Procedure by which plaque is removed
and prevention of occurrence of plaque
onto the surfaces of the tooth
CHEMICAL PLAQUE CONTROL
IDEAL REQUIREMENTS
Bral and Brownstein 1988
ELIMINATE PATHOGENIC BACTERIA ONLY
PREVENT DEVELOPMENT OF RESISTANT BACTERIA
EXHIBIT SUBSTANTIVITY
SAFE TO THE ORAL TISSUES AT THE DOSAGE AND
CONCENTRATION RECOMMENDED
SIGNIFICANTLY REDUCE PLAQUE AND GINGIVITIS
DO NOT STAIN TEETH OR ALTER TASTE
NO ADVERSE EFFECT ON TEETH OR
DENTAL MATERIALS
INHIBIT CALCIFICATION OF PLAQUE TO
CALCULUS
EASY TO USE
INEXPENSIVE
CLASSIFICATION
Based on antimicrobial efficacy and
relative substantivity (Kornman in
1986)
FIRST GENERATION
POOR RETENTION WITHIN MOUTH
REDUCES PLAQUE SCORE BY 20 -50%
Eg :ANTIBIOTICS,PHENOLS,QUATERNARY
AMMONIUM COMPOUND,SANGUINARINE
SECOND GENERATION
EFFECTIVELY RETAINED BY ORAL
TISSUES AND SLOW RELEASE PROPERTIES
REDUCES PLAQUE SCORE BY 70-90%
Eg BISBIGUANIDES
THIRD GENERATION
INTERFER IN BACTERIAL ADHESION
MILD ANTIBACTERIAL
Eg DELMOPINOL
FOURTH GENERATION
HYPOTHETICAL
INTRODUCTION OF MODIFIED OR
HANDICAPPED BACTERIA INTO ORAL
CAVITY WITH NO PATHOGENIC POTENTIAL
ANTIPLAQUE AND ANTICALCULUS
AGENTS
ENZYME : MUCINASE ,
MUTANASE,
DEXTRANASE
ANTIBIOTICS : PENICILLIN
VANCOMYCIN
ERYTHROMYCIN
PHENOLS: :THYMOL
QUATERNARY :BENZYLCONIUM CHLORIDE
AMMONIUM CETYLPYRIDIUM CHLORIDE
COMPOUND
BISBIGUANIDES : CHLORHEXIDINE
ALEXIDINE
BISPYRIDINES : OCTENIDINE
METALLIC SALTS : ZINC
TIN
COPPER
HERBAL EXTRACTS : SANGUINARINE
AMINOALCOHOLS : OCTAPINOL
DECAPINOL
OTHER SURFECTANTS : SODIUM
LAURYLSULPHATE
BISBIGUANIDES
Most effective antiplaque agent
2nd generation
Exhibit substantivity and antibacterial
properties
Includes CHX and Alexidine
CHLORHEXIDINE
As antiplaque and anticalculus
suggested by Schroeder in 1969.
2nd generation bisbiguanide
Substantivity and antibacterial
Bactericidal and bacteriostatic
Mechanism of action
Electrostatic forces between negatively charged
cells and positively charged CHX molecule
Access to the cell membrane- disorientates
lipoprotien structure, causing destruction of the
osmotic barrier of the bacterium
Cell permeability increases and intracellular
components such as potassium ions leak through
the damage membrane - BACTERIOSTATIC
If concentration of CHX increases cause
intracellular coagulation, slows down the
leakage of cell contents - BACTERICIDAL
INDICATIONS
As an adjunct to mechanical plaque control
After surgical procedures like flap surgery,
gingivectomy
Fixed orthodontic appliances or
intermaxillary fixation
Handicapped patients
Medically compromised pt eg Radiotherapy
High caries risk patients
Drug induced gingival enlargements
Local oral infections such as denture induced
stomatitis, apthous ulceration, dry sockets,
etc
Implant cases
Long stay hospital patients
Acute inflammatory procedure like ANUG
Pre procedural use.
SIDE EFFECTS
DARK YELLOW OR BROWNISH STAIN
IMPAIRMENT OF TASTE SENSATION
PAINFUL DESQUAMATIVE LESIONS ON THE
ORAL MUCOSA ASSOCIATED WITH BURNING
SENSATION
UNILATERAL OR BILATERAL PARITID SWELLING
ENHANCED SUPRAGINGIVAL CALCULUS
FORMATION
MODE OF DELIVERY
MOUTH RINSE
GELS
SPRAY
FLOSS
PERIOCHIP
VARNISH
CHEWING GUMS
DENTIFRICES
CERTAIN COMMERCIAL PRODUCTS AND
COMBINATION
Colgate Total–0.3%Triclosan
+2%copolymer+0.243%NaF
AM PM—Triclosan +zn
Prudent—Sodium benzoate
Cepacol—0.05% CPC
Brite smile—H2O2
Clohex,hexidine, peridex, perioguard,gingigel—
CHX
Meridol—amine fluoride+ SnF2
Veadent—sanguiranine
Listerine mixture of esential oil—Fresh burst
Crest Prohealth—nonalcohol based mouth
rinse
Sinclair mouth rinse--delmopinol
CHLORHEXIDINE IS AVAILABLE AS :
0.2% w/v chlorhexidine gluconate—10 ml for 60
sec.
0.12% w/v chlorhexidine gluconate—15ml for 30
sec
