Chemical Plaque Control Flashcards
Chemicals interfere at various stages of development of plaque
- Microorganisms responsible for plaque formation may be eliminated or reduced in number.
- The formation of bacterial and salivary products which constitute the antimicrobial substance in plaque may be inhibited.
- Established plaques may be dissolved.
- Calcification of plaque may be counteracted.
- Colonization of bacteria on the tooth surface may be inhibited
- Pathogenicity of plague may be reduced by interference with the metabolism of plaque bacteria.
Ideal requisites of a chemical anti plaque agents
- Should significantly reduce plaque and gingivitis.
- Should prevent growth of pathogenic bacteria.
- Should prevent development of resistant bacteria.
- Should be compatible with the oral tissues.
- Should not stain teeth/ alter taste.
- Should exhibit good retentive properties (Substantively).
- Should be inexpensive and easy to use.
Talk about Therapeutic mouth rinses
- A mouth rinses may be defined as a substance that is swished around the oral cavity and the expectorated in order to freshen the mouth and breath.
- Therapeutic mouth rinses can be defined as a formulation containing a drug substance and used to transfer this drug substance to hard and soft tissues of the oral cavity in order to reduce the incidence of plaque, caries, calculus and gingival diseases.
- The first therapeutic, anti-caries mouth rinse to be used extensively was 0.2% sodium fluoride rinse
To date, two agents have been accepted by the American Dental Council Therapeutics in September 1986, for the treatment of gingivitis:
- Bis Biguanides (Chlorhexidine mouth wash).
2. Phenols (Essential oil mouth wash or Listerine).
Talk about Chlorhexidine gluconate (0.2%)
- Is a cationic bisbiguanide which is effective against an array of microorganisms, including gram +ve, _ve organisms, fungi, yeasts and viruses.
- Chlorhexidine exhibits both antiplaque and anti bacterial properties.
- Plaque reductions of 45 to 61% and gingivitis reductions of 27 to 67% was noted by use of it.
- However, there are local reversible side effects like brown staining of teeth, tongue, silicate resin restoration and transient impairment of taste perception.
- It has a very low systemic toxic activity in humans, but is not associated with any teratogenic alterations. Hence supervised intermittent short-term use of CHX can be recommended for the control of plaque.
Chlorhexidine shows different effects at different concentrations. i.e
a) Bacteriostatic at low concentrations.
b) Bacteriocidal at high concentrations.
After a single rinse with CHX, saliva itself exhibits antibacterial activity for about 5 hours, and suppresses salivary bacterial counts for over 12 hours.
Following several rinses of CHX, number of aerobic and anaerobic species in saliva can be reduced by 8090%.
L is herine and other products
Listerine Listerine or essential oil mouth wash, a phenolic compound was also used. Plaque reductions of 20 to 35% and gingivitis reductions of 25 to 35% have been reported.
Several other products also were tried like:
Antibiotics- penicillin, kanamycin, erythromycin, vancomycin is a bacterial antibiotics and is poorly absorbed after oral dose. It was found to be quite effective in hospitalized patients for control of plaque formation.
Enzyme preparations- Mucinase, dextranase, ect. Enzymes capable of breaking down the matrix of already formed plaque were considered for inhibition of plaque and calculus formation.
benzethonium chloride and Metallic salts
benzethonium chloride, ect. These are cationic antiseptic and surface active charge, which reacts with the negatively charged cell membrane phosphates and the cell wall structure of microorganism is disrupted.
Metallic salts- zinc sulphate and zinc citrate have been found to have inhibitory effect on plaque formation
Disclosing agents
Is a preparation in liquid, tablet or lozenge from which contains a dye or other contouring agent and is used for the identification of bacterial plaque, which might otherwise be invisible to the naked eye.
Utility of disclosing agents
- Personalized patient instruction and motivation.
- Self-evaluation by the patient on a daily basis. To evaluate the effectiveness of oral hygiene maintenances.
- Preparation of plaque indices.
- In research studies with regard to effectiveness of plaque control devices like tooth brushes and dentifrices etc
Ideal properties of Disclosing agents?
Ideal properties Intensity of color: The color should contrast with normal colors of oral cavity.
Duration of intensity: The color should not rinse off immediately.
Taste: It should be pleasant and encourage cooperation of the patient.
Irritation to mucous membrane: It should produce no irritation or allergic reaction.
Diffusibility: A solution should be thin enough so it can be applied readily to the exposed surfaces of the teeth.
Methods of application Disclosing agents?
Method of application
a) Dry teeth with compressed air.
b) Retract check or tongue.
c) Use swab or small cotton pellet with cotton plier to carry the solution to the teeth.
d) Apply solution to the crowns of the teeth only.
e) Direct the patient to spread the agent over all surfaces of the teeth with the tongue.
Method of application
a) Dry teeth with compressed air.
b) Retract check or tongue.
c) Use swab or small cotton pellet with cotton plier to carry the solution to the teeth.
d) Apply solution to the crowns of the teeth only.
e) Direct the patient to spread the agent over all surfaces of the teeth with the tongue.
Application of Disclosing Agents
The disclosing solution may be directly applied on to the tooth surface using cotton pellets or it may be rinsed after proper dilution.
The tablets and wafers may be chewed, swished around the mouth for 30 to 60 seconds and rinsed.
When applied to the teeth, the agents imparts its color to soft deposits but can be rinsed easily from clean tooth surfaces.
Instruction to patients disclosing agent
Instruction to patients
- Patients need to be informed about bacterial plaque composition and effect of plaque in the production of gingival and periodontal infections.
- Patient should be shown about the location and distribution of plaque on lingual surfaces and posterior facial areas.
- Techniques of daily plaque instructed to the patients
Disclosing Agents e.g. (iodine solution preparations) form an important aspect of plaque control by staining plaque and aiding the patient in developing an efficient system of plaque control.
Objectives of plaque control
Objectives of plaque control
- The objective of oral hygiene is to reduce the number of microorganisms on the teeth.
- One of the causes of halitosis may be removed.
- Gingival stimulation (massage) may play a role in increasing gingival tone, surface keratinization, gingival vascularity and gingival circulation
