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CHEMICAL PLAQUE CONTROL

PLAQUE

 Dental plaque is defined as a highly specific variable
 structural entity formed by sequential colonization of
 microorganism on the tooth surface, epithelium and
 restorations.
Plaque control

    It is the removal of microbial plaque and the
  prevention of its accumulation on the teeth and
  adjacent gingival tissues. It also deals with the
  prevention of calculus formation.
Ideal requisites
• Should decrease plaque & gingivitis
• Prevent pathogenic growth
• Should prevent development of resistant
  bacteria
• Should be biocompatible
• Should not stain teeth or alter taste
• Should have good retentive properties
• Should be economic
CLASSIFICATION

CHEMICAL PLAQUE CONTROL AGENTS


                                            FIRST GENERATION
                  Eg: antibiotics, phenol,quarternary ammonium compounds & sanguinarine


                                          SECOND GENERATION
                                      Eg: Bisbiguanides,(chlorhexidine)



                                         THIRD GENERATION
                                            Eg: delmopinol
FIRST GENERATION AGENTS

TRICLOSAN

•   Phenol derivative
•   Is synthetic and ionic
•   Used as a topical antimicrobial
    agent
•   Broad spectrum of action
    including both gram positive
    and gram negative bacterias
•   It also includes mycobacterium
    spores and Candida species
MECHANISM OF ACTION


               TRICLOSAN




        ACT ON CYTOPLASMIC MEMBRANE



INDUCE LEAKAGE OF CELLULAR CONSTITUENTS



              BACTERIOLYSIS
• Triclosan is included in tooth paste to reduce
  plaque formation
• Used along with Zinc citrate or co-polymer
  Gantrez to enhance its retention within the oral
  cavity
• Triclosan delay plaque formation
• It inhibits formation of prostaglandins &
  leukotrienes there by reduces the chance of
  inflammation
2. METALLIC IONS

  eg: Zn & Cu ions


  MECHANISM OF ACTION


• It reduces the glycolytic activity in bacteria &delays
  bacterial growth
3.QUARTERNARY AMMONIUM
             COMPOUNDS



• Cationic antiseptics & surface active agents
• Effective against gram positive organisms
MECHANISM OF ACTION

• Positively charged molecule reacts with negatively
  charged cell membrane phosphates and thereby
  disrupts the bacterial cell wall structure

  Eg: Benzanthonium chloride, Benzalleonium
  chloride and cetylpyredinium
4.SANGUINARINE


• It is a benzophenanthredine alkaloid
• It is most effective against gram –ve organisms
• Used in mouth rinse
ANTIBIOTICS


• Vancomycin,erythromycin,Niddamycin and
  Kanamycin
• Due to bacterial resistance problems the use of
  antibiotics has been reduced
BISBIGUANIDES

CHLORHEXIDINE
   GLUCONATE(0.2%)

•   It is a cationic
    bisbiguanide
•   Effective against gram
    +ve, gram –ve organisms,
    fungi, yeasts and viruses
•   Exhibit antiplaque &
    antibacterial properties
MECHANISM OF ACTION

Antiplaque action of chlorhexidine

5. Prevents pellicle formation by blocking acidic
   groups on salivary glycoproteins thereby reducing
   glycoprotein adsorption on to the tooth surface
6. Prevents adsorption of bacterial cell wall on to the
   tooth surface
7. Prevents binding of mature plaques
Antibacterial action of chlorhexidine
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
1. Bacteriocidal action
       increased concentration 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
ADVERSE EFFECTS OF CHLORHEXIDINE



5. Brownish staining of tooth or restorations
6. Loss of taste sensation
7. Rarely hypersensitivity to chlorhexidine has been
   reported
8. Stenosis of parotid duct has also been reported
ENZYMES


• Enzymes has been used as active agents in antiplaque
  preparations
• It is due to the fact that enzymes would be able to
  breakdown already formed matrix some plaques and
  calculus
• Some are proteolytic and have bactericidal action
       eg:Mucinase, mutanase, dextranase etc
DELMOPINOL
• Inhibits plaque growth and reduces
  gingivitis


Mechanism of action

• Interfere with plaque matrix formation
  & also reduces bacterial adherence
• It causes weak binding of plaque to
  tooth, thus aiding in easy removal of
  plaque by mechanical procedures
• It is therefore indicated as a pre
  brushing mouth rinse
Adverse effect of delmopinol

4. Staining of tooth & tongue
5. Taste disturbances
6. Mucosal soreness & erosion
DENTIFRICES
  Dentifrice is a substance used with a
  tooth brush for the purpose of
  cleaning the accessible surfaces of
  the tooth

It contains
       • therapeutic agent such as
         fluoride to inhibit caries
       • Antimicrobial agents-
         chlorhexidine, cetrimide
       • Anticalculus agent - Zn-
         chloride
COMPOSITION
1. Polishing/ abrasive agents
        • Ca carbonate
        • Dicalcium phosphate dihydrate
        • Alumina
        • Silica
Functions
 Mild abrasive action aids in illuminating plaque
 Removes stained pellicle, restores natural luster,
   enhances enamel whiteness
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
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
6. Sweeteners and colouring agents
7. Antibacterial agents
3. Anti bacterial agents
     •   Triclosan, delmopinol, metallic ions & Zn-citrate
         trihydrate
4. Anticaries agents
     •   Na fluoride, stannous fluoride
5. Active agents-fluoride
6. Anticalculus agents(crystal growth
   inhibitors)
     •   Pyrophosphate, Zn citrate, Zn chloride
7. Desensitizing agents
     •   Sodium fluoride, potassium nitrate
Recent developments in dentifrices

•   Tooth paste for children
•   Natural tooth paste (herbal)
•   Whitening tooth paste
•   Breath freshening tooth paste
•   Sodium bicarbonate tooth paste
DISCLOSING AGENTS
• A disclosing agent is a
  preparation in liquid, tablet
  or lozenge from which
  contains a dye or other
  coloring agents
• A disclosing agent is used
  for identifying bacterial
  plaque
• When applied to the teeth,
  the agents imparts its colour
  to soft deposits but can be
  rinsed easily from clean
  tooth surface
IDEAL PROPERTIES

•   Intensity of colour
•   Duration of intensity
•   Taste
•   Irritation to mucous membrane
•   Diffusibility
•   Astringent and antiseptic property
Agents used for disclosing plaque
b. Iodine preparations
      •   Skinners iodine solution
      •   Diluted tincture of iodine
c.   Mercurochrome preparations
      •   Mercurochrome soln 5
      •   Flavored mercurochrome disclosing solution
d.   Bismark brown
e.   Mebromin
f.   Erythrosine
g.   Fast green
h.   Fluoresin
i.   Two tone solutions
j.   Basic fuschin
Chemical Plaque Control

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Chemical Plaque Control

  • 1. CHEMICAL PLAQUE CONTROL PLAQUE Dental plaque is defined as a highly specific variable structural entity formed by sequential colonization of microorganism on the tooth surface, epithelium and restorations.
  • 2. Plaque control It is the removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues. It also deals with the prevention of calculus formation.
  • 3. Ideal requisites • Should decrease plaque & gingivitis • Prevent pathogenic growth • Should prevent development of resistant bacteria • Should be biocompatible • Should not stain teeth or alter taste • Should have good retentive properties • Should be economic
  • 4. CLASSIFICATION CHEMICAL PLAQUE CONTROL AGENTS FIRST GENERATION Eg: antibiotics, phenol,quarternary ammonium compounds & sanguinarine SECOND GENERATION Eg: Bisbiguanides,(chlorhexidine) THIRD GENERATION Eg: delmopinol
  • 5. FIRST GENERATION AGENTS TRICLOSAN • Phenol derivative • Is synthetic and ionic • Used as a topical antimicrobial agent • Broad spectrum of action including both gram positive and gram negative bacterias • It also includes mycobacterium spores and Candida species
  • 6. MECHANISM OF ACTION TRICLOSAN ACT ON CYTOPLASMIC MEMBRANE INDUCE LEAKAGE OF CELLULAR CONSTITUENTS BACTERIOLYSIS
  • 7. • Triclosan is included in tooth paste to reduce plaque formation • Used along with Zinc citrate or co-polymer Gantrez to enhance its retention within the oral cavity • Triclosan delay plaque formation • It inhibits formation of prostaglandins & leukotrienes there by reduces the chance of inflammation
  • 8. 2. METALLIC IONS eg: Zn & Cu ions MECHANISM OF ACTION • It reduces the glycolytic activity in bacteria &delays bacterial growth
  • 9. 3.QUARTERNARY AMMONIUM COMPOUNDS • Cationic antiseptics & surface active agents • Effective against gram positive organisms
  • 10. MECHANISM OF ACTION • Positively charged molecule reacts with negatively charged cell membrane phosphates and thereby disrupts the bacterial cell wall structure Eg: Benzanthonium chloride, Benzalleonium chloride and cetylpyredinium
  • 11. 4.SANGUINARINE • It is a benzophenanthredine alkaloid • It is most effective against gram –ve organisms • Used in mouth rinse
  • 12. ANTIBIOTICS • Vancomycin,erythromycin,Niddamycin and Kanamycin • Due to bacterial resistance problems the use of antibiotics has been reduced
  • 13. BISBIGUANIDES CHLORHEXIDINE GLUCONATE(0.2%) • It is a cationic bisbiguanide • Effective against gram +ve, gram –ve organisms, fungi, yeasts and viruses • Exhibit antiplaque & antibacterial properties
  • 14. MECHANISM OF ACTION Antiplaque action of chlorhexidine 5. Prevents pellicle formation by blocking acidic groups on salivary glycoproteins thereby reducing glycoprotein adsorption on to the tooth surface 6. Prevents adsorption of bacterial cell wall on to the tooth surface 7. Prevents binding of mature plaques
  • 15. Antibacterial action of chlorhexidine 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
  • 16. 1. Bacteriocidal action increased concentration 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
  • 17. ADVERSE EFFECTS OF CHLORHEXIDINE 5. Brownish staining of tooth or restorations 6. Loss of taste sensation 7. Rarely hypersensitivity to chlorhexidine has been reported 8. Stenosis of parotid duct has also been reported
  • 18. ENZYMES • Enzymes has been used as active agents in antiplaque preparations • It is due to the fact that enzymes would be able to breakdown already formed matrix some plaques and calculus • Some are proteolytic and have bactericidal action eg:Mucinase, mutanase, dextranase etc
  • 19. DELMOPINOL • Inhibits plaque growth and reduces gingivitis Mechanism of action • Interfere with plaque matrix formation & also reduces bacterial adherence • It causes weak binding of plaque to tooth, thus aiding in easy removal of plaque by mechanical procedures • It is therefore indicated as a pre brushing mouth rinse
  • 20. Adverse effect of delmopinol 4. Staining of tooth & tongue 5. Taste disturbances 6. Mucosal soreness & erosion
  • 21. DENTIFRICES Dentifrice is a substance used with a tooth brush for the purpose of cleaning the accessible surfaces of the tooth It contains • therapeutic agent such as fluoride to inhibit caries • Antimicrobial agents- chlorhexidine, cetrimide • Anticalculus agent - Zn- chloride
  • 22. COMPOSITION 1. Polishing/ abrasive agents • Ca carbonate • Dicalcium phosphate dihydrate • Alumina • Silica Functions  Mild abrasive action aids in illuminating plaque  Removes stained pellicle, restores natural luster, enhances enamel whiteness
  • 23. 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
  • 24. 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
  • 25. 6. Sweeteners and colouring agents 7. Antibacterial agents 3. Anti bacterial agents • Triclosan, delmopinol, metallic ions & Zn-citrate trihydrate 4. Anticaries agents • Na fluoride, stannous fluoride 5. Active agents-fluoride 6. Anticalculus agents(crystal growth inhibitors) • Pyrophosphate, Zn citrate, Zn chloride 7. Desensitizing agents • Sodium fluoride, potassium nitrate
  • 26. Recent developments in dentifrices • Tooth paste for children • Natural tooth paste (herbal) • Whitening tooth paste • Breath freshening tooth paste • Sodium bicarbonate tooth paste
  • 27. DISCLOSING AGENTS • A disclosing agent is a preparation in liquid, tablet or lozenge from which contains a dye or other coloring agents • A disclosing agent is used for identifying bacterial plaque • When applied to the teeth, the agents imparts its colour to soft deposits but can be rinsed easily from clean tooth surface
  • 28. IDEAL PROPERTIES • Intensity of colour • Duration of intensity • Taste • Irritation to mucous membrane • Diffusibility • Astringent and antiseptic property
  • 29. Agents used for disclosing plaque b. Iodine preparations • Skinners iodine solution • Diluted tincture of iodine c. Mercurochrome preparations • Mercurochrome soln 5 • Flavored mercurochrome disclosing solution d. Bismark brown e. Mebromin f. Erythrosine g. Fast green h. Fluoresin i. Two tone solutions j. Basic fuschin