Chemical

plaque
control
Prepared by:
Kanza akbar
Iqra riaz
 Topics to be covered:
 Chemicals included in 3 generations of
chemical plaque control agents..
 Their:
 Mechanism of action
 Uses or indications
 Adverse effects
 Dentrifrices
 Properties of an
ideal antiplaque agent
1.Should eliminate only the pathogenic bacteria

2.Should not stain teeth or alter taste

3.Prevent gingivitis and colonization of

microorganisms
 CLASSIFICATION:

CHEMICAL PLAQUE
CONTROL AGENTS
FIRST GENERATION
e.g.: antibiotics, phenol,quarternary
ammonium compounds & sanguinarine

SECOND GENERATION
e.g.:Bisbiguanides,(chlorhexidine)

THIRD GENERATION
e.g: delmopinol
FIRST GENERATION AGENTS

 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
IT is included in tooth paste to reduce plaque
formation
Used along with Zinc citrate to enhance its
retention with in the oral cavity
• Triclosan delay plaque formation
• It inhibits formation of prostaglandins &
leukotrienes there by reduces the chance of
inflammation
• DISADVANTAGE
• Toxicity against infant dermal fibroblast
 eg: Zn & Cu ions
in form of zn citrate and zinc sulphate

MECHANISM OF ACTION

It reduces the glycolytic activity in bacteria &

delays bacterial growth… so have ihibitory effect
on plaque formation…
 ADVANTAGES
• EASY to handle & apply
• Effective in hard water

 DISADVANTAGES
• Effective over a limited PH range
• Needs alkalanity
• Metal ion leakage leads to protein loss
Quaternary ammonium
compounds:
Cationic antiseptics & surface active agents
Effective against gram positive organisms

 MECHANISM OF ACTION:

It reacts with negatively charged cell membrane

phosphates and cell wall structure of
microorganism is disrupted.
 EXMPLES:
Benzethonium chloride, cetylpyridinium etc
ADVANTAGES
• Pleasant odour
• Economical
• Non irritating

• DISADVANTAGES
• Inactivated by organic matter
• Easily inactivated by presence of soaps ,anionic
detergent & hard water
 SANGUARINE:

• It is a natural alkaloid
• It is most effective against gram –ve organisms
• Used in mouth rinse and dentrifices
• Often augmented with zinc chloride
• Reduces plaque by 17%-42% and gingivitis by
18%-57%
MECHANISM OF ACTION:
• Ability to inhibit bacterial adherence to newly
formed pellicle
 ADVANTAGES
• Ease to disclose plaque with UV light

• High specificity

DISADVANTAGES

• Causes a burning sensation when used

intially
ANTIBIOTICS

• Vancomycin (red man syndrome)

• Erythromycin
Nidamycin
• Kanamycin
• Penicillin(rashes,hepatitis,nepritis,git
disturbances)
• Spiromycin…
• Tetracycline not used now…
• Due to bacterial resistance problems the use of
antibiotics has been reduced
 PHENOLS:
• Action depends upon its ability to penetrate the lipid
component of the cell walls of gram negative organisms…
• Example includes listerine is a phenol containing mouth wash,
used widely
• LISTERINE contains:
• Thymol
• Eucalyptol
• Menthol
• Methylsalicylate
• Used as antiseptic oral rinse
• Reduce plaque reduction and gingivitis by 34% when used
twice per day after brushing
 ENZYMES:
• Has been used as active agents in
antiplaque agents
• it is due to the fact that enzymes would
be able to breakdown already formed
matrix some plaque and calculus thus
dislodging bacteria from tooth surface
• Some are protelytic and bactericidal
action
• e.g. mucinase, mutanase, dextranase etc
DISADVANTAGES
POOR
SUBSTANTIVITY

MUCOSAL
EROSION

NOT TRULY
ANTIMICROBIAL
 SECOND GENERATION:

BISBIGUANIDES

• Considered to most effective antiplaque

agents.

• Second generation agents exhibiting

substantivity and broad antimicrobial
properties.
CHLORHEXIDINE GLUCONATE
• It is a cationic
bisbiguanide
• Effective against gram
+ve, gram –ve
organisms, fungi,
yeasts and viruses
• Exhibit antiplaque &
antibacterial properties
• Mainly available in 3
forms: digluconate,
acetate & HCl salts
 CHLORHEXIDINE:
 It is used due to its dicationic nature, binds
to enamel pellicle or tooth surface and
salivary proteins. This adsorbed mouth wash
is released over a period of time.
Mode of delivery:
 mouth rinse
 gels
 tooth paste
 dental floss
 tooth picks.
 CHLORHEXIDINE:
• Plaque reduction by 50-55%
• Gingivitis reduction by 45%
• Used as 15ml rinse for 30sec twice per day..
• 0.12% U.S.A and 0.2% outside U.S

• Patients should be advised to allow at least 30

minutes to lapse between use of a dentifrice and
rinsing with chlorhexidine.

Interactions of chlorhexidinewith sodium

lauryl sulfate and fluoride contained in the
dentifrice may reduce its effectiveness.
 CHLORHEXIDINE:
• Chlorhexidine exhibits the quality of
substantivity.

• Wound healing is enhanced when

chlorhexidine rinses are used before
extractions
 MECHANISM OF ACTION
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 –

 It causes precipitation of bacterial cytoplasm so cell
death.
 It shows two actions
• Bacteriostatic at low
concentrations
• 1.Bacterial cell wall(-ve
charge)
• 2.Reacts with +ve
Antibacterial charged chlorhexidine
action of molecule
chlorhexidine • 3.Integrity of cell
membrane altered
• 4.chlorhexidine binds to
inner membrane
phospholipids & increase
permeability
• 5.Vital elements leak out
& this effect is reversible
BACTERIOCIDIAL ACTION:
• Progressive damage to membrane
• Large molecular compounds are lost
step1
• Free chlorhexidine enters the cell
and coagulate the proteins and
Step2 cytoplasm

• Vital cell activity ceases leading

step3 to cell death…
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 chlorhexidine to bacterial
capsule or glycocalyx and prevents them
binding on to tooth surface.
• Chlorhexidine competes for Ca ions which are
required for agglutination of plaque.
INDICATIONS:
1.Cases of excessive formation of
plaque
2.Prevention in the treatment of
gingivitis
3.People with difficulty performing
normal dental hygiene
4.Mouthwash before and after
surgery
5.Prevention of dental caries
ADVERSE EFFECTS OF
CHLORHEXIDINE
Brownish staining of tooth or
restorations

Loss of taste sensation

Hypersensitivity( rare)

Stenosis of parotid duct

oropharyngeal cancer
 Third generation
Delmophenol:
 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

Staining of tooth & tongue

Taste disturbances

Mucosal soreness & erosion

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
a. Iodine preparations
• Skinners iodine solution
• Diluted tincture of iodine
b. Mercurochrome preparations
• Mercurochrome soln 5
• Flavored mercurochrome disclosing solution
c. Bismark brown
d. Mebromin
e. Erythrosine
f. Fast green
g. Fluoresin
h. Two tone solutions
i. Basic fuschin
Dentifrices:
• is defined as a substance used with a
toothbrush for the purpose of cleaning
the accessible surfaces of the teeth.
• Available as tooth powders,tooth
pastes’liquids and gels.
• Used mostly in the form of pastes.
• Either cosmetic or therapeutic.
 Composition:
Abrasives 20-40 %

Water 20-40%

Humectants 20-40%

Foaming agent 1-2%

Binding agent 2%

Flavoring & sweetening agent 2%

Therapeutic agents 2%
 Abrasives:
are insoluble salts enhance abrasive action of
toothbrushing as mush as 40 times.
Tooth powders are more abrasive than pastes
and contain about 95% abrasive material.
e.g;silicon oxide,aluminium oxide,granular
polyvinyl chlorides
Abrasive often dull the tooth luster so polishing
agents are usually added
Small sized particles of
aluminium,calcium,tin,magnesium or zirconium
are used as polishing agent.
The abrasive quality of dentifrices affects
enamel only slightly,dentine is abraded 25
times faster and cementum 35 times faster
than enamel.
 Humectant:
added to maintain moisture.also helps to
maintain consistency of paste.
Sorbitol,mannitol and propylene glycol.
 Foaming agent (soaps
and detergents)
Stable,possess some anti-bacterial
properties,and low surface tension.
Sodium lauryl sulphte and sodium N-
lauroyl sarcosinate
 Flavouring agents:
 pleasant,immediate taste sensation and long
lasting flavour
 Binding agent:
hydrophilic collides disperse or swells in presence
of water,used to stabilize formulations by preventing
separation of the liquid and solid phases.
e.g:natural gums(Arabic,tragacanth),seaweed
collides(alginates) and synthetic
cellulose(carboxymethyl cellulose and
hydroxylmethyl cellulose.

 Sweetening agent:
Saccharin,Sorbitol and Mannitol.
 Therapeutic agents:
flourides and pyrophosphates
Flourides provide caries prevention function.
Flourides 1000-1100 ppm,to achieve caries
reduction effects

 Pyrophosphates :
containing toothpastes are referred as “calculus
control toothpastes” or “tartar containg
toothpastes”
•These ingredients interfere with crystal formation
in calculus
•Reduce formation of new supragingival calculus by
30% or more
•Do not affect subgingival calculus formation.
 Preservative:

benzoic acid is used

as preservative to
prevent microbial
contamination of
dentifrices.