Chemical plaque control

By:
NEELIMA.B
Guided by:
Dr. SRIPRIYA; MDS
INTRODUCTION
Chemical plaque control agents have
proven to be an ideal adjunct to
mechanical plaque control procedures
especially in individuals with a
defective host defensive mechanism,
mentally or physically handicapped and
in patients who have undergone
surgical procedures post operatively..
 IDEAL REQUIREMENTS:
Should significantly reduce plaque and
gingivitis
Should prevent the growth of pathogenic
bacteria
Should prevent development of resistant
bacteria
Should be compatible with oral tissues
Should not stain teeth or alter taste
Should exhibit good retentive properties
Should be inexpensive and easy to use
CLASSIFICATION OF CPC
AGENTS
1) FIRST GENERATION ANTIPLAQUE AGENTS:
 They are capable of reducing plaque scores by
25_50%.
 They exhibit poor retention within the mouth.
 Eg: antibiotics, phenols, quartenary compounds and
sanguanarine.
2) SECOND GENERATION ANTIPLAQUE AGENTS:
 They produce an overall reduction plaque around 70-90%
 They are better retained by oral tissues
 They exhibit slow release properties
Eg: bisbiguanides (chlorhexidine)
3) THIRD GENERATION ANTIPLAQUE
AGENTS
 They block binding of micro organisms to
tooth or to each other
They do not exhibit good retentive properties,
as compared to chlorhexidine.
Eg: delmopinol
.
TRICLOSAN:
It is a phenol derivative, recently used in
mouth washes and tooth pastes
It is synthetic, non ionic and used as topical
antimicrobial agent.
Triclosan has broad spectrum of activity
against both gram positive and gram negative
bacteria
MECHANISM:
It acts on microbial cytoplasmic membrane,
inducing leakage of cellular constituents and
thereby causing bacteriolysis
Triclosan can delay plaque maturation
METALLIC IONS
Some metals like copper and zinc have plaque
inhibitory capacity.
MECHANISM:
Mechanic salts delay the glycolytic activity in
micro organisms and delay bacterial growth.
QUARTENARY AMMONIUM COMPOUNDS:
 They are cationic antiseptics and surface active agents

They tend to b more active against gram positive

organisms than gram negative therefore effective
against developing of plaque consists of gram +ve than
gram –ve organisms.

Eg; benzathonium chloride, cetyl pyridinium chloride.

SANGUINARINE:
It is a benzo phenalthidine alkaloid derived
from plant sanguinarine canadensis.
It exhibits good retentive properties with
plaque when used as a mouth rinse.
ANTIBIOTICS:
Such as vancomycin, kanamycin,
erythromycin and niddamycin are used as
agents for plaque control.
BISBIGUANIDES:
CHLORHEXIDINE GLUCONATE(0.2%):
Chlorhexidine is a cationic bisbiguanide which
is effective against both gram +ve and gram –
ve organisms, fungi, yeasts and viruses.
It exhibits both anti plaque and anti bacterial
properties.
MECHANISM OF ACTION:
1)ANTIPLAQUE ACTION:
The superior antiplaque activity of chx is due to
its property of sustained availability-
SUBSTANTIVITY
This involves a reservoir of chx, slowly
dissolving from all oral surfaces, resulting in the
BACTERIOSTATIC MILEU in the oral cavity
CHX desorbed from oral mucosa has three
Mechanisms of plaque inhibition:
1) Prevents pellicle formation by blocking acidic groups on
salivary glycoproteins
2) Prevents adsorption of bacterial cell wall onto the tooth
surface by binding to the bacteria.
3) Prevents binding of mature plaque by precipitating
agglutination factors in saliva and displacing calcium
from the plaque matrix.
2) ANTI BACTERIAL ACTION OF CHX:
• CHX is a dicationic bisbiguanide with broad antibacterial
activity.
• It exhibits a wide spectrum of activity encompassing gram
+ve and gram –ve bacteria, yeasts, dermatophytes and
some lipophilic viruses.
Chx has strong affinity for binding to skin and mucous
membrane
Chx shows different effects at different concentrations
dat is
a) bacteriostatic at low concentrations
b) bacteriocidal at high concentrations
• After a single rinse with chx saliva itself exhibits
antibacterial activity for about 5 hrs, and suppresses
salivary bacterial count for over 12 hrs.
• Chx is found to be potent antifungal agent in oral cavity.
PIN CUSHION EFFECT:
• One charged end of chx molecule binds to the tooth
surface and the other remains available to initiate the
interaction with the bacterial membrane as the micro
organism approaches the tooth surfaces.
MECHANISM OF ANTIBACTERIAL ACTION:
• Bacterial cell wall (negatively charged)
sulphates+phosphates

• Dicationic postively charged chx molecule is rapidly

attracted to negatively charged bacterial cell wall with
specific and strong adsorption to phosphate containing
sample
This alter integrity of bacterial cell membrane and chx is
attracted towards the inner cell membrane.

Chx binds to the phospholipids in the inner membrane and

increase the permeability of the inner membrane and leakage
of low molecular weight compounds.

Vital cell elements leak out and gain of harmful substances

take place. At this stage effect if chx is reversible.
COAGULATIONS OF CELL CONTENTS:
• Increased concentation of chx
• Progressive greater damage to membrane
• Larger molecular weight compounds are lost from cell and
results in leakage.
• Coagulation and precipiation of cytoplasm by phosphated
compounds
• Free chx molecule enter into the cell and causes
coagulation of proteins.
• Vital cell activity ceases
• Cell death(irreversible)
OPTIMISING THE USE OF CHX:
• CHX doesn’t distinguish between bacterial and other
proteins found within mature plaque
• To optimise extraneous proteins must be first removed
• Chx prevents plaque formation
• Chx should not be used before or immediately after using
tooth paste as interaction with anionic surfactants will
reduce effective delivery of chx
• Tooth paste should be used prioi to using chx
• The effect may be minimised by reduced by intake of tea
and coffee during immediate period after morning rinse
with chx.
 Therefore use of mouthwash is recommended during
night times as no beverages will be consumed during
sleep.
 Chx should be targeted at the patient group for whom
clinical benefit is more beneficial
a) Patients with compromised oral hygeine
b) Pts with physical or mental or social handicap.
ADVERSE EFFECTS OF CHX:
a) brownish staining of teeth on restorations
b) Loss of taste sensation
c) Rarely hypersensitivity to chx
d) Stenosis of the parotid duct.
Enzymes:
Enzymes had been used as active agents in
antiplaque preparations.
They would be able to break down already
formed matrix of plaque and calculus.
Eg: mucinase, dehydrated pancreas, mutanase,
dextranase, lacto peroxidase.
Delmopinol:
It is a morpholino ethanol derivative. It has shown to
inhibit plaque growth and reduces gingivitis.
Mechanism;
It interfere with plaque matrix formation and also reduces
bacterial adherence.
It causes weak binding of plaque to the tooth surface
It is indicated as prebrushing mouth rinse.
Anti Calculus Agents:
Dentrifices containing either soluble pyro phosphatase
and zinc compounds have demonstrated 10-50%
reduction in calculus.
Mechanism:
Pyro phosphates and zinc compounds are thought to
produce their anti calculus effects.
Anti calculus are mostly designed to inhibit the
mineralisation of so called PETRIFIED PLAQUE.
Eg: pyrophosphates, zn citrates, zn chlorides.
 DENTRIFICES
 According to ADA council “A dentrifice is a substance used
with a tooth brush for the purpose of cleaning the accessible
surfaces of the tooth”
Webster describe the term dentrifice as derived from
dens{tooth} and fricare{to rub]
Dorland describe the term as preparation for cleaning and
polishing the tooth surfaces.
It may contain the following:
The therapeutic agent such as flourides to inhibit dental caries
Anti microbial agent such as chx, cetrimides, to reduce micro
organisms.
An anti calculus agent such as zinc chloride to dissolve
calculus.
Functions of tooth paste:
 Minimising plaque build up
 Anti caries action
 Removal of stains
 Mouth freshener
Composition of dentrifice:
1)Polishing or abrasive agents:
Calcium carbonate, dicalcium phosphate dihydrate,
alumina, silicas.
Function: a)These agents have mild abrasive action
which helps in removing plaque from tooth surface.
b)they remove stained pellicle from tooth surface.
2)Binding or thickening agents:
Eg. Water soluble agents:
carrageenates, alginates, sodium carboxymethyl
cellulose.
Water insoluble agents:
magnesium aluminium silicate, colloidal silica,
sodium magnesium silicate.
Function: control stability and consistency of
tooth paste and effects easy dispersion of tooth
paste in the mouth.
3) Detergents or surfactants:
Eg: sodium lauryl sulfate
Function: anti microbial property and produces the foam
which aids in the removal of debris.
4) Humectants:
Eg: Sorbitol, glycerin, poly ethylene glycol.
Function: aids in reducing the loss of moisture from the
tooth paste.
5) Flavoring agents:
Peppermint oil, spearmint oil. Oil of winter green
Function: They render the product pleasant to use and
leaves a fresh taste in the mouth after use.
6) Sweeteners and coloring agents:
Eg: saccharin
7) Anti bacterial agents: triclosan, delmopinol, metallic ions
8) Anti caries agents:
Sodium monofluoro phosphate, sodium fluoride, stannous
fluoride.
9) Active agents: fluoride
10) Anti calculus agents: Anti calculus are mostly designed
to inhibit the mineralisation of so called petrified plaque.

Eg: pyrophosphates, zn citrates

Desensitising agents:
sodium fluoride, potassium nitrate, strantium
chloride.
RECENT DEVELOPMENT IN DENTRIFICES:
Tooth paste for children
Natural tooth pastes(herbal)
Whitening tooth pastes
Breath freshening tooth paste.
Application of dentrifices
The amount of toothpaste or gel needed for
effective cleaning is a pea sized dab on the
top half of the toothbrush
The dentrifice should preferably dispersed
in between the bristles rather than on the tips
Children under 6yrs of age should only be
given half the amount
Disclosing agents
A disclosing agent is a preparation in liquid, tablet
or lozenge from which contains a dye or other
containing agent.
A disclosing agent is used for the identification of
bacterial plaque.
When applied to the teeth, the agent imparts its
color to soft deposits but can be rinsed easily from
clean tooth surface.
UTILITY OF DISCLOSING AGENTS:
Personalized patients instruction and
motivation.
Self evaluation by the patient.
To evaluate the effectiveness of oral
hygiene maintenances.
Preparation of plaque indices.
PROPERTIES:
A. INTENSITY OF COLOUR:
 A distinct staining of deposits should be evident.
 Color should contrast with normal colors of oral
cavity.
B. DURATION OF INTENSITY:
 The color should not rinse off with ordinary
rinsing methods, or be removable by saliva.
 It is desirable for color to be removed from
gingival tissue and lips as patient might react to
color retained for a long period of time.
C. TASTE:
The patient should not be made uncomfortable by
an unpleasant or highly flavored substance.
The main reason to use is to motivate the patient .

D. IRRITATION TO THE MUCOUSMEMBRANE:

The patient should be questioned concerning the
possibility of an idiosyncrasy to an ingredient.
E. DIFFUSABILITY:
A solution should be thin enough, so that it
can be readily applied to exposed surface of
teeth.

F. ASTRINGENT AND ANTISEPTIC

PROPERTY:
These properties may be highly desirable.
A disclosant may inhibit the growth of
microorganisms.
AGENTS USED
A) iodine preparations
B) Mercurochrome preparation
C) Bismarck brown (easlick’s disclosing
agent)
D) Merbromium
E) Erythrosine: FD & C No 3
F) fast green: FD &C green No 3
G) Fluoresin:FD & C yellow NO 8
APPLICATION OF DISCLOSING AGENTS
• The disclosing solution may be directly
applied onto the tooth surface using
cotton pellets or it may be rinsed after
proper dilution.
• The tablets and wafers may be chewed
for 30-60 sec and rinsed.