PLA CONTROL.ppt 126 timo cadde University

Community medicine

1. Prevention of Periodontal Disease
and plaque control
DR.ABDIAZIIZ

2. Aims
Mechanism of chemical plaque control
Types of chemical agents
Indications of chemical plaque control

3. Chlorhexidine digluconate isan antibacterial
ingredient and broad-spectrum antiseptic and
disinfectantthat has been used in dentistry for over 40
years.

4. .It's effective against a wide range of bacteria, fungi, and
viruses, and can help prevent plaque build-up, gingivitis,
and other infectious diseases of the mouth.

5. Chlorhexidine digluconate is often used in
mouthwash along with regular brushing and flossing
to treat gum disease.It can help reduce gum swelling
and redness, and bleeding when brushing

6. Chemical Plaque Control
Supragingival plaque control
Mechanism of action
1.Prevention of
colonization of enamel
2.Removal of attached
organisms
3.Antimicrobials

7. Chemical Plaque Control
1.Bisguanide antiseptics –Chlorhexidine
2.Quaternary ammonium compounds
3.Phenolic antiseptics
4.Metal ions
5.Natural products
6.Oxygenating agents

8. Bisguanide -Chlorhexidine
(CHX)

9. Chlorhexidine (CHX)
Used in the form of chlorhexidine digluconate
Broad-spectrum bactericidal against
Gram positive and Gram negative bacteria
yeasts and fungi
Mechanism
immediate antibacterial
prolonged effect –for several hours
Both bacteriostatic and bacteriocidal

10. CHX
highly effective anti-plaque
agent
more effective in preventing
plaque accumulation on a clean
tooth surface
Little or no effect on established
plaqueand established gingivitis
where subgingivalplaque has
already formed

11. How is CHX administered?
Mouthrinse
0.2% (Corsodyl)
0.12% (Peridex)
Toothpaste/Gel
Spray
Chewing gum

12. Chlorhexidine
Antiplaque effects are doserelated (not concentration
related)
Optimum daily dose = –20 mg

13. CHX Toothpaste/Gels
Toothpaste ingredients
inactivate CHX
Gels (1%) –no detergents or
abrasives –reduces patient
acceptance (staining)

14. Kin Gingival Paste (0.12%
CHX)
Curasept 0.12% Chlorhexidine
Toothpaste

15. CHX Spray
More popular than mouthwash or gels for use in
handicapped patients
Research shows that when used by parents less
effective than gels in trays
Applied to the teeth by a dentist under optimal
conditions –good results

16. Is CHX safe?
poorly absorbed by
the GIT -displays
very low toxicity
No carcinogenic or
teratogenic effects
have been found
following long-term
use

17. Side effects
1.Brown staining of
teeth/fillings
difficult to remove
result of dietary pigments
adhering to tooth surface
+
+
CHX
Tooth
Bacteria
Dietary
stains

18. Side effects (cont)
2.Supragingival calculus formation
suppresses acidogenic plaque bacteria
Raises pH
ppt of calcium and phosphate
1 +2 = dose-dependent
cannot be reduced without loss of
antiplaque effects

19. Side effects (cont)
3.Taste disturbances
4.Mucosal desquamation
3 and 4 can be decreased by reducing the
conc. and using a larger volume to maintain
clinical efficacy
5.Parotid swelling
? Mechanical obstruction of the duct

20. Chemical Plaque Control
1.Bisguanide antiseptics –Chlorhexidine
2.Quaternary ammonium compounds
3.Phenolic antiseptics
4.Metal ions
5.Natural products
6.Oxygenating agents

21. Listerine
Active ingredients
Phenol-related essential oils
(thymoland eucalyptol)
Menthol and methyl salicylate
Inactive ingredients
Water
Alcohol (26%)
Less effective than CHX
Side effects –bitter taste, staining

22. Phenolic compounds (cont)
Triclosan
Soaps, deodorants
Mouthwash
reduce plaque accumulation but to a much lesser
extent than CHX
dependent upon the presence of co-polymers in the
formulation to increase oral retention (Gantrez)
anti-inflammatory effect

23. Triclosan
Added to toothpaste -effect is improved by
Copolymer (Gantrez) to enhance retention in the mouth
OR
Zinc citrate to provide additional antibacterial activity
Provide significant reduction in plaque and
improvement in gingival health when
compared with fluoride toothpaste alone
(Volpe et al., 1996)

24. Chemical Plaque Control
1.Bisguanide antiseptics –Chlorhexidine
2.Quaternary ammonium compounds
3.Phenolic antiseptics
4.Metal ions
5.Natural products
6.Oxygenating agents

25. Metal ions
Zinc
additive effect with other antiseptics
Attaches to dental tissue and inhibits regrowth of plaque
Copper and Tin –local side effects of staining

26. Chemical Plaque Control
1.Bisguanide antiseptics –Chlorhexidine
2.Quaternary ammonium compounds
3.Phenolic antiseptics
4.Metal ions
5.Natural products
6.Oxygenating agents

27. Natural products -Sanguinarine
Root of Sanguinariacanadensis
(Bloodroot)
plaque inhibitory effect less
than CHX
Mouthwash is more effective
than toothpaste
Gingivitis prevention is questionable.

28. Chemical Plaque Control
1.Bisguanide antiseptics –Chlorhexidine
2.Quaternary ammonium compounds
3.Phenolic antiseptics
4.Metal ions
5.Natural products
6.Oxygenating agents

29. Oxygenating agents
Hydrogen peroxide, sodium peroxyborate
Mouthrinses
Inhibit obligate anaerobes
Some retardation in plaque growth
Further investigation is needed

30. Alcohol containing
mouthwashes dis
Accidental swallowing by children
Link with oral and pharyngeal cancer ???
Reduce the hardness of composite and hybrid-resin
restorations
related to % alcohol content of mouthwash

31. Bottom line
Chlorhexidine most effective
chemical agent

32. Indications of chemical plaque
control
1.To replacetoothbrushing when this is not possible
2.As an adjunctto toothbrushing in situations when this may be
painful or inadequate

33. 1. Replacing Toothbrushing
A.After oral/periodontal therapy
and during the healing period
B.Intermaxillary fixation

34. 1. Replacing Toothbrushing
c.Acute oral mucosal or gingival infections
D.Mentally or physically-handicapped patients who are
unable to brush their teeth themselves

35. 2. With Toothbrushing
Following subgingival scaling/root planing when
the gingivae may be sore
(used for ~3 days)
Following scaling -cervical hypersensitivity due
to exposed root surface

36. 2. With Toothbrushing
Following scaling in situations where the patient’s oral
hygiene remains inadequate
Need to remedy situation quickly
duration of the CHX mouthwash use should not >2
weeks
Antibacterial agent that does not cause significant
staining in a toothpaste or pre-brush rinse-TRICLOSAN

37. Assess mouthwash
Range of antibacterial activity against the various plaque bacteria
Substantivity (retention) to the oral surface
Possible anti-inflammatory effect
Acceptable taste
Ability to promote fresh mouth sensation

38. Categories –Group A
good substantivity (oral retention)
wide antibacterial spectrum
good anti-plaque effects
can be used to replace mechanical cleaning methods
for short periods when this is not possible
chlorhexidine

39. Group B
little or no substantivity
good antibacterial spectrum
cannotbe used to replace
toothbrushing but can be used as
adjuvantsto mechanical cleaning
cetyl pyridinium chloride, Listerine and
triclosan.

40. Group C
antibacterial effects in vitro
plaque inhibitory effects from moderate to low or
no statistical difference from the negative control
limited or no adjuvanteffects when combined
with mechanical cleaning and therefore cannot be
recommended for this purpose
Oxygenating agents, sanguinarine (Veadent)

41. REMEMBER!!!
Anti-plaque mouthwashes have noplace in the treatment
of existing periodontal disease(gingivitis or
periodontitis) since they cannot either reach the
subgingival environment or penetrate thick layers of
established plaque.

42. Miswak (Siwak) –chewing stick
Mechanical effect of fibers
Release of antibacterial
chemicals against
Periodontal pathogens
Cariogenic bacteria
Antiplaque effect similar to
0.2% CHX mouthwash
Salvadora
persica

43. Miswak
Recommended by WHO as alternative oral hygiene method
Proper use
Pen grip
Rolling or up and down movement
Massage the gum and tooth surfaces
Longer time than brushing –5 to 10 min

44. Literature
Essential oil mouthwash (EO) may be equivalent to
chlorhexidine (CHX) for long-term control of gingival
inflammation but CHX appears to perform better than
EO in plaque control.
Neely 2012
EO less staining
Neely 2012
The alcohol-free CHX rinse was as effective as the one
containing alcohol in controlling plaque and reducing
gingival inflammation.
Todkaret al. 2012

45. Maintaining and recovering soft tissue
health around dental implants
”There was weak evidence that antibacterial
mouthrinsesare effective in reducing plaque
and marginal bleeding around implants”
Grusovinet al. 2010

46. Chemical plaque control in
special needs patients
“No-spell”
Beaker

47. Thank you