CHEMICAL PLAQUE

CONTROL
 DENTAL PLAQUE
Definition: It is defined as a highly specific
variable structural entity formed by sequential
colonization of micro-organisms on the tooth
surface epithelium & restoration.
 PLAQUE CONTROL:-

• Removal of the microbial plaque & the

prevention of the
plaque accumulating on the teeth and
adjacent gingival
tissues.
• Plaque It also
control deals
is an withmethod
effective prevention of
of treating
as well as
calculus preventing PDL diseases.
formation.

• It is the primary level of prevention of

periodontal disease and caries.
 METHODS OF PLAQUE
CONTROL

Mechanical Chemical
CHEMICAL
PLAQUE

CONTROL
 IDEAL REQUISTES OF ANTIPLAQUE AGENTS :-

 It should significantly reduce plaque &

gingivitis.
 Should prevent growth of pathogenic
bacteria.
 Should prevent development of
resistant bacteria.
 Should be compatible with oral tissues.
 Should not stain teeth or alter taste.

 CLASSIFICATION
Based on substantivity

1st generation
• Capable of reducing plaque spores about 20-50%
• Exhibit retention in mouth.

eg. 1. Antibiotics
2. Phenols
3. Quaternary ammonium compounds.
4. Sanguanarine
2 nd
generation
• Produce an over all plaque
reduction about 70- 90%

• are better retained by oral tissues

& exhibit slow
release properties.

eg. Bis-biguanides
Chlorhexidine
3rd generation

• Block binding of micro-organism to

the tooth.

eg. Delmopinol
 Classification of chemical
agents

• Antibiotics
• Phenols
• QAC
• Biguanides
• Enzymes
• Metallic salts
• Herbal extracts
• Amino alcohols
• Other surfactants
Vehicles for delivery of chemical
agents.
• Tooth Paste
• Mouth rinses
• Irrigative
• Chewing gum
• Varnishes
• Gel
• Lozenges
• Dentifrices
 Aims

 Inhibits microbial colonization.

 Prevent subsequent plaque
development
 Elimination / dissolution of
plaque.
 Inhibition of plaque
calcification.
 1st Generation Agents

Antibiotics:

• Penicillins
• Tetracycline
• Vancomycin
• Kenamycin
• Erythromycin
• Niddamycin
• Spiromycin
• Metronidazole
Mechanism of Action
Bactericidal or bacteriostatic action.

Limiting factors of systemic drug therapy.

Hypersensitivity reduction to penicillin

toxicity.
Bactericidal resistance
 Phenols Related
essential oils
eg. Triclosan
Listerine

25-35% - plaque reduction

Mechanism of action :

• Cell wall disruption + inhibiting of bacterial

enzymes.

Listerine compounds:

• Thymol + mixed with menthol and

methylsalicylate, Benzoic acid and basic acid in
Triclosan:-

• has recently been introduced in

toothpaste & mouth rinses along with
zinc citrate with the copolymer of
gantrez to enhance its retention within
the oral cavity.

• It can delay plaque maturation & also

inhibits formation of prostaglandins +
leukotriens.
Quaternary ammonium compounds :
eg. Benzathonuim chloride
Benzalkonium chloride
Acetyl pyridinium
They are cationic, antiseptics & surface active
agents.

Side effects:

• burning sensation of oral mucosa

• brownish discoloration of teeth
• recurrent ulceration
• discoloration of tongue
Mechanism Of Action:

Molecules have net positive charge

interact with negatively charged
cell membrane phosphates
resulting in rupture of cell wall
structure & increase its
permeability.
 Sanguanarine
(Natural products/ Herbal extracts)

• It is benzophenanthradine alkaloid found in

commercial mouth rinse paste.

Mechanism of action:
Inhibiting the growth of bacteria.

• pH is 4.5 and alcohol content of 11.5%

 Metal salts
Zinc Salts
Tin Salts (Stannous fluoride)
Sodium fluoride
Copper salts

Adverse effects
• Metallic taste
• Dryness of Mouth
• Yellow – brown discoloration of teeth and tongue

 Have a plaque inhibitory capacity as they reduce glycolytic

activity in micro-organisms & delayed bacterial growth.
 2 Generation :-
nd

Bisbiguanides:
eg. Chlorhexidine gluconate – 0.2 %
Alexidine
Cationic Chlorophenyl biguanide

• Suggested for oral use by Schroder in 1969

• pH – 3.5
• It is a cationic effective against gram +ve
,gram-ve, fungi, yeasts & viruses.
• Its superior action is due to its property of
sustain availability i.e. substantivity.
Mechanism Action

• It prevents pellicle
formation.
• It prevents adsorption
of bacterial cell wall on
to the tooth surface.
• It prevents binding of
mature plaque.
 Metabolism of Chlorhexidine Glauconate
Bacteriostatic Bactericidal
(Reversible effects )
(irreversible effects )
• Cationic Chlorhexidine molecule is
attached towards negatively • increase Conc. of chlorhexidine
charged bacterial cell surface & it
is adsorbed by phosphate
containing compounds.

• The cationic Chlorchexidine

• Coagulation + precipitation of
molecule added integrity of the cytoplasm by the formation
bacterial cell memb. enter into cell of phosphated complexes,
memb. adenosine phosphate & nucleic
acid.
• Permeability of inner memb will
increases & there will be leakage of
low molecular weight components.
Properties:
• Bacteriostatic at low conc.
• Bactericidal at high conc.
• It exhibits antibacterial activity for 5 hrs & supresses
salivary bacterial count for over 12 hrs. after a single
use.
• Plaque reduction upto 80-90%.
• Potent antifungal agent in oral cavity.

European Formula - 0.2%

USA Formula - 0.12%
 Adverse effects (chlorhexidine)

• Brownish staining of teeth & restoration which is

reversible.
• Has a bitter taste.
• Loss of taste sensation which is transient
• Painful desquamative lesions of the oral mucosa
with burning
sensation.
• Parotid swelling – rarely cause side- effects
• Condition subside in a few days by discontinuing the
mouth
wash.
• Rarely hypersensitivity.
 Enzym
es
• Used as active agents in antiplaque
preparations.
• Capable of breaking down the matrix of
already formed plaque were considered for
inhibition of plaque & calculus formation.

eg.: Mucinase
Dextranase
Mutanase
Dehydrated pancrease
 3rd Generation

Delomopinol:-

• Inhibits plaque growth – reduce gingivitis

• It interferes with plaque matrix formation
& also reduces bacterial adherence.
• It is indicated as pre- brushing mouth
rinse as it weakens binding of plaque to
the tooth surface.
Surfactants:

eg. Plax

• Commercial mouth rinse with surfactants

properties.
• It is a combination of anionic & ionic
surfactants inducing sodium lauryl
sulphate and polysorbate 20.
• Loosen the already formed plaque
• Indicated as pre-brushing mouth- rinse.