DISCLOSING AGENTS in dentistry ptx

different disclosing agents used in dentistry for plaque detection.

1. DISCLOSING AGENTS

2. INTRODUCTION

3. Certain Terminologies Soft deposits: Acquired pellicle Bacterial plaque Materia Alba Food debris Hard deposit: Calculus

4. Acquired Pellicle It is a homogenous, organic, translucent, thin film layer that forms over exposed surfaces. It is cellular, free from micro-organisms until plaque begins to collect on it. It is derived from: Saliva – supragingival GCF – subgingival

5. Bacterial Plaque Also called microbial or bacterial dental plaque, it is organized masses of micro-organisms held together by a gel-like inter-microbial matrix. It forms - on acquired pellicle - on the teeth - on other oral surfaces - in the gingival sulcus & pockets Water irrigation removes only the outer layer.

6. Plaque: as defined by WHO A specific but highly variable structural entity formed by the colonization & growth of micro-organisms of varying strains & species that are embedded in an extracellular , gelatinous, homogenous matrix, which accumulates on the surface of teeth, gingiva & other restorations.

7. Composition of plaque Organic constituents: Polysaccharides ,Proteins , Lipids , Glycoprotein. Inorganic constituents: Calcium ,Phosphorous ,Sodium, Potassium ,Fluorides. Water: 70% - 80%. 20% - 30%

8. Materia Alba Loosely adherent unstructured white or grayish mass of oral debris & bacteria that lies over bacterial plaque. It can be removed by vigorous rinsing and water irrigation.

9. Food debris Derived from food retention, it is unstructured, loosely attached particulate matter. This debris gets removed by: - self-cleansing activities of the tongue & saliva - vigorous rinsing of the mouth

10. Hard Deposit Calculus: Calcified bacterial plaque, hard tenacious mass that forms on - the clinical crowns of the natural teeth - dentures - other appliances

11. Plaque retention factors Orthodontic Appliances Partial Dentures Malocclusions Faulty Restorations Calculus Deep Pockets Gingival craters following destructive gingival disease. Lingual surfaces and posterior facial areas Open or poor contacts

12. Disclosing agent A disclosing agent is a preparation in liquid, tablet or lozenge form that contains a dye or other coloring agent. These are solutions and wafers capable of staining bacterial deposits on the surfaces of teeth , tongue and gingiva. (Carranza 6 th edition)

13. Raybin (1943) defined a disclosing solution as “ A solution which when applied on teeth, makes visible by staining roughness and foreign matter on the teeth. Foreign matter includes plaque, materia alba, calculus.

14. Purposes Disclosing agent clearly demarcates soft deposits that otherwise invisible and thus facilitates : Personalized patient instruction in the location of soft deposits and techniques for removal. Self evaluation of patient on daily basis during initial instructions and periodic checks thereafter.

15. Continuing evaluation of the effectiveness of the instruction for the patient: - To study long term effects over successive maintenance appointments. - To determine the need for revisions of the plaque control procedures Preparation of plaque indices. Further research studies.

16. Properties of a disclosing agent Intensity of the color: - Distinct staining of deposit should be evident. - The color should contrast with normal colors of oral cavity.

17. Duration of intensity : - The color should not rinse off immediately with ordinary rinsing method or removed by saliva for period of time required. - It is desirable for color to be removed…..

18. Taste: - The patient should not become uncomfortable by an unpleasant or highly flavored substance. - The chosen agent should be pleasant, encouraging cooperation. Irritation to the mucous membrane : - Possibility of allergy by an ingredient of a disclosing agents ……availability of more than one disclosing agent.

19. Diffusibility : - Solution should be thin enough so that it can be applied readily to the exposed surfaces of teeth. - And also thick enough to impart an intense color to bacterial plaque. Antiseptic properties: - Antiseptic disclosing agent serve a dual purpose. In quantitative plaque research studies……

20. Different formulae A wide variety of disclosing agents have been used. Skinner’s iodine solution was widely used earlier. Aniline dyes have been shown to have carcinogenic potential. So the use of basic fuchsin and beta rose (flavored basic fuchsin ) are discouraged.

21. Iodine preparation: - Skinners solution Iodine crystals - 3.3 gms. Potassium iodide - 1.0 gm. Zinc iodide - 1.0 gm. Water (diluted) - 16.0 ml. Glycerin - 16.0 ml. - Diluted Tincture of iodine Tincture of iodine - 21.0 ml. Water ( distilled) - 15.0 ml.

22. Iodine based solutions: Advantages - Plaque is stained deeply brown or black, and associated gingiva also shows up as dark areas - Discoloration disappears in few minutes, very useful in clinical photography. - Low cost. Disadvantage - Possibility of allergy to iodine; taste unacceptable.

23. Mercurochrome preparations: - Mercurochrome solution – (5%) Mercurochrome - 1.5 gm. Water (Distilled) - 30ml - Flavored mercurochrome disclosing solution Mercurochrome - 13.5 gms. Water ( distilled) - 3.0 ml. Oil of peppermint - 3 drops.

24. Bismark Brown – (Easlicks Disclosing solution) Bismark Brown - 3.0 gms. Ethyl alcohol - 10.0 ml. Glycerin - 120.0ml. Anise (Flavoring agent) - 1 drop

25. Merbromin Merbromin NF - 450 mg. Peppermint oil - 1 drop Distilled water - 100 ml. Fast Green F. D. & C Green no. 3 - 5 %

26. Erythrosine : - Concentrate (for rinsing) F.D. C. Red no. 3 or no. 28 - 6.0 gms. Water - 100 ml. - For direct topical application Erythrosine - 0.8 gms. Water ( distilled) - 100 ml. Alcohol (95%) - 10.0 ml. Oil of peppermint - 2 drops

27. Erythrosine : Tablets and Wafers F.D.& C. Red no. 3 - 15.0 mg. Sodium Chloride - 0.747% Sodium Succaryl - 0.747% Calcium stearate - 0.995% White oil - 1.124% Flavouring - 2.239% Sorbitol to make a ‘7’ grain tablet.

28. Erythrosine Red Advantages - It fades in brief time. - Does not disclose composite type of restorations permanently. - Does not permanently stain clothing or dental equipment. - Does not have any known possible adverse side effects that iodine or mercury stains may have.

29. Flourescin: - F.D.& C yellow no. 8 ( used with a special ultra violet light source to make the agent visible.) Plak-lite :- According to John O. Forrest. - Consists of a small lamp which gives a white light through a special dichrotic filter. - Two drops of the Fluorescin based solution is introduced into the mouth and patient should instruct to swish it with the saliva all around the mouth. - This indicator fluid has a special affinity for plaque but is invisible: light making it fluoresce with a greenish yellow glow.

30. Two tone solutions: F.D.& C. Green no: 3 F.D.& C. Red no: 3 e.g. Alpha-Pac. (DPI), Plaque-C.(ICPA) - Thicker older plaque stains blue. - Thinner plaque (newer) plaque stains Red or pink.

31. Basic fuchsin : 6 gms. Ethyl alcohol (95%) 100 ml. Add two drops of solution to water. In 1962 Quigley and Hein used basic fuschin mouth wash as as disclosing agent for measurement of plaque. (Quigley-Hein plaque index.)

32. Methods of application Gingival tissue evaluation should be done before application because disclosing agent will mark tissue colors. 1. Solution for direct application : Dry the teeth with air , retract cheek and tongue. Use small cotton pellet to carry solution to teeth. Apply solution to crown of the teeth only.

33. Examine the distribution of the agent and request patient to rinse if indicated. 2. Rinsing : A few drops of concentrated preparation should be appropriately diluted. Instruct the patient to rinse and swish the solution over all the tooth surfaces.

34. 3. Tablets and wafer: Patients should chew the wafer and tablet. Swish it around for 30 to 60 seconds and then rinse. Effect: Clean tooth surface do not absorb the colouring agent or dye. When pellicle and bacterial plaque are present, they absorb the agent and are disclosed.

35. Pellicle stains as thin, relatively clear covering and plaque appears darker , thicker and more opaque. The oral mucous membrane and lips may retain the color from certain disclosing agent so application of petroleum jelly is advisable.

36. Mechanism of Action of a Two Tone Plaque Disclosing Agent Disclosing solutions which differentiate between new and old plaque have distinct advantage. A Two- tone dye solution developed by Block & Lobene, and Derdivanis contains dyes F.D. C. Red no. 3 , F.D.& C. Green no.3 ……. old plaque blue or blue-purple and new plaque red or pink .

37. Old plaque New plaque

38. REFERENCES Disclosing agent – A review JISP.1998. Carranza - 6 th , 8 th edition. Bacterial plaque disclosure survey. ( J.P. 1974 vol.45, No. 6., pg 439- 443) Mecahanism of action of a two-tone plaque disclosing agent. (JP 1977, vol.47, 7: 395-396) Aggregation of plaque disclosing agent in a dentifrice  J. Appl. Oral Sci. vol.12 no.2 Bauru Apr./June 2004

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