Mouthwashes in oral lesions

MOUTHWASHES IN A GLANCE

1. MOUTHWASHES IN ORAL LESIONS KAUSTAV TARAN MCODS,MANIPAL FINAL YEAR BDS 1

2. DEFINITION A medicated liquid used for cleaning the oral cavity and treating mucous membranes of the mouth, may contribute to surface softening and increased wear of dental resins and composite materials. 2

3. CLASSIFICATION ANTISEPTIC MOUTHWASHES- CHLORHEXIDINE, LISTERINE MOUTHWASH. ANALGESIC MOUTHWASH- BENZYDAMINE, LIDOCAINE MOUTHWASH. ANTICAVITY MOUTHWASHES- FLUORIDE RINSE. ANTIALLERGIC MOUTHWASHES- BENADRYL MOUTHWASH. ANTIBIOTIC MOUTHWASH- TETRACYCLINE MOUTHWASH. HAEMOSTATIC MOUTHWASH- TRANEXAMIC ACID MOUTHWASH. STEROID MOUTHWASHES- TRIAMCINOLONE ACETONIDE. HOSPITAL FORMULATIONS- MIRACLE MOUTHWASH. AYURVEDIC MOUTHWASHES- TRIPHALA MOUTHWASH. HOMEMADE MOUTHWASHES- NORMAL SALINE GARGLE. 3

4. ADVANTAGES Easy to apply. Economical. Mouthwashes can reach places in the mouth that brush or floss might miss. DISADVANTAGES It should be used only as an adjunct to mechanical plaque control . It does not remain in the mouth for a long time. Certain mouthwashes contain high levels of alcohol ranging from 18 to 26%. This may produce a burning sensation in the cheeks, teeth and gums. 4

5. ANTISEPTIC MOUTHWASHES CHLORHEXIDINE GLUCONATE It is available in 2 concentrations- 0.12% and 0.2%. It is a cationic bis-biguanide which is effective against an array of organisms including gram-positive, gram-negative, fungi, yeast and viruses. It has both antiplaque and antibacterial properties. 5

6. MECHANISM OF ACTION ANTIPLAQUE ACTION Prevents pellicle formation by blocking acidic groups on salivary glycoproteins, thereby reducing glycoprotein adsorption onto the tooth surface. Prevents adsorption of bacterial cell wall onto the tooth surface by binding to the bacteria. Prevents binding of mature plaque precipitating agllutunation factors in saliva and displacing calcium from the plaque matrix. ANTIBACTERIAL ACTION Bacteriostatic at low concentration. Bacteriocidal at high concentration. Also a potent antifungal agent in oral cavity. 6

7. DIRECTION FOR USE Take 15ml(1 cap) of 0.12% chlorhexidine gluconate mouthwash and swish around the mouth undiluted for 30 sec and spit out. Do not rinse with water immediately. Repeat this twice daily. It should not be used for more than 15 days. It is recommended not to use chlorhexidine before/immediately after using a toothpaste as the interactions with anionic surfactants found within the formulations reduces effective delivery of chlorhexidine as an active form. Toothpaste should be used prior to using chlorhexidine and excess toothpaste should be rinsed with water. 7

8. ADVERSE EFFECTS Brownish staining on teeth. Loss of taste sensation. Oral mucosa erosion. Supragingival calculus formation. Parotid duct stenosis. Hypersensitivity. 8

9. TRICLOSAN It is used as a topical antimicrobial agent. It has a broad spectrum of activity against gram-positive and gram-negative bacteria . Its spectrum of activity also includes mycobacterium spores and candida species. Mechanism of action It acts on the microbial cytoplasmic membrane and causes leakage of cellular constituents and causes bacteriolysis . It also inhibits formation of prostaglandins and leukotrienes , which are key mediators of inflammation, via inhibition of both cyclooxygenase and lipoxygenase pathway. 9

10. LISTERINE Listerine was created by Dr. Joseph Lawrence and Jordan Lambert and named it in honour of Dr. Joseph Lister, the pioneer in antiseptic surgery. Consists of essential oils, salicylates. It is used to reduce supragingival plaque and gingivitis and halitosis. 10

11. POVIDONE-IODINE No significant plaque inhibitory activity when used as 1% mouthwash. Unsatisfactory in long term use as significant amount of this compound is absorbed by oral cavity. Certain studies show it can reduce inflammation and progression of periodontal diseases. Low substantivity . 11

12. ANALGESIC MOUTHWASHES BENZYDAMINE MOUTHWASH(TANTUM MOUTHWASH) A locally acting analgesic and anti-inflammatory treatment for the relief of painful inflammatory conditions of the mouth and throat. Used to treat stage 1 OSMF. DOSAGE - 15 mL (1 tablespoonful) of 0.15% w/v mouthwash used to rinse the mouth, 3 or 4 times a day,  depending on the severity of the condition being treated. Keep the liquid in contact with the affected area for at least 30 seconds and then spit it out of the mouth . CONTRAINDICATIONS - Hypersensitive to benzydamine or any other ingredients of the mouthwash. ADVERSE EFFECTS - local burning or stinging sensation -local numbness -nausea or vomiting -throat irritation -cough 12

13. LIDOCAINE MOUTHWASH DOSAGE- Adults : 5-10 ml of lidocaine mouthwash is recommended for the treatment of painful mucous membranes of the mouth or throat. Keep the liquid in contact with the affected area for at least 30 seconds and then spit it out of the mouth . Children (2-12 years ) : Dosing is based on weight. Do not exceed 1 ml per 5 kg of child's weight per dose . ADVERSE EFFECTS- allergic  or anaphylactic reactions. 13

14. ANTICAVITY MOUTHWASH( FLUORIDE MOUTHWASH) 14

15. HAEMOSTATIC MOUTHWASH TRANEXAMIC ACID(PAUSE MOUTHWASH) DOSAGE- 5-10ml of the mouthwash is used to swish around the mouth for 1 minute and then spit out. ADVERSE EFFECTS- nausea, diarrhea, gastrointestinal problems, headache, giddiness. ANTIBIOTIC MOUTHWASH TETRACYCLINE MOUTHWASH It has to be prepared by dissolving a tetracycline tablet in ½ glass of water and then used to rinse the mouth. USES- It is used in the cases of bacterial infections of the mouth and also to treat osteoradionecrosis. 15

16. STEROIDAL MOUTHWASHES TREATMENT OF ORAL LICHEN PLANUS Corticosteroids are the class of drug most commonly used for the treatment of oral lichen planus. Topical corticosteroids, including triamcinolone acetonide , betamethasone valerate , fluocinolone acetonide and clobetasol propionate have been used successfully in treating oral lichen planus. T hese products are only appropriate when the disease is not widespread and when the lesions are relatively accessible for site-specific application . We can prepare this mouthwash by dissolving betamethasone tablets in a glass of water and using it. 16

17. HOSPITAL FORMULATIONS MIRACLE MOUTHWASH Miracle mouthwash is the term given to a solution used to treat mouth sores (oral mucositis) caused by some forms of chemotherapy and radiation therapy . There are several versions of magic mouthwash. Some are available in pre-measured kits (First-Mouthwash BLM, First-BXN Mouthwash) that can be mixed together by pharmacists , while others are prepared to order by a pharmacist . Miracle mouthwash usually contains at least three of these basic ingredients: -An antibiotic to kill bacteria around the sore. -An antihistamine or local anesthetic to reduce pain and discomfort. -An antifungal to reduce fungal growth. -A corticosteroid to treat inflammation. -An antacid. 17

18. PRESCRIPTION 18

19. DIRECTIONS FOR USE It is to be held in your mouth for one to two minutes before being either spit out or swallowed. It's recommended that you don't eat or drink for 30 minutes after using magic mouthwash so that the medicine has time to produce an effect . Repeat this 3-4 times a day. ADVERSE EFFECTS Problems with taste sensation. A burning or tingling sensation in the mouth. Drowsiness Constipation Diarrhoea Nausea 19

20. AYURVEDIC MOUTHWASHES 20

21. HIMALAYA( HiOra mouthwash) ACTION - kills germs protects gums prevents halitosis INDICATIONS - plaque control gingivitis halitosis INGREDIENTS - betel meswak belleric myrobalan DIRECTION - Take 15 ml of mouthwash. Rinse mouth thoroughly for 30 seconds and expel. Use twice daily. 21

22. HOMEMADE MOUTHWASHES Warm saline gargle can also be used as a mouthwash. It is prepared by dissolving ¼ to ½ teaspoon of salt in a 8 ounce glass of water. It is contraindicated in cases of erosions in the mouth. 22

23. BAKING SODA MOUTHWASH DIRECTION- Add half a teaspoon of baking soda to half a glass of warm water, and use it to gargle . It's an instant fix for even the worst case of bad breath . MECHANISM OF ACTION-   Baking soda neutralizes the odors in your mouth, rather than just covering them up. It is of an alkaline pH, which balances against acids produced by bacteria in your mouth and acidic drinks such as sodas and coffee. 23

24. CONCLUSION There are a lot of mouthwashes available in the market today. We should have a knowledge about the functions of each because… It is upon us to correctly diagnose the patient’s condition and make the rightful decision about which mouthwash to use , to relieve the patient both quickly and economically of the problems he is facing. 24

25. REFERENCES CARRANZA’S CLINICAL PERIODONTOLOGY, SECOND SOUTHASIA EDITION, ELSEVIER PUBLICATIONS. https:// en.wikipedia.org/wiki/Mouthwash http:// www.medclik.com https:// dailymed.nlm.nih.gov www.medicines.org.uk www.medicinenet.com 25

26. THANK YOU 26