CONTENTS Plaque control Types of Plaque control Chemical Plaque Control Goals of Chemical Plaque Control Factors influencing effects of Chemical Plaque Control Types of Chemical Plaque Control 1. Chlorhexidine Gluconate 2. Non prescription Essential oil rinses 3. Other Plaque Control Agents a. Triclosan b. Delmopinol c. Metallic ions d. Quarternary Ammonium Compounds e. Enzymes f. Antibiotics Plaque control “The removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues”. TYPES Mechanical plaque control Chemical plaque control CHEMICAL PLAQUE CONTROL Chemical plaque control should always be regarded as needs-related supplement to and not a substitute for mechanical plaque control. Therefore, based on individual patients' predicted risk for oral disease, the choice of agent and frequency of use. Goals of Chemical Plaque Control 1. To prevent plaque formation 2. To control plaque formation 3. To reduce, disrupt or remove existing plaque 4. To alter composition of plaque flora 5. To exert bactericidal or bacteriostatic effects on micro flora implicated in caries and periodontal disease 6. To alter surface energy of the tooth, in turn, affecting the plaque adherence Factors Influencing Effects of Chemical Plaque Control 1. Substantivity 2. Penetrability 3. Selectivity 4. Solubility 5. Accessibility Ideal requisites of an Antiplaque agent Plaque and gingivitis Pathogenic bacteria Resistant bacteria Compatible Stains/ taste Retentive property Inexpensive and easy to use CHLORHEXIDINE GLUCONATE: Cationic bisbiguanide Both antiplaque and antibacterial properties Mechanism of action: Substantivity Bacteriostatic and bactericidal 5 hours – antibacterial, over 12 hours – bacterial count 80-90% reduction Inhibits plaque by: Preventing pellicle formation Preventing adsorption of bacterial cell wall Preventing binding of mature plaque Adverse effects Brownish staining Taste sensation Hypersensitivity Stenosis of parotid duct Indications of Chlorhexidine Gluconate 1. As an adjunct to mechanical oral hygiene 2. As root canal disinfectant 3. Following oral surgical procedures, including periodontal therapy, periodontal surgeries root planning, gingivectomy and after extraction. 4. In patients with intermaxillary fixation, removable and fixed orthodontic appliance and prosthesis. 5. Effective plaque control among physically and mentally handicapped individuals. 6. Management of recurrent aphthous ulceration NON PRESCRIPTION ESSENTIAL OIL RINSES: Thymol Eucalyptol Menthol Methyl salicylate Other Plaque Control Agents: Triclosan : Phenol derivative Synthetic, non-ionic, antimicrobial Mycobacterium spores and candida species Bacteriolysis In combination with zinc citrate Delay plaque maturation Inhibit formation of prostaglandins and leukotrienes Delmopinol: Morpholino ethanol derivative Pre-brushing mouthrinse Adverse effects: Numbness of Tongue Staining of tooth and tongue staining

2. CONTENTS
• Plaque control
• Types of Plaque control
• Chemical Plaque Control
• Goals of Chemical Plaque Control
• Factors influencing effects of Chemical Plaque Control
• Types of Chemical Plaque Control
• Chlorhexidine Gluconate

3. • Non prescription Essential oil rinses
• Other Plaque Control Agents
 Triclosan
 Delmopinol
 Metallic ions
 Quarternary Ammonium Compounds
 Enzymes
 Antibiotics

4. Plaque control
“The removal of microbial plaque and the prevention of its
accumulation on the teeth and adjacent gingival tissues”.

5. TYPES
• Mechanical plaque control
• Chemical plaque control

6. CHEMICAL PLAQUE CONTROL
• Chemical plaque control should always be regarded as needs-related
supplement to and not a substitute for mechanical plaque control.
• Therefore, based on individual patients' predicted risk for oral
disease, the choice of agent and frequency of use.

7. Goals of Chemical Plaque Control
1) To prevent plaque formation
2) To control plaque formation
3) To reduce, disrupt or remove existing plaque
4) To alter composition of plaque flora
5) To exert bactericidal or bacteriostatic effects on micro flora implicated
in caries and periodontal disease
6) To alter surface energy of the tooth, in turn, affecting the plaque
adherence

8. Factors Influencing Effects of Chemical Plaque
Control
1) Substantivity
2) Penetrability
3) Selectivity
4) Solubility
5) Accessibility

9. 1) Triclosan
2) Delmopinol
3) Metallic ions
4) Quaternary Ammonium
compounds
5) Enzymes
6) Antibiotics
Chemical Plaque Control
Prescription
Chlorhexidine
rinse
Non Prescription
Essential oil rinses
Other Plaque
control agents
1) Thymol
2) Eucalyptol
3) Menthol
4) Methyl salicylate

10. • Ideal requisites of an Antiplaque agent
– Plaque and gingivitis
– Pathogenic bacteria
– Resistant bacteria
– Compatible
– Stains/ taste
– Retentive property
– Inexpensive and easy to use

11. – Cationic bisbiguanide
– Both antiplaque and antibacterial properties
Mechanism of action
 Substantivity
 Bacteriostatic and bactericidal
 5 hours – antibacterial, over 12 hours – bacterial count
 80-90% reduction
CHLORHEXIDINE GLUCONATE

12. Inhibits plaque by:
• Preventing pellicle formation
• Preventing adsorption of bacterial cell wall
• Preventing binding of mature plaque

13. Adverse effects
– Brownish staining
– Taste sensation
– Hypersensitivity
– Stenosis of parotid duct

14. Indications of Chlorhexidine Gluconate
1) As an adjunct to mechanical oral hygiene
2) As root canal disinfectant
3) Following oral surgical procedures, including periodontal therapy,
periodontal surgeries root planning, gingivectomy and after extraction.
4) In patients with intermaxillary fixation, removable and fixed
orthodontic appliance and prosthesis.

15. 5) Effective plaque control among physically and mentally handicapped
individuals.
6) Management of recurrent aphthous ulceration

16. NON PRESCRIPTION ESSENTIAL OIL
RINSES
1. Thymol
2. Eucalyptol
3. Menthol
4. Methyl salicylate

17. Triclosan
• Phenol derivative
• Synthetic, non-ionic, antimicrobial
• Mycobacterium spores and candida species
 Bacteriolysis
 In combination with zinc citrate
 Delay plaque maturation
 Inhibit formation of prostaglandins and leukotrienes
OTHER PLAQUE CONTROL AGENTS

18. Delmopinol
• Morpholino ethanol derivative
• Pre-brushing mouthrinse
Adverse effects
1. Numbness of Tongue
2. Staining of tooth and tongue
3. Taste disturbance
4. Mucosal soreness and erosion

19. Metallic ions
• Salts of zinc and copper
• Glycolytic activity

20. Quaternary ammonium compounds
• Cationic antiseptics and surface-active
• More active against gram positive
• Benzathonium chloride
Sanguinarine
• Benzophenanthridine alkaloid
• Sanguinaria Canadensis
• Gram negative organisms

21. Enzymes
• Break down matrix of plaque and calculus
• Proteolytic enzymes - bactericidal
• Mucinase, Protease, Lipase, Nuclease, Mutanase, Glucose
oxidase

22. Antibiotics
• Erythromycin, Vancomycin, Kanamycin, Penicillin, Spiromycin
• Bacterial resistance and hypersensitivity