Chemical plaque control /certified fixed orthodontic courses by Indian dental academy

Chemical plaque control

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

PLAQUE CONTROL

 Plaque control is the regular removal of dental plaque
and the prevention of its accumulation on the teeth
and adjacent gingival surfaces.
 Since plaque control is an effective method of treating
as well as preventing periodontal disease,it forms an
important aspect of all procedures involved in the
management and prevention periodontal disease. It is
the primary level of prevention of periodontal diseases
and caries.


Objectives of plaque control

 To reduce the number of micro organisms on the

teeth. This reduces factors of irritation and

inflammation.

 One of the causes of halitosis may be removed.

 Gingival stimulation.


Disclosing agents

 Used for identification of the bacterial
plaque,which might otherwise be invisible to
naked eye.
 It is a preparation in liquid, tablet or lozenge
form which contains a dye or other colouring
agent,which when applied to teeth imparts colour
to soft deposits but can be rinsed easily from
clean tooth surfaces.

 Solutions and wafers are available commercially.

 Solutions are applied to teeth as concentrates on

cotton swabs or diluted as rinses.

 These can be used as educational and

motivational tools to improve the efficacy of
plaque control procedures.


Methods

Mechanical plaque control aids:
Tooth brushes
Manual tooth brush
Electrical tooth brush
Inter dental aids
Dental floss
Triangular tooth picks
Inter dental brushes


Aids for gingival stimulation
Rubber tip stmulator
Balsa wood edge
Aids for denture wearers
Denture and partial clasp brushes
Cleansing solutions

Chemical plaque control aids:
Mouth rinses
dentifrices


 Mechanical plaque control seems to be the most

dependable form of plaque control.

 Chemical plaque control is used only as an

adjunct to mechanical means and not a
substitute even tough various chemicals are
widely used nowadays.


CHEMICAL PLAQUE
CONTROL


Chemical plaque control agents have been proven

as an adjunct to mechanical plaque control

procedures especially in individuals with a

defective host defence mechanism, mentally or

physically handicapped and in patients who have

undergone surgery.


While evaluating antimicrobials the
following criteria are considered
Does it reach the site?
Is it present in adequate concentration?
Is it effective against target organisms?
Is it in the oral cavity for long enough?
Does it have minimal or controllable side
effects?

Ideal requisites

 Should significantly reduce plaque and gingivitis
 Prevent growth of pathogenic bacteria.
 Prevent development of resistant bacteria.
 Be compatible with the oral tissues.
 Should not stain teeth or alter taste.
 Should exhibit good retentive properties.
 Should be inexpensive and easy to use.


Classification of chemical plaque control
agents.
 First generation anti plaque agents
They are capable of reducing plaque scores by 20-50%.
Exhibit poor retention.
ex:antibiotics,phenols,quaternery ammonium
compounds and sanguanaire
 Second generation
Upto 70% and are better retained by the oral tissues
and exhibit slow release properties
ex:bisbiguanides
 Third generation
Donot exhibit good retentive properties as CHX
ex:delmopinol

Modes of action of antiplaque agents

 Inhibition of bacterial growth and metabolism

 Inhibition of bacterial colonisation

 Disruption of established plaque

 Modification of plaque biochemistry

 Alteration in plaque ecology


ANTIBACTERIAL AGENTS

 Effective only supragingivally
 Agents with complementary modes of actions are
being combined to increase their antibacterial
effectiveness.
 Their long term use should not
 Disrupt the natural balance of the oral microflora
 Lead to colonisation by exogenous organisms
 Lead to the development of microbial resistance


 Bisguanide antiseptics
 Quaternary ammonium compounds
 Phenolic antiseptics
 Triclosan
 Povidone iodine
 Metal ions
 Sanguanarine
 Oxygenating agents
 Enzymes
 Delmopinol
 Prebrushing rinses

Bisguanide antiseptics

Chlorhexidine ,alexidine,octenidine.

 Chlorhexidine gluconate is most commonly used
 It is a salt of chlorhexidine and gluconic acid
 Containing 0.12%chx gluconate in a base containing
11.6%alcohol,FD&C blue no.1,glycerine,peppermint
flavour,purified water,and saccharine sodium.
 ph 5-7.


Pharmacology
 Effective against both gram positive and gram
negative bacteria including aerobes and
anaerobes
 30%of the active ingredient is retained in the
oral cavity following rinsing.this retained drug is
slowly released into oral fluids. The ability of the
drug to adsorb onto and bind to soft tissues and
hard tissues is known as substantivity.

 Mechanism of action:
Mechanism of plaque inhibition:
• Based on the interaction of its positive charge with
negatively charged sites in the oral cavity
• CHX molecules adsorb to salivary glycoproteins and
prevent their adsorption to the tooth surface and the
formation of acquired pellicle.
• Bacteria coated with CHX—adsorption of bacteria to
tooth surface is prevented
• By displacing calcium ions—prevents plaque
maturation
• CHX is retained
• The bactericidal action of CHX would thus render the
established plaque less

Mechanism of antibacterial action:
• The bacterial wall contains many negatively charged
groups—sulphite and phosphates…to which the CHX+
adsorbs
• On the cell wall CHX causes irreversible damage to its
integrity and disturbs the permeability
mechanism..vital cell elements leak out and harmful
substances may gain entry into the cell.this occurs at
low concentrations..this accounts for bacteriostatic
action.
• At higher conc..CHX+ enters into the cell and causes
coagulation of cytoplasmic proteins..rendering the
bacteria dead


Clinical usage:
• 0.2%...10 ml per rinse with equal amount of
water…
• After 30-45 mins after brushing using a
flourinated tooth paste
• Difficult to incorporate in toothpastes.


Side effects:
Unpleasant taste,Staining,Mucosal erosion
and parotid swelling
Adverse reactions:
stomatitis,glossitis,ulcers,dry
mouth,hyperaesthesia,desquamation.

Advantages:
o Wide spectrum of action
o Immediate action
o Prolonged action after a single use
o Lack of aquired bacterial resistance
o No risk of sensitization
o Safe,non toxic


Quaternary ammonium compounds

 Cetylpyridium chloride(CPC 0.1%),
benzathonium chloride
 CPC have moderate plaque inhibitory activity. it
has low substantivity.
 The positively charged molecules react with the
negatively charged cell membrane phosphates—
disrupts cell wall of micro organisms
 Adverse effects—staining of teeth and burning of
oral tissues.

Phenolic antiseptics

 Used alone or in combination.
 Listerine (26.9%alcohol,ph-5.6),contains the
essential oils-thymol ,menthol,eucalyptal oil,
methylsalicylate in an hydroalcohol vehicle.
 Acts by alteration of the bacterial cell wall as well
as reduction in bacterial endotoxins.Also have an
anti inflammatory action which contributes to
the inhibitory effect on gingivitis

 Listerine is uncharged compound and has low
substantivity.
 Adverse effects include burning sensation of
tongue, oral mucosa and bitter taste.
 They produce less stain than CHX.


Triclosan

o It is a non-ionic antiseptic with hydrophobic and
hydrophilic properties, a broad spectrum of
antimicrobial activity and low toxicity, low substantivty.
o It may adsorb to lipids of the bacterial membrane thus
effecting mechanisms of transport ,cause leakage of
intracellular compounds and cell lysis
o It can delay plaque maturation and also inhibit
formation of prostaglandins and leukotrienes


o Formulations containing triclosan(0.15%) and zinc
citrate(0.4%) have been developed to improve the
antiplaque and antigingivitis affects observed with each
agent alone.
o Other attempt—addition of polyvinyl methyl ether and
maleic acid(PVM-MA) known as gantrez, in an attempt
to increase the oral retention of triclosan
o However, unlike CHX&CPC it is compatible with
conventional dentifrices and does not cause tooth
staining.

Povidone iodine

o It does not appear to have significant plaque inhibitory
activity.

o Besides, a significant amount of iodine is absorbed
through the oral mucosa making it unsatisfactory for
prolonged use.


Metal ions

o Zn,Cu,Sn
o Zn is retained by the dental plaque and inhibits its
regrowth without disrupting the oral ecology
o Metallic salts reduce the glycolytic activity in micro
organisms and delay bacterial growth.
o Stannous ion also interferes with bacterial biochemical
synthesis ,metabolism,and aggregation.
o SnF has moderate substantivity.(conc-0.63%
rinse,0.4%gels)
o Adverse effects include metallic taste,short shelf life and
formation of black lines


Sanguinarine

o Alkaloid derived from rhizomes of Sanguinaria
candensis. it contains chemically reactive iminium
o It acts by alteration of bacterial cell attachment
o Low substantivity, has moderate plaque inhibitory effect
and less anti gingivitis effect
o Acts synergistically with zinc
o Causes burning sensation of the oral tissues.


Oxygenating agents

 Such as hydrogen peroxide and buffered sodium peroxy
borate and peroxy carbonate in mouth rinses have a
beneficial effect on acute ulcerative gingivitis ,probably
by inhibiting aerobic bacteria.
 Adverse effects---tissue injury, delayed wound healing,
potential carcinogenic effects as well as candida albicans
overgrowth


Enzymes

• Enzymes have been used as active agents in antiplaque
preparations due to the fact that they would be able to
breakdown already formed matrix of plaque and
calculus.

• Besides, certain proteolytic enzymes are bactericidal

Ex: mucinase , mutanase, dextranase.


Delmopinol

• It is an morpholinoethanol derivative.
• It acts by interfering with plaque matrix formation and
reduction of bacterial adherence…therefore can be used
as pre brushing mouthrinse.
• Conc of 0.1-0.2%
• Adverse effects include transitory numbness of the
tongue,tooth and tongue staining,taste disturbance and
rarely mucosal soreness and erosion.


Pre brushing rinses

 Plax is currently available

 It enables the mechanical action of brushing and flossing

to remove the plaque more easily.

 The active ingredient is sodium benzoate and that

combined with detergents may have surfactant action on

plaque.


Delivery vehicles for antiplaque agents

 Locally delivered
 It should ensure user compliance and have a
compound that allows for stability,
bioavailability, solubility of the
chemoprophylactic agent
 Mouthrinses
 Dentifrices
 Gels
 Sprays
 Chewing gums

Mouth rinses

Types:

• Fluorides mouthrinses

• Antiplaque mouthrinses

• Plaque control mouthrinses

• Desensitizing mouthrinses


Uses:
To replace mechanical tooth brushing when it is
not possible in following situations
 After oral or periodontal surgery during healing
 After IMF
 Acute oral mucosal or gingival infections
As an adjunct to normal tooth brushing in
situations where this may be compromised by
discomfort or inadequacies
 Following subgingival scaling and root planing
 Following scaling in situations where the patients oral
hygiene remains inadequate


Assessing the mouthwashes:

 Range of antibacterial activity

 Substantivity

 Possible anti inflammatory effect

 Acceptable taste

 Ability to promote fresh mouth sensation


Dentifrices

A dentifrice is a substance used with a tooth

brush for the purpose of cleaning the

accessible surfaces of teeth.


Composition:
INGREDIENTS % FUNCTION CHEMICAL

Mild abrasives 15-45 Mechanically CaCO3,Ca2(PO
clean the teeth 4)3,SiO2,Al2O3

water 20-38 Vehicle and Double
solvent medium distilled water
humectants 25-40 reduces loss of Sorbitol,manni
surface moisture tol,propylene
glycol
detergents 1-5 Anti microbial Na lauryl
properties sulphate,Na N-
lauryl
sarcosinate
Binding agents Upto 2 Controls Synthetic
stability&consist cellulose
ency

Flavouring Upto 1 Pleasant taste Peppermint
agents oil,spearmint
oil,oil of winter
green
Sweetening Upto 2 Sweet taste Sorbitol,mannit
agents ol,saccharin

Therapeutic Upto 2 Specific Tetra
agents therapeutic act Napyrophosphat
e,Zn chloride
preservatives upto0.5 Prevent Benzoic acid
microbial
growth
Colouring agents Upto 0.5 Pleasing colour Manufacturer’s
choice


Other agents-
• Antimicrobial agents: triclsan, delmopinol,metallion

ions,zinc citrate trihydrate.

• Anticaries agents: Na monofluorophosphate, Na

fluoride, stannous flouride.

• Anticalculus agents: pyrophosphate ,Zn citrate, Zn

chloride ,gantrez.

• Desenstizing agents: Na flouride, potassium nitrate,

strontium chloride.

Types of toothpastes:
 Fluoride toothpaste

 Desensitizing toothpaste

 Anti calculus toothpaste

 Antiplaque toothpaste

 Whitening toothpaste

 Ayurvedic medicated toothpastes


CONCLUSION

There currently exists no one procedure or agent that meets
the stringent demand of clinicians, absolute plaque
control and that of patients ease and negligible adverse
effects. At present it is necessary to selectively apply the
cumulative effects of various mechanical and chemical
modalities,individualised according to the patient need.
Adjustments based on disease process and
charecteristics as well as on patient compliance should
be made as needed.

Chemical plaque control /certified fixed orthodontic courses by Indian dental academy

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