Third generations
Enzymes
 Enzymes has been used as active agents in antiplaque
preparations
 It is due to the fact that enzymes would be able to
breakdown already formed matrix of some plaques and
calculus
 Some are proteolytic and have bactericidal action
ex. Mucinase, mutanase, dextranase etc
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29. Delmopinol
 Inhibits plaque growth and reduces gingivitis
Mechanism of action
 Interfere with plaque matrix formation &
also reduces bacterial adherence
 It causes weak binding of plaque to tooth, thus
aiding in easy removal of plaque by
mechanical procedures
 It is therefore indicated as a pre brushing
mouth rinse
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30. Adverse effect of delmopinol
1. Staining of tooth & tongue
2. Taste disturbances
3. Mucosal soreness & erosion
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31. Dentifrices
 Dentifrice is a substance used with a tooth brush for the
purpose of cleaning the accessible surfaces of the tooth
It contains
therapeutic agent such as fluoride to inhibit
caries
Antimicrobial agents- chlorhexidine, cetrimide
Anticalculus agent - Zn-chloride
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32. COMPOSITION
1. Polishing/ abrasive agents
• Ca carbonate
• Dicalcium phosphate dihydrate
• Alumina
• Silica
Functions
 Mild abrasive action aids in elimination plaque
 Removes stained pellicle, restores natural luster,
enhances enamel whiteness
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33. 2.Binding/ thickening agents
a. Water soluble agents
• Alginates, Sodium carboxy methyl cellulose etc
b. Water insoluble agents
• Colloidal silica, Magnesium aluminium salts etc
Functions
 Controls stability &constitency of tooth paste
3.Detergents/ surfactants
• Sodium lauryl sulfate
Functions
 Produces foam & removes food debris
 Antimicrobial property
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34. 4. Humectants
 Sorbitol, glycerine, polyethylene glycol
Function
 reduces the loss of moisture from tooth paste
5. Flavoring agents
 Peppermint oil, spearmint oil, oil of
wintergreen
Function
 Render the product pleasant to use & leaves a
fresh taste in mouth after use.
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35. 6. Sweeteners and colouring agents
7.Anti bacterial agents
Triclosan, delmopinol, metallic ions & Zn-citrate
trihydrate
8.Anticaries agents
Na fluoride, stannous fluoride
9.Active agents-fluoride
10.Anticalculus agents(crystal growth inhibitors)
Pyrophosphate, Zn citrate, Zn chloride
11.Desensitizing agents
Sodium fluoride, potassium nitrate
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36. Recent developments in dentifrices
 Tooth paste for children
 Natural tooth paste (herbal)
 Whitening tooth paste
 Breath freshening tooth paste
 Sodium bicarbonate tooth paste
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37. Disclosing Agents
 A disclosing agent is a
preparation in liquid, tablet
or lozenge from which
contains a dye or other
coloring agents
 A disclosing agent is used
for identifying bacterial
plaque
 When applied to the teeth,
the agents imparts its colour
to soft deposits but can be
rinsed easily from clean
tooth surface
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38. Ideal Properties
 Intensity of colour
 Duration of intensity
 Taste
 Not cause irritation to mucous membrane
 Diffusibility
 Astringent and antiseptic property
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39. Agents used for disclosing plaque
a. Iodine preparations
 Skinners iodine solution
 Diluted tincture of iodine
b. Mercurochrome preparations
 Mercurochrome soln
 Flavored mercurochrome disclosing solution
c. Bismark brown
d. Mebromin
e. Erythrosine
f. Fast green
g. Fluoresin
h. Two tone solutions
i. Basic fuschin
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40. Thank you
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