Dental Products

Dental Plaque
Dental Plaque is a whitish soft accumulation of bacteria and their substrate which deposits on the teeth while not cleaned adequately.

Plaque Formation
Plaque formation does not take place haphazardly, but in a reasonably orderly manner. A pellicle derived from the saliva gingival fluid first forms on the teeth. This pellicle is a thin clear cuticle and is composed mainly of glycoproteins. Very soon after its formation, bacteria of the coccus type (streptococci largely) are attached to the pellicle which has a sticky surface, i.e. one which enables colonies of organisms to be anchored. These organisms divide and form colonies.

Plaque Formation (cont.)

Attachment of the microorganisms is further enhanced by the production of dextrans by the bacteria as by products of metabolic activity. Later other types of organisms are attracted to the mass and a dense mixed flora of filamentous forms i.e. plaque results. Plaque may attach to the teeth supragingivally or subgingivally in the gingival crevice or in peridontal pocket.

Antiplaque agents
Antiplaque agents are the agents or drugs that are used to prevent or inhibit the plaque formation in the mouth e.g. chlorohexidine, povidone iodine etc.

Antiplaque agents (cont.)

Ideal properties of an antiplaque agent: It should be nontoxic, non allergic and non irritating. It should have a broad spectrum of antimicrobial activity. It should specifically affect only the pathogenic flora. It should not have any induced drug resistance. It should have an acceptable taste. It should possess sufficient chemical stability, so that it can be stored for a reasonable length of time. It should be of low price and available.

Chlorohexidine
Chemistry: It is a chlorophenyl bis biguanide that has been used as the acetate and more commonly the gluconate salt in mouth rinses, gel and dentifrice for control of plaque and gingivitis. It is highly cationic antiseptic. It has fungicidal activity and bactericidal action against both gram positive and gram negative microorganism.

Chlorhexidine (cont.)
Mechanism of action: Due to its high cationic nature, chlorhexidine binds the anionic groups on the bacterial surface, i.e. Phosphate group of techoic acid in gram positive bacteria and phosphate group of lypopolysaccharides in gram negative bacteria. When the bis biguanide binds to the organism, the cell membrane becomes permeable allowing the cytoplasmic contents to leak out of the cell. At higher concentration, chlorhexidine causes precipitation of cytoplasmic proteins.

Chlorhexidine (cont.)
Mechanism of action (cont.): By virtue of their cationic properties, the bis biguanide also bind electrostatically to the hydroxyapatite of teeth and forms pellicle (film or surface) against plaque and to buccal mucosa. This is how it acts as an antiplaque agent.

Chlorhexidine (cont.) Uses: Chlorhexidine is used in the following vehicles: Mouth rinses:
a) 0.12% chlorohexidine gluconate solution is used as a mouthwash for oral hygiene and oropharangeal infections, especially apthus ulcers. b) 0.2% chlorhexidine gluconate solution prevents the accumulation of plaque. It is absorbed on to tooth enamel, where it exerts a persisting action to decrease the growth.

Irrigator:
400 ml of a 0.2% solution of chlorhexidine solution (80mg totally) applied once daily in an oral irrigator will give complete plaque inhibition.

Chlorhexidine (cont.) Gels:

1% gel of chlorhexidine gluconate applied for a period of five minutes, once or twice a day is effective in the inhibition of bacterial plaque particularly in the treatment of denture somatities(set of artificial teeth).

Antiseptics:
4% aqueous solution of chlorhexidine is effectively used as a surgical scrub, it decreases the cutaneous bacterial population more than either hexachlorophene or povidone iodine.

Chlorhexidine (cont.)
Clinical indication: Short time application a) Healing phase in peridontal surgery
b) Healing phase in oral surgery i. Mandibular fracture ii. Third molar extraction c) Pre surgical use to reduce bacterema (bacteria in blood) d) Therapy for apthus ulceration e) Therapy for denture somatities f) Therapy for acute necrotizing ulcerative gingivities.

Intermediate short term applicationa) Repeated denture somatities b) Adjunct to periodontal maintenance care c) Dental implant.