Successfully reported this slideshow.

Class dental pharmacology 2

30

Share

Upcoming SlideShare
Chemical Plaque Control
Chemical Plaque Control
Loading in …3
×
1 of 36
1 of 36

More Related Content

Related Books

Free with a 14 day trial from Scribd

See all

Related Audiobooks

Free with a 14 day trial from Scribd

See all

Class dental pharmacology 2

  1. 1. Dr. RAGHU PRASADA M S MBBS,MD ASSISTANT PROFESSOR DEPT. OF PHARMACOLOGY SSIMS & RC.
  2. 2. Agents or mechanical aids meant for cleanse and polish natural teeth. Maximum cleansing efficiency with minimum tooth abrasion. Properties of an Ideal Dentifrice –assist the toothbrush to mechanically remove debris, soft deposits and stains –impart a polished surface –Non-poisonous to the body –pleasant taste, odour, sufficient cleansing property –reduce caries and mouth odour, healthy gingiva, improve aesthetics
  3. 3. Abrasive agents –fine dental preparations, help the scouring action –abrasion -wearing away of a substance or structure through a mechanical process, such as grinding, rubbing or scrapping –three categories. Finishing abrasives hard, coarse abrasives to develop contour and remove gross irregularities. Coarse stones. Polishing abrasives Fine particle size and less hard smoothening the surfaces that have been roughened by coarse stones, pumice, polishing cakes Cleansing abrasives Soft materials with small particle size remove soft deposits that adhere to enamel or restorative material.
  4. 4. Humectants keep paste from drying out glycerine, sorbitol, propylene glycol Detergents and foaming agents cleansing agents and decreases surface tension of dentifrice. loosening of debris which adhere to teeth and also dissolving fatty substances and mucous plaques sodium lauryl sulfate. Binders –Carboxy methyl cellulose Sweetening agents –Artificial sweeteners such as sorbitol saccharin –More palatable having no food value –diabetics
  5. 5. Aqueous concentrated solutions containing one or more active ingredients and excipients meant for cleansing and deodorising the oral cavity. They contain astringents, antiseptics obtundents, flavouring and sweetening agents. Swishing the liquid in the oral cavity using 15–30 ml for about a minute Antiseptic and astringent mouth wash- for soreness under dentures. They harden the mucous membrane Obtundent mouth wash- for sensitive oral lesions Detergent mouth wash- for cleansing and deodorising action
  6. 6. Therapeutic use –reduce plaque, dental caries, gingivitis, stomatitis Cosmetic purpose –bad breath and it contains used antimicrobial and/or flavoring agent Soreness under dentures Halitosis Surgical impaction
  7. 7. Astringents are agents which precipitate superficial proteins when applied to the skin or mucous membrane Diminish the excretion or exudation of superficial cells also used as local haemostatics and mummifying agents TANNIC ACID –Vegetable –nutgalls –forms pellicle while hardening the superficial cells –Used as astringent mouth wash, 1-5% Astringent dentrifices, local haemostatics, mummifying agent obtundent
  8. 8. Catechu –another vegetative astringent ZINC CHLORIDE Caustic 5-10% sol ulcerative gingivitis, pyorrhoeal pockets and apthous ulcers ZINC SULPHATE 0.5-1% con, Mouthwash lotion in mastoiditis, stomatitis and chronic alveolar abscess COPPER SULPHATE 0.5-2% concentration indolent ulcer of gums ALUM -1-2% concentration, astringent, antiseptic and haemostatic properties. Harden the gum or for inflamed and ulcerated gums
  9. 9. These are the agents that decrease the dentine sensitivity They are used to make the excavation painless They act by one of the fallowing mechanisms Paralyzing sensory nerves-phenol, menthol, thymol, clove oil Camphor benzyl alcohol Precipitating proteins- astringents like silver nitrate, zinc oxide and zinc chloride Destruction of nervous tissue Disadvantages with use of obtundants Pulp may shrink Irritants may stimulate the formation of secondary dentine Use of obtundents has declined after use of local anaesthesia
  10. 10. ETHYL ALCOHOL (70%) painless and non toxic to the pulp penetrates rapidly applied locally, allow the alcohol to evaporate PHENOL Irritation followed by numbness alone and in combination with chloroform + olive oil in a 2:4:10 Acts rapidly but does not penetrate deeply protoplasmic poisonous nature CREOSOTE same as that of phenol, in addition its penetrability is relatively more
  11. 11. harden and dry tissues of the pulp and root canal so that the tissues are resistant to infection. Dental procedures -not possible to completely remove the pulp form of paste or semi-liquid preparation PARAFORM (PARAFORMALDEHYDE) combination of zinc oxide or zinc sulphate, Glycerine and creosote slow liberation of formaldehyde S/E penetrate the pulp and can cause inflammation form of paste with local anaesthetic. IODOFORM slow liberation of iodine antiseptic and local pain relieving properties Supplied as paste which contains tannic acid, phenol, eugenol(clove oil), cinnamon oil and glycerine
  12. 12. A dye used in dentistry as a diagnostic acid -reveal the presence of dental plague. self-examination for dental plaque harmless vegetable dye -bright red Disclosing tablets- Erythrosin tablets Disclosing solution- Fluorescein dyes-viewed under special light iodine containing solutions Disclosing swabs.
  13. 13. Antiseptics are drugs that are applied on the body surfaces to prevent infection by killing or inhibiting the growth of pathogenic bacteria either by oxidation of bacterial protoplasm or denaturation of bacterial proteins including enzymes Amongst the various types of antiseptics available, chlorhexidine a biguanide, is one of the most commonly used. DISINFECTANTS –are those germicides or chemical substances which are used to destroy or inhibit the growth of pathogenic vegetative bacteria (not their spores) on inanimate (nonliving )surfaces such such as glassware or surgical instruments Ex. Formaldehyde, phenols, ethyl alcohol, soaps
  14. 14. These are Zn -ions and Cu -ions. It acts by reducing the glycolytic activity in bacteria and hence delays bacterial growth. Quaternary Ammonium Compounds: These are Benzathonium Chloride, Benzallenium Chloride and Cetyl pyredinum. These are cationic antiseptics and surface active agents which are effective against gram +ve organisms. Mechanism of action: Positively charged molecule reacts with negatively charged cell membrane phosphates and thereby disrupting the bacterial cell wall structure. The side effects  staining and enhanced calculus formation  it also causes burning sensation and desquamation.
  15. 15. Bacteriostatic and bactericidal actions. Thymol, menthol, Eugenol, benzoic acid boric acid, calcium and Megnesium peroxide Thymol is a powerful antiseptic and de-odourant Coloring and flavoring agents –(methylene blue (0.001%), magenta (0.05%) flavoring agents (peppermint, clove) –attractive, palatable and acceptable. Preservatives-–preserve the quality and stability –Methyl paraben
  16. 16. Sialogogues are the agents which enhance salivary secretions. They activate muscarinic cholinergic receptors of the parasympathetic nervous system to increase salivary flow. All commercially available preparations have a limited duration of action, making frequent application necessary. Pilocarpine- is regularly used Cevimeline is newly introduced drug enhances salivary secretions by directly stimulating the muscarinic receptors They are used to treat sialadinitis that may be seen sialolithiasis Xerostomia often seen after radiotherapy of head and neck Sjogren’s syndrome cevimeline is used
  17. 17. These are substances that reduces salivary secretions Propanthaline bromide an atropine substitute is commonly used Sialocele –an antisialogogue used to suppress glandular function during healing or to encourage spontaneous resolution of the sialocele. Post surgical- an antisialogogue is used for a short period following surgeries of salivary gland and ducts In post traumatic parotid fistulas and sialiceles Trauma to the salivary gland and salivary ducts
  18. 18. Plaque is the soft non mineralised bacterial deposit formed on inadequately cleaned teeth All plaques should be removed quickly virulent micro organism of plaque flora streptococcus mutans, streptococcus sobrinus are associated with pathogenesis of caries. Scaling is done to remove plaque. Anti-bacterial agents pencillins, tetracyclines, erythromycin are effective in controlling plaque. Vancomycin, bacitracin, kanamycin and polymyxin B are topical mouth rinses Controlled delivery systems- tetracylines
  19. 19. Phenols (Triclosan): It’s a non ionic bisphenol derivative and a germicide used in toothpaste and dental preparations. A topical antimicrobial agent with a broad spectrum of action including against both gram -ve and gram +ve bacteria. It also has specific action against mycobacterium and candida species. Mechanism of Action: Triclosan acts on cytoplasmic membrane and induce leakage of cellular contents which leads to bacteriolysis and Cell death. Triclosan is inducted in toothpaste to prevent plaque formation. It is used along with zinc citrate or its polymer gantrez to enhance its retention in the oral cavity. It also inhibits prostaglandins and leukotrienes thereby it reduces the degree of inflammation.
  20. 20. Bisbiguanides posses anti plaque activity including Chlorhexidine, Alexidine and Octenidine. The antiplaque properties of chlorhexidine are unsurpassed by other agents. It has much greater and more prolonged effects than other antiseptics. The digluconate of chlorhexidine (1: 6 – Di 4 – chlorphenyl – diguanidohexane) is a synthetic antimicrobial drug which is effective in vitro against both gram positive and gram negative bacteria including aerobes, anaerobes, yeast and fungi
  21. 21. Prevents pellicle formation by blocking acidic groups of salivary glycoprotein’s thereby reducing glycoprotein adsorption on to tooth surface. Prevents adsorption of bacterial cell wall on tooth surface. Prevents binding of mature plaque Antibacterial action of Chlorhexidine consists of two actions, i.e., bacteriostatic at low concentration and bactericidal at high concentration. Bacteriostatic action at low concentration is mainly due to the negative energy of the bacterial cell wall reacts with positive energy chlorhexidine molecule. This alter the integrity of cell membrane and Chlorhexidine binds to inner membrane phospholipids and increases permeability. This leads to the vital elements leaks out resulting in bacterial cell death.
  22. 22. It is used as mouth rinses, gels in dentifrices for control of plaque and gingivitis Disinfectant of oral cavity Ulcerative gingivitis Following oral surgery and denture insertion Prophylactically in immunocompromised patients Fluorides- stannous fluoride mouth rinses -inhibit enzymatic reactions involved in glycolysis Oxygenating agents-like hydrogen peroxide sodium perborate act by liberating nacent oxygen is to suppress the bacterial growth (anaerobes)
  23. 23. Cetyl pyridium chloride Benzalkonium chloride, cetrimide Sanguinarine: Sanguinare chloride is currently used in both mouth rinses and toothpaste. It is an extract from blood root plant Sanguinare candensis. The alkaloid converted to active metabolite at low ph.it is used as antiplaque and antigingivitis mouth rinse or paste
  24. 24. It’s a combination of phenol related essential oil, thymol and methyl salicylate. It has shown to have moderate plaque inhibitory effect and antigingivitis effect. It has poor oral retention and has burning and bitter taste. Mechanism of Action: The action of phenol acid is cell wall disruption and inhibition of bacterial enzyme. The phenolic compound are also known to act as scavengers of oxygen free radical and hence has an effect on leucocyte activity
  25. 25. Steroids play a role in the modulation of the inflammatory reaction by inhibitory activity affecting the production of mRNA and thus protein synthesis. Application of topical steroid preparations provides temporary relief of symptoms associated with inflammation and ulcerated lesions in the oral cavity such as recurrent apthous stomatitis. These topical ointments include Triamcinolone acetonide 0.1% Hydrocortisone acetate 1% Betamethasone dipropionate 0.05%.
  26. 26. Topical use of steroids is usually well tolerated but some patients may develop a secondary erythematous candidiasis or pseudomembranous candidiasis (thrush) if predisposing conditions like xerostomia Systemic and/or topical use of antibiotics corticosteroid asthma inhalants prostheses and cigarette smoking are present in them. Even though clinical experience and laboratory studies have shown systemic absorption of steroids to be insignificant through the oral mucosa but caution should be exercised when used in patients  Diabetes Hypertension tuberculosis
  27. 27. Toothpaste is an excellent vehicle for delivering oral health benefits and hence many therapeutic agents are added. These include Anti caries agents Anti plaque agents Anti tartar agents Anti sensitivity agents. Therapeutic agents and their mechanism of action:
  28. 28. ANTI- 1. Fluoride: Fluoride is considered to be the most effective caries- inhibiting agent, and almost all toothpastes today contain fluoride in one form or the other. Most common form - sodium fluoride(NaF). Mono-fluoro-phosphate (MFP) Stannous fluoride (SnF) are also used. The fluoride amount in toothpaste is usually between 0.10- 0.15 %. Toothpastes are the main vehicle for fluoride.
  29. 29. Three main theories considering the positive action of fluoride in the prevention Of caries: It is claimed that fluoride, incorporated into the enamel during tooth development in the form of flurohydroxyapatite (FAP), reduces the solubility of the apatite . It is also suggested that fluoride has antibacterial actions. In an acidic environment, if fluoride is present, hydrogen fluoride (HF) is formed . Today the most important anti-caries effect is claimed to be due to the formation of calcium fluoride (CaF2) in plaque and on the enamel surface during and after rinsing or brushing with fluoride. CaF2 serves as a fluoride reservoir .
  30. 30. Xylitol is a sugar alcohol that cannot be fermented by oral microorganisms. It is considered to be a cariostatic agent since it can inhibit the carbohydrate metabolism in different oral microorganisms . The inhibitory effect on glycolysis has been related to the uptake of xylitol via a constitutive fructose specific PTS system and subsequent intracellular accumulation of xylitol-5- phosphate. Such a mechanism leads to reduced acid formation from glucose, and a reduction in the streptococcus mutans content in both plaque and saliva
  31. 31. Calcium and phosphate supplementation in a toothpaste will increase the concentration of these ions in the oral cavity. This has been reported to improve remineralization and increase fluoride uptake. 4.Sodium Bicarbonate: Several studies have shown that bicarbonate is one of the salivary components that potentially modifies the formation of caries. It increases the pH in saliva, and in this way creates a hostile environment for the growth of aciduric bacteria. Sodium bicarbonate can also change the virulence of the bacteria that cause tooth decay
  32. 32. Of the anti-calculus agents, the crystal growth inhibitors have been most extensively tested clinically. These agents act by delaying dental plaque calcification, thereby promoting plaque removal with normal tooth brushing 1.Pyrophosphate: Inhibit the formation of supragingival dental calculus. Added as tetrasodium pyrophosphate, tetrapotassium pyrophosphate or disodium pyrophosphate. It has been shown that pyrophosphate has high affinity to hydroxyapatite (HA) surfaces, probably by an interaction with Ca+ in the hydration layer, reduces their protein-binding capacity.
  33. 33. Gum paints are the combination of antiseptics and tanning agents which precipitate proteins but do not penetrate cells thereby affecting only the superficial layer making it mechanically stronger and decreases exudation. They have germicidal, fungicidal, anesthetic and healing properties. When applied, they provide a soothing, cooling and an astringent effect. All these preparations contain Choline salicylate, Tannic acid Cetrimide, Thymol Camphor, Cinnamon oil, Iodine Alum (hydrated potassium aluminumsulfate).

×