This document provides information on dental plaque and methods for plaque control, including mechanical and chemical approaches. It discusses various chemical agents used for plaque control, including chlorhexidine, essential oils, quaternary ammonium compounds, triclosan, sanguinarine, propolis, stannous fluoride, and pre-brushing rinses. It provides details on the classification, mechanisms of action, effectiveness, and examples of various chemical plaque control agents. The document emphasizes that removal of dental plaque is key to preventing periodontal disease.

1. Name : Rishi lakdawala
Roll no: 18
Department of pedodontics
Batch c
Date : 21-02-2022

2. • Definition of plaque
• Classification
• Chlorhexidine
• Essential oils
• Quaternary ammonium compounds
• Triclosan
• Sanguinarine
• Propoile
• Stannous fluoride
• Prebrushing rinse
• Mouth-washes used in pedodontics

3. • WHO(1978) defined bacterial dental plaque as a specific but highly variable
structural entity resulting from colonisation and growth of microorganisms
consisting of various species and strains embedded on an extracellular matrix.
• Dental plaque has also been defined as the non mineralised microbial
accumulatatiom that adheres tenaciously to tooth surfaces, restorations and
prosthetic appliances shows structural organisation with predominance of
filamentous form and is composed of an organic matrix derived from salivary
glycoproteins and extracellular microbial products and cannot be removed by
rinsing or water spray

4. Mechanical plaque control Chemical plaque control
Denitrifies Mouthwash
Tooth brush Chlorhexidine
Dental floss Other compounds
Oral irrigation
Interdental cleaning aids

5. • Plaque control : is the removal of plaque and the prevention of its
accumulation on thr teeth and adjacent gingival surfaces
• Plaque control is the key to prevention and successful treatment of periodontal
disease
• Removal of microbial plaque leads to resolution of gingival inflammation in its
early stages and cessation of plaque control measures leads to its recurrence.
• Plaque control is accomplished by professional plaque removal and by patient
performing oral hygiene practice for both.

6. Classification of chemotherapeutic plaque removal agents
BIGUANIDES AND RELATED COMPOUNDS
*Chlorhexidine
*Alhexidine
FLOURIDE AND INORGANIC IONS
*Stannous fluoride
*hydrodgen peroxide
QUATERNARY AMMONIUM COMPOUNDS
*cetylpyridinum
ANTIBIOTICS
*penicillin
*metronidazole
ENZYMES
*dextranase
*glucose-amyloglucosidase
ORGANIC COMPOUNDS
*sanguinarine
*menthol/thymol

7. • Dental profession has used cholrhexidine over 2 decades.
• Recognized as primary agent in chemical plaque control and is well known for
its clinical efficacy.
• Chlorhexidine has also been recognised by Pharma industry as a positive test
control against which the efficacy of alternative plaque controlling agents
should be measured.

8. • It is a cationic bisguanide with
• 1)broad spectrum antibacterial activity
• 2)low mammalian toxicity
• 3)strong affinity for binding to skin and mucous membranes
• Chlorhexidine has a wide spectrum of activity including gram positive, gram
negative bacteria, yeasts, dermatophytes, and some lipophilic viruses.
• Action: low concentration = bacteriostatic
• High concentration = bactericidial

11. • chlorhexidine(0.12% - 0.2%) binds to the different surfaces within mouth (teeth
and mucosa) and also to the pellicle of saliva.
• After a single rinse with chlorhexidine the saliva itself exhibits the antibacterial
property for upto 5h, whereas the persistence at the oral surfaces has been
shown for over 12h

12. • incfluence on pellicle by blocking the acidic groups on the salivary glycoprotein,
thus reducing the protein adsorption to the tooth surface
• Influence on adsorption of plaque onto the tooth surface by binding to the
bacterial surface in sublethal amounts.
• Key features = substantivity
• Substantivity is the ability of an agent to be retained in the oral cavity and
slowly released in its active form over an extended period of time.
• An influence on formation of plaque by precipitating the agglutination factors in
saliva and displacing calcium form plaque matrix.

13. • Yellowish staining of teeth.
• Alteration in taste.
• Example : 1)rexiding plus
mouthwash(124.60/-)
• 2) dr reddys chlohex ad(164/-)

14. • These are the oldest form of
mouthwashes.
• Most popular = listerine
• Composition = phenol related
essential oils + thymol +
eucalyptus mixed with methanol
+ methyl salicylate

15. • It is by disrupting the cell wall and inhibition of bacterial enzymes

16. • Goodson (1985) has pointed out that most phenolic compounds have anti-inflammatory activity
and prostaglandin synthesise inhibitor activity.
• Phenolic compounds are also known as scavengers of oxygen free radicals and should have an
effect on leucocyte activity
• It has shown effectiveness in plaque reduction in the range of 20-30%
• Gingivitis reduction 28-34%
• Disadvantages : initial burning sensation and bitter taste.
• Example : listerine (150/- for 250ml)

17. • Most commonly used = cetylpyridinium chloride at conc. Of 0.05%.
• Cationic and binds to the oral tissues, but not as strongly as bisguanides
• When used orally, binds strongly to plaque and tooth surface but are released
from these binding sites more rapidly than chlorhexidine.
• MOA = related to their ability to rupture cell wall and alter the cytoplasmic
contents.

18. • Adverse effects : yellow
brownish discoloration of the
tongue and strong gingival
margin of the tooth.
• Commercial names :
cepacol(0.05%) (2400/- for
710ml)

19. • Example : scope (0.45%)(2200/-
for 33.3 0z)

20. • Trichloro-2-hydroxydiphenyl ether
• Available in dentrifices and mouth rinses
• It is both a bisphenol and a non ionic germicide with low toxicity.
• Broad spectrum anti-bacterial activity and lack the staining effects of cationic agents.
• Since it doesnot bind well to the oral sites due to its lack of a strong positive charge ions,
therefore, it is used in combination with zinc citrate take advantage of it’s potential
antibacterial property; copolymer of methoxyethylene and maleic acid to increase its
retention time, and combination with pyrophosphates to enhance its calculus reducing
property.

21. • Acts = anti-inflammatory agent in
mouth rinse
• Inhibit = both cyclooxygenase and
lipooxygenase and thus synthesis of
prostaglandins and leukotrien which
are key mediators in inflammation.
• Example : 1)rexiding plus
mouthwash(124.60/-)

22. • Currently used in both mouth rinse and toothpaste
• It is an alkaloid extract from the blood root plant- sanguinaria canadenasis
• Contents = extracts 0.03% (equivalent to 0.01% sanguinarie & 0.2% zinc-
chloride )
• 17-42% plaque reduction
• 18-57% gingivitis reduction
• Adverse effects= burning sensation when used initially

23. • Naturally occurring bee product
used by bees to seal opening on
their hives.
• Consist of wax , plant extracts ans
contents flavones , flavonols.
• It has been shown that it has very
low level of clinical effectiveness but
significant plaque reduction
• Example : miracle propolis
mouthwash (26.61$ for 16oz)

24. • Actions = decreasing the solubility of enamel to
bacterial acids + enhance mineralization +
secondary benefits of inhibiting microbial plaque
accumulation
• MOA= interference with bacterial biochemical
synthesis +metabolism + aggregation
• Most effective = 0.04% concentration
• Available as aqueous gel and suggested uses
for 1-2 times daily.
• Example :3m ESPE periomed(0.63% SF)
• Element(perio maintenance rinse)(0.63% SF)

25. • PLAX is the only available agent
• Chemical composition =sodium
benzoate when combined with a
soapy agent it may have a
surfactant action on plaque
• Not approved by ADA
• Example : plax advanced pre
brush rinse (3900/- for 24 ounce)

26. The American Dental Association recommends that children under 6 years of age should completely refrain from using mouthwash. Young children
may not have developed the fine motor control and muscle reflexes necessary to properly spit out mouthwash, and children under 6 are very likely to
swallow it.
It's rarely advisable for kids under the age of 6 to use mouthwash. There are two reasons for this:
1) Too much exposure to fluoride (contained in most mouth rinses) while permanent teeth are still developing can create a condition called fluorosis.
2)Fluorosis creates unsightly spots or streaks on the teeth.
Crest kids anti cavity fluoride rinse .(460/- for 500ml)
Act kids anti cavity mouthwash . (2254/- for 16oz)
Kidodent mouthwash (SODIUM FLUORIDE+TRICLOSAN+XYLITOL )
*Sodium fluoride prevents cavities/decay by making the enamel resistant to the action of acids and bacteria.
Xylitol helps in reducing the number of decay-causing bacteria in the mouth.
Triclosan kills the micro-organisms by damaging their outer coverin

27. Suggested use
• Adults and children 6 years & older: Use twice a day after brushing your teeth with a toothpaste.
• Vigorously swish the 10 ml (2 teaspoonfuls) of rinse between your teeth for 1 minute and then spit
out.
• Do not swallow the rinse.
• Do not eat or drink for 30 minutes after rinsing.
• : sodium fluoride 0.02%(0.01 w/v fluoride ion)
• : Water, propylene glycol, polysorbate 80, benzoic acid, flavor, sucralose, sodium
benzoate, phosphoric acid, disodium phosphate, red 33.