CHEMICAL
CHEMICAL
PLAQUE
PLAQUE CONTROL
CONTROL
PLAQUE CONTROL:-
• Removal of the microbial plaque & the prevention of the
plaque accumulating on the teeth and adjacent gingival
tissues. It also deals with prevention of calculus
formation.
• Plaque control is an effective method of treating as
well as preventing PDL diseases.
• It is the primary level of prevention of periodontal
disease and caries.
METHODS OF PLAQUE CONTROL
Mechanic Chemical
al
CHEMICAL
CHEMICAL
PLAQUE
PLAQUE CONTROL
CONTROL
CLASSIFICATION BASED ON
SUBSTANTIVITY
• Substantivity is defined as the ability of an agent to bind to
tissue surfaces and be released over time, delivering an
adequate dose of the active principle ingredient in the agent
• Thus the agent delivers sustained activity necessary to
confront bacteria attempting to colonize the tooth surfaces.
CLASSIFICATION
BASED ON SUBSTANTIVITY
1 ST
GENERATION
• Capable of reducing plaque spores about 20-50%
• Exhibit less substantivity.
eg. 1. Antibiotics
2. Phenols
3. Quaternary ammonium compounds.
4. Sanguanarine
2
ND
GENERATION
• Produce an over all plaque reduction about 70-
90%
• good substantivity
eg. Bis-biguanides
Chlorhexidine
3 RD
GENERATION
• Block binding of micro-organism to the
tooth.
eg. Delmopinol
CHEMICAL
WhyPLAQUE
is chemical
plaque control
CONTROL
necessary??????
RATIONALE OF CHEMICAL PLAQUE
CONTROL
TO OVERCOME
TO
INADEQUACIES
OF
MECHANICAL
CLEANING
CHLORHEXIDINE GLUCONATE
• 2nd generation antiplaque agent
• Chlorhexidine is a bis-biguanide with bacteriostatic and
bactericidal action
• Suggested for oral use by Schroder in 1969
• pH – 3.5
• Its superior action is due to its property of
SUBSTANTIVITY.
STRUCTURE
• It is a bisbiguanide antiseptic
• a symmetrical molecule consisting of 4
chlorophenyl rings and 2 biguanide groups
connected by a central hexamethylene
bridge
Substantivity:-
Chlorhexidine binds with hard and soft
tissues in the oral cavity
slowly released over time in a
concentration that is bactericidal.
Safety:-
Chlorhexidine seems to have a very low
level of toxicity and shows no permanent
retention in the body.
Spectrum Of Activity:-
The wide spectrum of activity emcompasses,
a. gram-positive bacteria
b. gram-negative bacteria
c. yeasts
d. some lipophilic viruses
PHARMACODYNAMICS
• Bacteriostatic:- at low concentration
alters the osmotic balance of the bacteria cell
it promotes release of low molecular weight
molecules [ potassium and phoshorous]
• Bactericidal:- at high concentration.
Coagulation + precipitation of the cytoplasm by the formation of
phosphated complexes, adenosine phosphate & nucleic acid.
cell death by cytolysis
MECHANISM OF ACTION
• 1. An influence on pellicle formation by
blocking the acidic groups on the salivary
glycoprotein, thus reducing the protein
adsorption on the tooth surface.
• 2. An influence on the adsorption of
plaque onto the tooth surface by binding to
the bacteria in sub-lethal amounts
• 3. An influence on the formation of
plaque by precipitating the agglutination
factors in saliva and displacing calcium from
the plaque matrix.
• BEING A DICTIONIC MOLECULE BINDS TO THE
BACTERIAL CELL WALL AND TOOTH SURFACE.
PHARMACOKINETICS
• At the end of single rinse with chx
mouthwash, around 30% of active
ingredient remains on the oral mucosa
and a negligible amount is swallowed.
• the saliva itself exhibits antibacterial
activity for up to 5 hrs
• whereas persistence at the oral mucosal
surfaces has been shown to suppress
salivary bacterial counts for over 12
hours
AVAILABLE PREPARATIONS
CHLOHEX 0.2%
PERIOGARD 0.12%
Clinical Applications Of
Chlorhexidine:-
• as an ADJUNCT TO ORAL HYGIENE and
professional prophylaxis.
• post oral prophylaxis and in periodontal surgery
or root planing.
• patients undergoing orthodontic treatment.
[Shaw et al 1984]
• oral malodour [Halita is the name of a mouth
rinse containing 0.05% of chlorhexidine, 0.05%
cetyl pyridinium chloride and 0.14% of zinc
lactate]
PATIENT USE INSTRUCTIONS
• After rinsing with 10 ml of 0.2% aqueous
solution of chlorhexidine for 1 min
• The usage is restricted in cases of anterior
composite restorations and glass ionomer
restorations.
• There should be a 30 minute lapse
between the usage of a dentifrice or food and
chlorhexidine mouth wash .
• Chlorhexidine molecule being dicationic
tends to bind with the anionic agents of
dentrifices leading to a reduction in the
substantivity of chlorhexidine mouthrinse.
ADVERSE EFFECT- TOOTH
DISCOLORATION
• Brown discolouration of the teeth, restorative
materials and yellow discoloration of tongue.
• The mechanisms proposed for CHX staining have
been proposed as:
• 1. Degradation of the chlorhexidine molecule to
release parachloraniline.(Addy and Roberts 1981)
• Catalysis of Maillard reactions:- Carbohydrates
and proteins , which adhere to the enamel surface
[ acquired dental biofilm] undergo a series of
condensation and polymerization reactions leading
to the formation of brown pigmented substances
known as melanoidins , giving the film a brownish
colour.
CHLORHEXIDINE ADS
(ANTI-DISCOLORATION SYSTEM )
• reducing and / eliminating pigmentation
associated with the use of chx based products
• by adding antioxidants such as essential oils ,
peroxyborate , polyvinypyrolidine , sodium
metabisulphite or ascorbic acid
• Interupts the millard reaction and interfering
with the pigmentation reaction comes from the
reduction of Fe III to Fe II thereby avoiding the
reaction between Fe III and SH groups.
• DISADVANTAGE:
• Hampers the activity of chx.
2. SUPPRESSION OF ORAL FLORA
• Long-term oral use resulted in a small shift in the flora
towards less sensitive organisms but the effect was
rapidly reversible after discontinuation of use (Schiott et
al 1976).
3. DRYNESS OF MOUTH
[Link] IMPAIRMENT OF TASTE ENSATION
5. UNI/BILATERAL SWELLING OF PAROTID
GLAND
REFERENCES
• CARRANZA ,CLINICAL PERIODONTOLOGY ,13TH
EDITION
• Chlorhexidine – An Insight. Nazam Lakhani and
*K. L. Vandana,International Journal of
Advanced Research (2016), Volume 4, Issue 7,
1321-1328
