Chemical plaque control

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Chemical plaque control
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• Used as adjunct to mechanical plaque control.
• Many vehicles may be used to deliver anti plaque
  agents such as
• MOUTH RINSES,
• TOOTHPASTES,
• SPRAY,
• IRRIGATORS,
• CHEWING GUM,
• VARNISHES.

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• Approaches to chemical supragingival plaque
  control
• ANTIADHESIVE Prevention of attachment of
  bacterial biofilm.
• ANTIMICROBIAL by inhibition of bacterial
  proliferation and as bactericidal.
• PLAQUE REMOVAL
• ANTIPATHOGENIC

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Properties of an ideal antiplaque agent

1. Should eliminate only the pathogenic bacteria.
2. Prevent development of resistant bacteria.
3. Exhibit substantivity i.e. ability of an agent to
   bind to tissue surfaces and to be released over
   time to deliver an adequate dose of active
   principal ingredient the agent carries. (CHX gets
   adsorbed to oral tissues).

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1. Safe to oral tissues at concentrations and
   dosages recommended.
2. Significantly reduce and gingivitis and prevent
   colonization of microorganisms.
3. Should not stain the teeth or alter taste.

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classification

• Depending on the antimicrobial efficiency and
  relative substantitivity.
• 1st generation decreases plaque scores by
  20-50, but efficacy is decreased by poor
  retention in the mouth. E.g. antibiotics ,
  phenols etc.
• 2nd generation 70-90
• more effectively retained by oral tissues and
  release slowly. E.g. Bisbiguanides

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Various chemical agents are

1. Antibiotics penicillin, vancomycin
2. Enzymes proteases, lipase, dextranase
3. Bisbiguanide chlorhexidine, alexidine
4. Quaternary ammonium compounds cetylpyridinium
   chloride, benzalkonium chloride
5. Phenols and essential oils thymol, triclosan

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1. Natural products sanguinarine
2. Fluorides sodium fluoride, stannous F
3. Metal salts tin, zinc, copper
4. Oxygenating agents Hydrogen peroxide
5. Detergents sodium lauryl sulfate
6. Amine alcohols octapinol, delmopinol

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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

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MECHANISM OF ACTION

• TRICLOSAN
• ACT ON CYTOPLASMIC MEMBRANE
• INDUCE LEAKAGE OF CELLULAR CONSTITUENTS
• BACTERIOLYSIS

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• 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

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• 2. METALLIC IONS
• eg Zn Cu ions
• MECHANISM OF ACTION
• It reduces the glycolytic activity in bacteria
  delays bacterial growth

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3.QUARTERNARY AMMONIUM COMPOUNDS

• Cationic antiseptics surface active agents
• Effective against gram positive organisms

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• 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

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4.SANGUINARINE

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

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ANTIBIOTICS

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

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Bisbiguanides

• Considered to most effective antiplaque agents.
• Second generation agents exhibiting substantivity
  and broad antimicrobial properties.

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CHLORHEXIDINE GLUCONATE(0.2)

• It is a cationic bisbiguanide
• Effective against gram ve, gram ve organisms,
  fungi, yeasts and viruses
• Exhibit antiplaque antibacterial properties

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• CHX due to its dicationic nature, binds to enamel
  pellicle or tooth surface and salivary proteins.
  This adsorbed CHX is released of a period of
  time.
• Mode of delivery of CHX mouth rinse, gels, tooth
  paste, dental floss, and tooth picks.

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Mechanism of action of CHX

• Antimicrobial action and antiplaque action
• 1. ANTIMICROBIAL
• a. at low concentration is bacteriostatic -
  positively charged chlorhexidine molecule will
  adhere to negatively charged bacterial cell
  surface. Integrity of cell membrane disrupted
  causing leakage of intracellular components.
• b. at high concentration is bactericidal
• causes precipitation of bacterial cytoplasm so
  cell death.

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• Antibacterial action of chlorhexidine
• It shows two actions
• 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

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• 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

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• ANTIPLAQUE ACTION
• Prevents formation of acquired pellicle. Blocks
  the acidic group of salivary glycoproteins which
  reduces their adsorption to hydroxyapetite.
• Reduces the ability of bacteria to bind to tooth
  surface. Adsorption of CHX to bacterial capsule
  or glycocalyx and prevents them binding on to
  tooth surface.
• CHX competes for Ca ions which are required for
  agglutination of plaque.

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• ADVERSE EFFECTS OF CHLORHEXIDINE
• Brownish staining of tooth or restorations
• Loss of taste sensation
• Rarely hypersensitivity to chlorhexidine has been
  reported
• Stenosis of parotid duct has also been reported

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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
• egMucinase, mutanase, dextranase etc

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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

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• Adverse effect of delmopinol
• Staining of tooth tongue
• Taste disturbances
• Mucosal soreness erosion

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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

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• IDEAL PROPERTIES
• Intensity of colour
• Duration of intensity
• Taste
• Irritation to mucous membrane
• Diffusibility
• Astringent and antiseptic property

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• Agents used for disclosing plaque
• Iodine preparations
• Skinners iodine solution
• Diluted tincture of iodine
• Mercurochrome preparations
• Mercurochrome soln 5
• Flavored mercurochrome disclosing solution
• Bismark brown
• Mebromin
• Erythrosine
• Fast green
• Fluoresin
• Two tone solutions
• Basic fuschin