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![TOOTHPASTE
A dentifrice is a substance used with a tooth brush for
purpose of cleaning the accessible surface of teeth and
removing dental plaque, materia alba and food debris
Basically, used for applying specific agents to tooth
surface for preventive or therapeutic purposes
It is derived from dens= [tooth]
Fricare= [to rub] (WEBSTER’S)](https://image.slidesharecdn.com/chemical-plaque-control1-210128040929/85/Chemical-Plaque-Control-15-320.jpg)
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Chemical Plaque Control
- 1.
- 3. INDEX 1.Classification 2. Vehicles fordelivery of chemical agents • Toothpastes • Sprays • Irrigators • Chewing gums • Mouthwashes (Listerine, Chlorhexidine, Triclosan, Fluorides, Hydrogen peroxides, Povidone iodine)
- 4. PROPERTIESOF IDEALANTIPLAQUE AGENTS(BRAL AND BROWNSTEIN1988) Eliminate pathogenic bacteria only Prevent development of resistant bacteria Exhibit Substantivity Safe to oral tissues Significantly reduce plaque and calculus Should not stain teeth or alter taste Inexpensive Easy to use No adverse effects on teeth or dental materials
- 5.
- 6. I. CLASSIFICATION BY (LINDHE1983) FIRST GENERATION AGENTS • Poor substantivity and thus used 4-6 times daily. • Reduces plaque score by 20-50% Examples: • Antibiotics - Penicillin - Erythromycin - Metronidazole
- 8. SECOND GENERATION AGENTS •Reduce plaque score by 70-90% • Used twice daily Example: • Bisbiguanides -Chlorhexidine -Alexidine • Bispyridines -Octenidine
- 9. THIRD GENERATION AGENTS •Effective against specific periodontal pathogens Example: Delmopinol
- 10. II. CHEMICAL ANTIPLAQUE AGENTS •Antibiotics: Penicillin, Vancomycin, Kanamycin • Bisbiguanide antiseptics: Chlorhexidine, alexidine, Octenide • Phenols and essential oils: Thymol, Triclosan, Hexylresorcinol • Natural products: Sanguinarine • Quarternary ammonium compounds: Cetylpyridinium chloride
- 11. • Oxygenating agents:hydrogen peroxide, sodium perborate, sodium peroxycarbonate • Detergents: sodium lauryl sulphate • Enzymes: protease, lipase, dextranase, mutanase- glucose oxidase • Amine alcohol: octapinol, delmopinol • Metal salts: tin, zinc, copper • Fluorides: Sodium fluoride, Stannous fluoride, Amine fluoride.
- 12. III. ACCORDING TOACTION OF ANTIPLAQUE AGENT— MANDEL IN 1988 • ANTIADHESIVE • ANTIMICROBIAL • PLAQUE REMOVAL • ANTIPATHOGENIC • ENZYMES
- 13.
- 14. VEHICLES FOR DELIVERYOF CHEMICAL AGENTS • TOOTHPASTE • SPRAY • IRRIGATORS • CHEWING GUM • VARNISHES • MOUTHRINSES
- 15. TOOTHPASTE A dentifrice isa substance used with a tooth brush for purpose of cleaning the accessible surface of teeth and removing dental plaque, materia alba and food debris Basically, used for applying specific agents to tooth surface for preventive or therapeutic purposes It is derived from dens= [tooth] Fricare= [to rub] (WEBSTER’S)
- 16. WHY BRUSHING WITHTOOTHPASTE IS IMPORTANT ?? Remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes caries, gum disease, and eventual tooth loss if not controlled. Fluoride makes the entire tooth structure more resistant to decay and promotes remineralization , which aids in repairing early decay before the damage can even be seen. Special ingredients in the dentifrice help to clean and polish the teeth and remove stains over time. Toothpastes help freshen breath and leave your mouth with a clean feeling.
- 17. COMPOSITION 1. Polishing/ abrasiveagents • Ca carbonate • Dicalcium phosphate dihydrate • Alumina • Silica Functions Mild abrasive action aids in illuminating plaque Removes stained pellicle, restores natural luster, enhances enamel whiteness
- 18. 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
- 19. 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
- 20. 6. Sweeteners andcolouring agents 7. Antibacterial agents 8. Anti bacterial agents • Triclosan, delmopinol, metallic ions & Zn-citrate trihydrate 9. Anticaries agents • Na fluoride, stannous fluoride 10. Active agents-fluoride 11. Anticalculus agents(crystal growth inhibitors) • Pyrophosphate, Zn citrate, Zn chloride 12. Desensitizing agents • Sodium fluoride, potassium nitrate
- 21. • Anti-Caries /Cavity Protection • Plaque & Gingivitis Prevention • Tooth Whitening • Sensitivity • Tartar Control • Fresh Breath • For Children THE DIFFERENT TYPES OF TOOTHPAS
- 22. Colgate Cavity Protection •contains Sodium monofluorophosphate as the active ingredient. Colgate Simply White • A whitening toothpaste that is "Clinically-proven to whiten in 14 days". Its whitening ingredient is hydrogen peroxide, which gradually bleaches the teeth. It utilizes two separate chambers that contain a whitening agent and a cleaning gel.
- 23. SPRAYS • Sprays havethe advantage of focusing delivery on the required site. • The dose is clearly reduced and for antiseptics such as chlorhexidine, this has taste advantages. • When correctly applied chlorhexidine sprays were as effective as mouthrinses for plaque inhibition although there was no reduction in staining (Francis et al. 1987, Kalaga et al. 1989). Chlorhexidine sprays were found particularly useful for plaque control in physically and mentally handicapped groups
- 24. IRRIGATORS • Irrigators weredesigned to spray water, under pressure, around the teeth. As such they only removed debris, with little effect on plaque deposits. • Antiseptics and other chemical plaque control agents, such as chlorhexidine, have been added to the reservoir of such devices. • Waterpik cordless advanced water flosser available and can be used at home.
- 25. CHEWING GUMS • Thereappear to be significant benefits to dental health through the use of sugar-free chewing gum. • Unfortunately, chewing gums alone appear to have little in the way of plaque control benefits particularly at sites prone to gingivitis • Nonetheless, the vehicle has been used to deliver chemical agents such as chlorhexidine and, when used as an adjunct to normal toothbrushing, reduced plaque and gingivitis levels have been shown.
- 26. VARNISHES • Varnishes havebeen employed to deliver antiseptics including chlorhexidine, but the purpose has been to prevent root caries rather than as a reservoir for plaque control throughout the mouth
- 27.
- 28.
- 29. ANTIPLAQUE AGENTS ACCEPTED BYFDA FOR TREATMENT OF GINGIVITIS 1) CHLORHEXIDINE: Prescription drug 2) LISTERINE: Over the counter/Non prescription drug. • In September 1987, Listerine antiseptic mouthwash was the first non prescription product to be awarded the ADA council on Dental Therapeutic seal of acceptance as an aid in controlling supragingival dental plaque. • The mouthwash has been named in the honour of Dr. Joseph Lister, a pioneer in the field of antiseptic surgery.
- 30. COMPOSITION Ethanol-21.6% in flavouredproduct • 26.9% in original gold Listerine antiseptic Active ingredients: • Menthol- 0.042%- local anaesthetic • Thymol- 0.064%- antiseptic • Methyl salicylate-0.060%-cleaning agent • Eucalyptol-0.092%
- 31.
- 32. CHEMISTRY • Chlorhexidine isa bis-biguanide formula with cationic properties. • Effective against gram +ve, gram –ve organisms, fungi, yeasts and viruses. Exhibit antiplaque & antibacterial properties • The compound is a strong base and dicationic at pH levels above 3.5, with two positive charges on either side of a hexamethylene bridge. 3 Forms : Digluconate ; Acetate ; Hydrochloride
- 33. PHARMACOKINETICS Approximately 30% ofchlorhexidine is retained in the oral cavity following rinsing and is slowly released into the oral fluids. It is poorly absorbed from the GI tract. Detectable levels are not present in the plasma 12 hours after administration. Excretion occurs primarily through the feces (90%) and 1% is excreted in the urine.
- 34. MECHANISM OFACTION Antiplaque actionof 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
- 35. ANTI BACTERIAL ACTION •LOW CONC. – Bacteriostatic • HIGH CONC. – Bactericidal • PIN CUSHION EFFECT – one charge end interact with tooth and other remains available to initiate the interaction with bacterial membrane as microorganism approaches the tooth surface
- 36. Antibacterial action ofchlorhexidine 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
- 37. 2. Bacteriocidal action Increasedconcentration 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
- 38. SUBSTANTIVITY OF CHLORHEXIDINE •The ability of the drug to absorb onto and bind to hard and soft tissues is called substantivity. • Chlorhexidine is gold stranded mouthwash due to its substantivity of 12 hours, which is maximum among all mouthwashes. • Advocated twice daily.
- 39. TOXICOLOGY, SAFETY ANDSIDE EFFECTS • In oral use as a mouthrinse, chlorhexidine has been reported to have a number of local side effects These side effects are: 1. Brown discoloration of the teeth and some restorative materials and the dorsum of the tongue.
- 40.
- 41.
- 42. 2.Taste perturbation wherethe salt taste appears to be preferentially affected (Lang et al. 1988) to leave food and drinks with a rather bland taste. 3. Oral mucosal erosion . This appears to be an idiosyncratic reaction and concentration dependent. Dilution of the 0.2% formulation to 0.1%, but rinsing with the whole volume to maintain dose, usually alleviates the problem. Erosions are rarely seen with 0.12% rinse products used at 15 ml Volume.
- 43.
- 44. 4. Unilateral orbilateral parotid swelling . This is an extremely rare occurrence and an explanation is not available. 5. Chlorhexidine also has a bitter taste, which is difficult to mask completely. 6. Increase calculus levels • dead bacteria accumulates on the tooth surfaces, acting as sites for calculus deposition • Also dead bacteria release pyrophosphatase leading to decreased natural pyrophosphate levels
- 45. CHLORHEXIDINE STAINING • Themechanisms proposed for chlorhexidine staining can be debated (Eriksen et al. 1985, Addy & Moran1995, Watts & Addy 2001) but have been proposed as: 1.Degradation of the chlorhexidine molecule to release parachloraniline (Addy & Roberts 1981). 2.Catalysis of Maillard reactions (Nordbo 1979). 3.Protein denaturation with metal sulfide formation (Ellingson et al 1982). 4.Precipitation of anionic dietary chromogens. (Addy & Moran 1995).
- 46. SHORT -TERM APPLICATIONS Healingphase in periodontal therapy Healing phase in oral surgery : mandibular fractures , third molar extractions , immediate denture Presurgical use to reduce bacteremia Therapy for apthous ulceration Therapy for denture stomatitis Therapy for acute necrotizing ulcerative gingivitis
- 47. INTERMITTENT SHORT TERMAPPLICATION (3 TO 4 MONTHS CYCLE ) Repeated denture stomatitis Adjunct to periodontal maintenanc e care High caries level Dental implant s
- 48. LONG TERM APPLICATION Medicallycompromised patients (Agranulocytosis, leukemia, hemophilia, thrombocytopenia, kidney disease, allergies, bone marrow transplant, AIDS). Iatrogeniic risk patients (immunosuppressive agents, radiation therapy Physically handicapped patients ( Arthritis, scleroderma, disturbed motor capacity or muscle function) Mentally handicapped patients.
- 49.
- 50. QUATERNARY AMMONIUM COMPOUNDS • Cetylpyridiniumchloride - concentration of 0.05%. • At oral pH these antiseptics are monocationic and adsorb readily and quantitatively, to a greater extent, than chlorhexidine to oral surfaces. • The substantivity of cetylpyridinium chloride appears to be only 3-5 hours either due to loss of activity once adsorbed or rapid desorption…..Roberts & Addy 1981.
- 51. COMMERCIAL PRODUCTS • cetylpyrinidiumchloride (Cepacol .05%) • cetylpyrinidium chloride with domiphen bromide (Scope) • benzethonium chloride (Colgate 100).
- 52.
- 53. PHENOLS AND ESSENTIALOILS- TRICLOSAN • Phenol derivative • Synthetic, non-ionic topical antimicrobial agent. • Colorless, crystalline, readily soluble in some organic solvents (Zinkernagel & Koenig 1967). • Broad spectrum of action (Diamant 1976). • Available as toothpaste and mouthrinses. • In simple solutions, at relatively high concentrations (0.2%) and dose (20 mg twice per day), triclosan has moderate plaque inhibitory action and antimicrobial substantivity of around 5 hours.
- 54. MECHANISM OF ACTION •Acts on the microbial cytoplasmic membrane, inducing leakage of cellular constituents…..bacteriolysis (Regos & Hitz 1974).
- 55. Three strategies havebeen developed to enhance the clinical effectiveness of oral triclosan products:
- 56. • combine itwith zinc citrate to take advantage of the potential anti-plaque and anti-calculus properties of the latter, • incorporate triclosan in a copolymer of methoxyethylene and maleic acid to increase its retention time; and • combine it with pyrophosphates to enhance its calculus reducing properties.
- 57. • Significant reductionin plaque, gingivitis, and calculus have also been found with a dentifrice containing 3% triclosan and 2% of the copolymer of methoxyethylene and maleic acid. TRICLOSAN CONTAINING TOOTHPASTE • Colgate total, Anchor, Sensodyne, Crest cavity protection TRICLOSAN CONTAINING MOUTHRINSE • Plax
- 58.
- 59. FLUORIDES • The cariespreventive benefits for a number of fluoride salts are well established but the fluoride ion has no effect against the development of plaque and gingivitis. • Amine fluoride and stannous fluoride provide some plaque inhibitory activity and antigingivitis action but not comparable to CHX….Brecx et al 1990, 1992. Interfere with enzyme activity & reduce acid production…Marsh 1988, Hamilton 1990, Shani 2000.
- 60. • Side effectof fluoride rinse included slight staining which can be easy to remove, as in the case of stannous fluoride in Gel Kam (anti- hypersensitivity agent).
- 61.
- 62. OXYGENATING AGENTS • Oxygenatingagents have been used as disinfectants in various disciplines of dentistry, including endodontics and periodontics. • Hydrogen peroxide (Wade et al.1966). • Peroxyborate may be used in the treatment of acute ulcerative gingivitis.
- 63. MECHANISM OF ACTION •The mechanism of action are the ability to altered membrane permeability. Hydrogen peroxide breaks down to form oxygen and hydrogen. • When applied to tissue, protective enzyme such as peroxidase and catalase act on the material, causing rapid decomposition with resulting effervescence.
- 64. INDICATIONS INDICATED IN ANAEROBICINFECTIONS: • Pericoronitis • ANUG • Staining of teeth
- 65. SIDE EFFECTS • Branemarkand Ekhol studied the effect of 3% hydrogen peroxide , showed that increase degree of the injury to damage tissue, thus delayed wound healing. • Hydrogen peroxide also may cause soft tissue lesion in high dose in animal studies, hairy tongue, and also overgrowth of opportunistic microbial organism such as Candida Albicans. • Emphysema due to bubble formation.
- 66.
- 67. POVIDONE IODINE HISTORY • In1811 Bernard Courtois, a chemist, discovered the natural element iodine and in 1880, Devaine described its bactericidal efficacy. Spectrum and Mechanism of Microbial Destruction • PVP-I is microbicidal for Gram-positive and negative bacteria, fungi, mycobacteria, viruses, and protozoans. • Its bacterial activity is due to oxidation of amino (NH−), thiol (SH−), and phenolic hydroxy(OH−) groups in amino acids and nucleotides. • PVP-I also reacts strongly with double bonds of unsaturated fatty acids in cell walls and organelle
- 68. Schreier et al.reported that electron microscopic and biochemical assessments supported the contention that PVP-I interacted with cell walls, causing a transient or permanent pore formation. This resulted in loss of cytoplasmic material and deactivation of enzymes due to direct contact with iodine.
- 69. Use of PVP-1for reduction of salivary bacteria and prevention of transient bacteremia. Provide better results than chlorhexidine in-(INDICATIONS) Preprocedural rinse Subgingival irrigation as, spectrum of antimicrobial activity is broader for povidone iodine than chlorhexidine.
- 70. PVP-I used asa preprocedural rinse, considered better than chlorhexidine: • The greatest decrease of streptococci was attained when PVP-I was diluted 1/1, creating a 5% concentration and applied for 30 seconds. (action is better in diluted form) • When PVP-I (5%) was compared to chlorhexidine (0.2%), the PVP-I achieved a 2 to 3 log decrease of streptococci, whereas the chlorhexidine achieved only 1.5 log reduction. • The data indicated that the amount of bacteria in saliva can be reduced almost 33% by rinsing with PVP-I (5%) for 30 seconds prior to dental procedures.
- 71. • Furthermore, thedecrease found within 5 minutes did not rebound to baseline after 90 minutes. • The author suggested, but did not verify, that pre-rinsing with PVP-I would reduce the amount of bacteria in aerosols generated after using an ultrasonic scaler or high-speed handpiece.
- 72. SIDE EFFECTS • Stainingof teeth. • Staining of the tongue • PVP-I should not be used in individuals who are allergic to iodine. • Its use is contraindicated in pregnant women and nursing mothers ,because it can induce thyroid dysfunction due to excessive incorporation of iodine.
Editor's Notes
- #33 Chemistry Chlorhexidine gluconate, a cationic bisbiguanide, is a topical anti-infective agent.1 2 5 The drug is a salt of chlorhexidine and glucuronic acid.1 2 Chlorhexidine is practically insoluble in water, but the gluconate salt is very soluble in water4 5 and soluble in alcohol.5 Chlorhexidine gluconate cannot be isolated as a solid and occurs as a colorless to pale yellow solution4 5 that is odorless and has a very bitter taste.5 Vantocil is a heterodisperse mixture of polyhexamethylene biguanides (PHMB) with a molecular weight of approximately 3,000. Polymeric biguanides have found use as general disinfecting agents in the food industry and, very successfully, for the disinfection of swimming pools. Vantocil is active against gram-positive and gram-negative bacteria, although P. aeruginosa and Proteus vulgaris are less sensitive. Vantocil is not sporicidal. PHMB is a membrane-active agent that also impairs the integrity of the outer membrane of gram-negative bacteria, although the membrane may also act as a permeability barrier . Its salts for commercial uses include: Chlorhexidine diacetate Chlorhexidine dihydrochloride Chlorhexidine digluconate Chlorhexidine phosphanilate Chlorhexidine Gluconate Solution Molecular formula:C22H30CL2N10·2C6H12O7 Molecular Weight:897.77 Specification:(Quality Standard:CP2000,JP13,USP25,EP4) Appearance Clear, colourless to pale yellow solution . Content 19-21% . PH-value 5.5-7.0 p-Chloroaniline content 100PPMmax Density 1.060-1.070 Usage: bactericide, strong function of broad-spectrum bacteriostasis, sterilization, used for disinfecting hands, skin, washing wound. as a safe antiseptic or disinfectant to apply to prevent body infection and in oral rinses for sore gums,mouth ,ulcers , preventing plaque on teeth. Package: 25, 200kgs drum to be packed by iron barrel with plastic coating inside.