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1. Drugs & Aids with specific
applications in dental disorders
Dr. Karun Kumar
Senior Lecturer
Dept. of Pharmacology

2. Antiplaque agents
1. Chlorhexidine
2. Quaternary ammonium antiseptics
1. Benzalkonium chloride
2. Cetylpyridinium chloride
3. Phenols
1. Triclosan
2. Listerine

3. 4. Oxygenating agents
1. Hydrogen peroxide
2. Sodium perborate
5. Stannous fluoride
6. Zinc citrate
7. Sanguinarine

4. • Major component of plaque is bacteria
• Most imp. antiplaque agent  Antibact. Drugs
• Effective ther. req.
1. Antimicrobial spectrum covering the relevant
microbes
2. Substantivity  Persistence of the subst. on the
surface of teeth/gums due to initial binding &
subsequent slow release

5. Chlorhexidine
• Exerts high antiplaque activity (largely due to
substantivity)
• It binds electrostatically to the acidic grps. in the
surface proteins affording the substantivity
• Amt. of Chlorh. retained on the oral mucosa / tooth
surface depends on the vol. & conc. of rinse soln.
• Toothpastes containing Ca2+ salts ↓ substantivity of
Chlor. if rinsing done within 30-60 mins. of brushing

6. • Mouth rinsing for 1-3 mins. with 10-15 ml of 0.12-
0.2% Chlorh. soln. BD  Optimum benefits
• Resist. by bact. not clin. signif.
• Oral rinse with 0.2% Chlorh. BD ↓ dental plaque &
prev. onset of gingivitis
• Long term use protects against periodontal diseases
& improves gingival health
• S/E  Bitter aftertaste & mucosal ulceration

7. Quaternary ammonium antiseptics
• Benzalkonium chloride, Cetylpyridinium chloride &
Cetrimide are inf. to Chlorhexidine
• Due to cationic nature, exert substantivity but
retention is less than Chlorhexidine
• More active against GP as compared to GN bact.
(better suited for prophyl. of plaque than t/t)
• A/E  Burning sens. in mouth, bad taste, discol. of
teeth & oral ulcers

8. Phenolic antiseptics
• Triclosan & Listerine employed in mouth washes,
tooth pastes / powders & gum paints
• Triclosan is active against both GP & GN bact.
• Binding to gingival tissues & dental plaque is weak
(can be ↑ by Zn salts, polyvinyl copolymers &
dentifrices)
• Non staining, non irrit. nature favours its use

9. Oxygenating agents
• Hydrogen peroxide & Sodium perborate used as oral
rinse rel. mol. O2 & inh. anaer. microbes
• Used in ANUG
• Freq. rinsing may cause oral ulceration

10. Zinc citrate / chloride
• Incl. in toothpastes & gum paints
• ↓ plaque formn. (GP cocci)
• Mild astringent action on gums
• Utility only as adjuvant antiplaque agent

11. Stannous fluoride
• Daily oral rinsing ↓ dental plaque
• Both tin & F ions contribute to antiplaque activity
• Both are mild antibact.
• Long term efficacy inf. to Chlorhexidine
• Causes staining of teeth

12. Antibiotics in period. disease
• Only tetra. & Metro. have adjuvant therap. value in
severe / rapidly progr. or refr. forms of periodontitis
• Tetra (1 g/d) or Doxy (200 mg/d) alter subgingival
flora by elim. spirochetes & GNB

13. Anticaries drugs
• Only prevent dental caries
1. Fluoride
2. Antiplaque agents
• Other prev. meas. are
1. Restr. of sugar cont. food
2. Freq. brushing of teeth
3. Prev. of xerostomia by good hydration

14. Fluoride
• MOA  F radical being highly reactive exchanges
with hydroxyl radical forming fluorapatite (more
compact, harder, less acid labile than hydroxyapatite)
• F enh. remineraliz. of enamel that has been attacked
by acid
• Free F ions rel. from fluorapatite by action of acid
raise local F ion conc. & facilit. remineraliz. Of
damaged enamel
• Mild antibact.

15. Plaque bact. bind F with high affinity
↓
F conc. in plaque higher than salivary conc.
↓
Signif. intraplaque bacteriostasis
• Other MOA  Inh. acid forming enz. of plaque bact.

16. Fluoride therapy
• Systemic fluoride  Only in areas with estd. F def.
water supply
1. Fluoridation of water supply
2. Fluoridation of common salt
3. Sod. F tabs / lozenges / drops
• Topical fluoride
1. F toothpastes 2. F mouth rinse
3. Professionally applied F  Acidulated PO4 F (APF), F
varnishes

17. Desensitizing agents
1. KNO3
2. Strontium chloride
3. Pot. oxalate
4. Fluoride
5. Formaldehyde  Not favoured now
6. Dentine bonding agents

18. Potassium nitrate
• Most freq. incl. active ingred. of desens. toothpaste
• Paste is to be applied on sens. teeth & left in place
for ≈ 5 mins. before brushing lightly & then rinsing
• Repeated 2-3 times daily
• Obliterates the dentinal tubules by pptn.
• Also dampens pain inducing nerve impulses

19. Strontium chloride
• Ppts. proteins in the dentinal tubular fl. & limits /
obstr. easy displ. of fluid by the pain ind. stimuli
• Other MOA  Calcif. Of bony component of tooth by
Sr ions
• Many desens. toothpastes & gels contain 10%
Strontium chloride

20. Potassium oxalate
Diffuses into the dentinal tubules
↓
Reacts with ionic Ca2+ to produce Calcium oxalate cryst.
↓
Crystals hinder fl. movement in the tubules
↓
Pain is lessened

21. Fluoride
• Included in many multi-ingredient desens. toothp.
• React with Ca2+ & produce CaF2 crystals in the
dentinal tubules
• Stannous F may deposit fine layers of tin particles in
the tubules creating partial obstr.
• In long term, F ions accelerate secondary dentine
formation which may reinforce the tubules & reduce
dentine sensit.

22. Dentine bonding agents
• Hydroxy ethyl methacrylate, some resins,
composites, varnishes, etc.
• Can be burnished on the exposed root or sens. part
of crown to seal off the ext. op. of exp. dentinal tub.
• After suitable prep. of sens. tooth & use of primers,
the bonding agent is applied & allowed to dry
• Long lasting bonding with dentine occurs rapidly
• T/t has to be repeated at suitable intervals

23. Obtundants
• Obsolete drugs. MOA is
1. Stimulation followed by desens. of n. endings 
Clove oil, thymol, menthol, camphor, phenol. They
have counterirrit. prop. & prod. rel. numbness due
to desens. of sensory nerves lasting 1 – 2 hrs.
2. Astringent action  Stannous chloride, Zinc
chloride, paraformaldehyde. Ppt. surface proteins.
• LA have rendered them redundant

24. Mummifying agents
• Protoplasmic poisons having astringent &
preservative prop. (no longer used)
• Before modern RCT filling materials, used to kill the
tissues in tooth pulp, make it hard & dry to prev. inf.
1. Formaldehyde & Paraformaldehyde
2. Iodoform & Phenol made into a paste with glycerine
3. Tannic acid

25. • Modern techn. of RCT
1. Pulpectomy
2. Achieving a tissue free dry canal
3. Obliterating it by packing with
1. Gutta-percha (tough material made from latex) points
2. Silver points OR
3. Epoxy resin canal sealant
• Inert, impervious, nonirrit. & do not cause any
compl. & prev. reinf.

26. Bleaching agents
• Used to remove stains from teeth or improve their
whiteness
1. O2 rel. agents  H2O2, Carbamide peroxide, Na per.
2. Chlorine rel. agents  Bleaching powder
3. Reducing agent  Na thiosulfate
4. Silica
• Use of laser for whitening teeth is increasing

27. O2 releasing agents
• Rel. O2 which reacts with the organic pigment to
decolourise it & loosen it from tooth surface
• It is washed off to expose white enamel
• H2O2  Primary oxygenating agent
• 3% mouthwash used as antiseptic / antiplaque agent
• Conc. soln. (20-30%) in water (perhydrol) or ether
(pyrozone) may be applied carefully to the stained
teeth & wiped off for cosmetic whitening

28. • Burning sens., erythema, infl. & sloughing may occur
if it comes in contact with gingival / oral mucosa
• Carbamide peroxide  Equimolar complex of H2O2
with urea which acts as a carrier & rel. H2O2 on
reacting with water
• Some tooth whiteners contain 10% carb. peroxide
• Sod. peroxide & sod. perborate rel. O2 & may be
used for bleaching teeth

29. Chlorine rel. agents
• Bleaching powder (chlorinated lime) slowly rel. Cl2
which acts as an oxidizing agent & decol. many dyes
• Addn. of acetic acid to bleaching powder immed.
before applic. accel. its decomposition & hastens
stain removal
• Exc. use of any oxid. bl. agent may damage tooth
enamel and affect dentine. Tooth sens. & weakening
of crown may result.

30. Reducing agent
• Sod. thiosulfate is used for removing certain stains
(iodine stain)
• Seq. applic. of an oxidiz. agent foll. by a reducing
agent may be needed for silver stain

31. Silica
• Nonabrasive adsorbant which is incl. in some
whitening tooth pastes & tooth powders

32. Disclosing agents
• Dyes used to facil. clear visual. of dental plaque. By
staining the bact. plaque deeply, they ↑ contrast
b/w plaque and gums.
• Dyes sel. for this purpose are those which :-
1. Have higher aff. for the bact. plaque than for oral
mucosa / teeth
2. Are not bad tasting, irritating or toxic
3. Diffuse uniformly and stain all supragingival plaque
4. Easily washed off by rinsing after plaque removal

33. Discl. agents may be applied either by rinsing the
mouth with a dilute soln. of the dye or it may be
painted on the teeth with a brush / cotton swab
↓
Plaque is removed by scaling / other techniques

34. • Dyes used as disclosing agents are :-
1. Erythrosine  M/c used discl. agent.
• Red dye is bland tasting, nontoxic & stains plaque
deeply, but the gums & oral mucosa also take light
stain.
• Residual stain goes after repeated rinsing

35. Fluorescein
• Yellow dye which fluoresces under uv light
• Sel. taken up by bact. Plaque (Plaque can be
demarcated clearly but needs uv light)
• Nontoxic & nonirrit.

36. Two-tone dye
• Used to diff. older & thicker part of plaque from
thinner, newer plaque
• Mix. of red & green dye is used
• Mature plaque app. blue while fresh plaque app. Red

37. Dentifrices
• Powders or pastes used as hygiene aids for routine
dental care during brushing
• Facil. cleaning of teeth & gums, improve their app. &
control bad breath
• May be medicated to impart sp. prev. & therap. prop.
• Usual ingredients can be grouped into :-

38. 1. Abrasives  Silica, NaHCO3, MgO, Al2O3, MgCO3
2. Detergents  Na lauryl sulfate
3. Humectants & binding agents  Glycerine, sorbitol
& propylene glycol, methyl cellulose
4. Sweetening agents  Saccharine
5. Flavouring agents  Menthol, thymol, clove oil

39. 6. Colouring agents  Methylene blue, chlorophyll
7. Medicated dentrifices
1. Fluoride  NaF (caries prev.)
2. Antiseptics  Chlorh., tricl., b.cl. (plaque prev.)
3. Desens. Agents  KNO3, Sr cl (dentine sens.)
4. Bleaching agents  Carbamide peroxide (commonest)

40. Abrasives
• Finely powdered inert & poorly soluble solids having
smooth particles
• Prep. chalk, silicates, Ca3(PO4)2, MgO, Al2O3, MgCO3
• NaHCO3 on reacting with saliva rel. CO2 (facilit.
foaming during brushing)
• Toothpastes are less abrasive than tooth powders

41. Detergents
• Surface acting agents (surfactants) which ↓ s.t. b/w
oil & water & prod. foam on brushing
• Emulsify fats & help in susp. fine particles (promote
cleaning of teeth & gums & removal of food particles
sticking to the teeth)
• Foam also provides lubrication during brushing
• Na lauryl sulfate promotes penetr. of F into dentine,
can loosen plaque & has antibact. action ; irritates
oral mucosa & regular use prod. sore mouth

42. • Has been replaced by nonirrit. agents like lauryl
sarcosinate
• Other deterg. in dentifrices are :-
1. Dioctyl sodium sulfosuccinate
2. Amm. lauryl sulphate
3. Dodecyl benzene sulfonate

43. Humectants
• Humectants like glycerine (glycerol), sorbitol &
propylene glycol retain moisture & prev. drying of
toothpaste
• Glycerine  M/c incl. because it is
1. Sweet
2. Nongreasy
3. Adds thickness
4. Softness
5. Smoothness to paste

44. Binding agents
1. Methyl cellulose
2. Bentonite
3. Mucilage of tragacanth
• They swell in the presence of water & hold together
the solid & liquid phases of the paste
• Also, give thick consistency to the paste

45. Sweetening agents
• Saccharine  Artif. sweetener added to dentifr. to
1. Mask their blandness
2. Improve their taste
3. Make them acceptable (to children)
• Noncariogenic
• Other sweeteners are :-
1. Sorbitol
2. Glycerol

46. Flavouring agents
• Essential (volatile) oils with a char. pleasant aroma
are added to dentifr. to improve flavour & acceptabil.
• Also counteract halitosis (bad breath)
1. Menthol
2. Thymol
3. Clove oil
4. Eugenol
5. Camphor

47. Colouring agents
• Many dentifr. are white but some are brightly
coloured blue, green or cherry red to make them
look attractive by addn. of
1. Methylene blue
2. Chlorophyll
3. Liquor rubri
4. Other permitted colours

48. Medicated dentifrices
• Certain medic. are added to toothpastes & tooth
powders so as to empower them with prophyl./ther.
activity against sp. dental condns.
1. Fluoride  Sod. Mono F PO4, NaF (caries prev.)
2. Antiseptics  Chlorh., tricl., benz. cl. (plaque prev.)
3. Desens. Agents  KNO3, Sr Cl (dentine sens.)
4. Bleaching agents  Carbamide peroxide
(commonest)