2. Introduction
Bacterial Plaque: prime etiologic factor;
• Supragingival; removal by patient
(toothbrush & floss/pick) = Prevention
• Subgingival; professional removal (Sc & RP)
= treatment
Removal is primarily Mechanical; not
sufficient in all individuals; Chemical
agents used to augment mechanical
plaque removal in prevention and
treatment
3. History of Chemical Agents
Dentifrices and mouth rinses; since
4000 B.C.: animal products,
abrasive, acidic, herbal, arsenic,
mercury, sulfuric acid, carbolic acid,
formaldehyde.
Recently, more specific antimicrobial
agents; with the recognition of the
microbial etiology of period. disease:
Antiseptics
4. Prevention
Rationale for the chemical supragingival
plaque control:
• Prevention of occurrence or recurrence of
gingivitis and periodontitis is dependent on
supragingival plaque control
• Mechanical plaque control is dependent on
the compliance and dexterity of the
individual
• Chemical plaque control is useful to
overcome the inadequacies of mechanical
control
5. 2.
Antimicrobial
4. Alter Pathogenicity
Chemical Plaque Control
Plaque formation: a dynamic and
well ordered process
Bacterial attachment & proliferation
TOOTH
Gram +ve
Aerobic, simple
Gram -ve
Anaerobic, complex
Plaque age
1.
Antiadhesive
3.
Plaque
removal
6. Chemical agents and vehicles
More effective in prevention of new plaque
formation and gingivitis
Most effective of antiseptics are those showing
“persistence of action in the mouth measured
in hours”; Substantivity, dependent on:
• Prolonged retention on oral surfaces by adsorption
• Maintenance of antimicrobial activity once adsorbed
• Minimal and/or slow neutralization in oral
environment, or slow desorption from surfaces
7. Antibiotics
Enzymes
Bisbiguanide antiseptics
Quaternary ammonium compounds
Phenols and essential oils
Natural products
Fluorides
Metal Salts
Oxygenating agents
Detergents
Amine Alcohols
Other Products: Povidone iodine/Hexetidine
Chemical agents and vehicles
8. Enzymes
Plaque removal agents:
• Protease
• Lipase
• Nuclease
• Dextranase
• Mutanase
Agents to enhance host defense
system:
• Glucose Oxidase
• Amyloglucosidase
Both agents act as catalyst in the salivary
lactoperoxidase system; production of
hypothiocyanite
Poor substantivity
Side effects
9. Effective in preventing caries and
gingivitis or resolving gingivitis, BUT;
• Antibiotics should not be used either
topically or systemically as preventive
agents against these diseases
• Antibiotics in periodontal treatment; narrow
use.
• Risk-benefit is high;
Bio-film nature of plaque; effect is temporary
Infections in periodontal diseases are mostly
opportunistic; needs continues care
Development of resistant strains
Antibiotics
10. Bisbiguanide Antiseptics
Chlorhexidine;
• The most effective antiseptic for plaque
inhibition and prevention of gingivitis
• Used in number of vehicles and
available in commercial products
Other Bisbiguanides;
• Alexidine
• Octenidine
11. Quaternary ammonium compounds
Cetylpyridinium Chloride, Benzalconium chlordie
Rapid and good adsorption, but poor
substantivity;
• Lost of activity once adsorped
• Rapid desorption
Efficay can be increased by doubling the
frequency;
• Side effects will be increased
• Compliance will be reduced
12. Phenols and essential oils
Phenols: Triclosan;
• Moderate anti plaque effect. Enhanced by
addition of zinc citrate or a copolymer
(maleic acid)
• Anti-inflammatory effect; reduces
gingivitis
Essential oils used in combination with
cetylpyridinium
13. Group Example of Agent Action Used now/Product
Antibiotics Penicillin
Vancomycin
Kanamycin
Nidamycin
Spiromycin
Antimicrobial No
Enzymes Protease
Lipase
Nuclease
Dextranase
Mutanase
*Glucose Oxidase
*Amyloglucosidase
Plaque Removal
Antimicrobial
No
*Yes
Toothpaste
Bisbiguanide
antiseptics
*Chlorohexidine
Alexidine
Octenidine
Antimicrobial *Yes
Mouthrinse
Spray
Gel
Toothpaste
Chewing gum
Varnish
Quaternary
ammonium
compounds
*Cetylpyridinium
chloride
*Benzalconium cl.
Antimicrobial *Yes
Mouthrinse
14. Group Example of Agent Action Used now/product
Phenols and
Essential
oils
*Thymol
*Hexylresorcinol
*Ecalyptol
*+Triclosan
*Antimicrobial
+Anti-
inflammatory
*Yes
Mouthrinse
Toothpaste
Natural
products
*Sanguinarine Antimicrobial *Yes
Mouthrinse
Toothpaste
Flourides (*)Na Flouride
(*) Na mono-
flourophosphate
*+Stannous flouride
+Amine fluoride
*Antimicrobial
() minimal
+ Questionable
+*Yes
Toothpaste
Mouthrinse
+Gel
15. Group Example of Agent Action Used now/product
Metal Salts *Tin+
*Zinc
Copper
*Antimicrobial +*Yes
Toothpaste
Mouthrinse
+Gel
Oxygenating
agents
*Hydrogen peroxide
*Na peroxyborate
*Na
peroxycarbonate
Antimicrobial
Plaque
removal?
*Yes
Mouthrinse
Detergents *Na lauryl sulfate Antimicrobial
Plaque
removal?
*Yes
Toothpaste
Mouthrinse
Amine
Alcohols
Octapinol
Delmopinol
Plaque matrix
inhibition
No
16. Antiseptic agents
Effective agents must have high substantivity
Chlorhexidine is the most effective anti-
plaque agent to date
Stannous flouride and triclosan oral hygiene
products are now available with proven anti-
plaque activity
Combinations of agents may provide additive
or synergistic action
The amine alcohol delmopinol appears
affective bur products are not available
17. Vehicles
The substance which is used to carry the antiseptic
agent to the oral cavity;
• Solution; the simplest: mouthrinse, spray,
irrigator
• Gel, toothpaste, chewing gum, varnish or filling
material
Mouthrinse:
• Agent, plus:
• Flavoring, coloring, preservative, detergent
• Ethyl alcohol: as solvent, and to increase shelf
life; Precancerous?
Toothpaste; most practical and cost-effective
method for chemical plaque control:
• Abrasives, Detergents, Thickeners, Sweeteners,
Humecntants, Flavors, Actives
Spray: used with chlorhexidine; reduces side
effects, specially useful in handicapped
18. Chlorhexidine
Bisbiguanide antiseptic
Three forms of salts;
• Hydrochloride
• Acetate
• Digluconate
1940s as skin disinfectant
Latter used in medicine and surgery, for patients
and suregons
Dentistry; presurgery and endodontics
As plaque inhibitory first introduced by Shroeder
1969, and more definitly by Loe and Schiott 1970;
• 0.2% chx digluconate solution, 10 ml, for one
minute
Most oral formulations
19. Chlorhexidine
Cationtic guanide antiseptic
Strong base (positively charged);
extremely reactive with anions
(negatively charged)
• Relates to efficacy, safety, side effects
as well as difficulties with formations in
products
20. General side effects
Systemic toxicity; rare, due to
decreased absorption through skin and
membranes
Hypersensitivity, rare, not oral
Neurosensory effect if introduced into
mid. Ear
Broad antibacterial , antifungal and
antiviral effects;
• No resistant strains
• No superinfection by fungi or viras
21. Oral side effects
Brown discoloration of teeth, restorations and
tongue;
• Ppt of anionic dietary chromogens
Bitter taste; difficult to mask
Taste disturbance
Mucosal erosion; less common
Parotid swelling, exteremly rare
All side effects are temporary
22.
23. Mechanism of Action
Potent antimicrobial; binds strongly
to bacterial cell;
• Bacteriostatic action; in low conc.
• Bacteriocidial; in high conc.
Mouth;
• binds to surfaces, esp pellicle coated
tooth surface
• Persistent bacteriostatic action
• Slow relaese; prolonged action: 12 hrs
