Materia alba: refers to soft accumulations of bacteria and tissue cells that lack the organized structure of dental plaque and it is easily displaced with a water spray. Calculus: Calculus is a hard deposit that forms by mineralization of dental plaque and it is generally covered by a layer of unmineralized plaque. Chemical plaque control: With the help of antiplaque and anticalculus agents. Mechanical tooth cleaning through toothbrushing with tooth paste is the most common method of oral hygiene practiced. Tooth cleaning is largely influenced by the compliance and dexterity of the individual.

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Materia alba: refers to soft accumulations of bacteria and tissue cells that lack the organized structure of dental plaque and it is easily displaced with a water spray. Calculus: Calculus is a hard deposit that forms by mineralization of dental plaque and it is generally covered by a layer of unmineralized plaque. Chemical plaque control: With the help of antiplaque and anticalculus agents.

Mechanical tooth cleaning through toothbrushing with tooth paste is the most common method of oral hygiene practiced. Tooth cleaning is largely influenced by the compliance and dexterity of the individual. The concept of chemical plaque control can be justified as a means of overcoming inadequacies of mechanical cleaning. Uses of antiplaque agents To replace mechanical tooth brushing when this is not possible in situations like: - After oral or periodontal surgery during the healing period.

Classification of Antiplaque agents 1. On the basis of mechanism of action: Antiadhesives Antimicrobial Plaque removal Antipathogenic 2. On the basis of chemical nature: Bisguanides: chlorhexidine, alexidine, octenidine Quarternary ammonium compounds: benzalkonium chloride, cetyl pyridinium chloride Phenols and essential oils: listerine Fluorides: sodium fluoride, stannous fluoride, organic amine fluoride Antiseptics: iodine, povidone iodine, chloramine To Antibiotics: penicillin, tetracycline, vancomycin, spiramycin, kanamycin, streptomycin, actinomycin, erythromycin, bacitracin etc.

Oxygenating substances: hydrogen peroxide, buffered sodium peroxyborate Enzymes: protease, amylase, mutanase, amyloglycosidase, glucose oxidase and amyloglucosidase Plant alkaloid: sanuinarine Metal ions: Zn, Cu, Sn Triclosan Other agents: salifluor, delmopinol, detergents, propolis, hexetidine. On the basis of form: Mouthrinses Sprays Irrigators Chewing gums Varnishes Bisguanides Several bisguanides possess antiplaque activity, including chlorhexidine, alexidine, octenidine.

However chlorhexidine is the most studied and used. The most common preparation is chlorhexidine digluconate that is water soluble and at physiologic pH readily dissociates releasing the positively charged chlorhexidine component. Access to the bacterial cell wall is enhanced by the electrostatic force between positevly charged chlorhexidine cations and negatively charged lipoteichoic acid and other components of bacterial cell wall, thereby altering the osmotic equilibrium.

Having gained access to the inner cell membrane, chlorhexidine disorientates its lipoprotein structure causing destruction of the osmotic barrier and resulting in the leakage of intracellular components. At low concentrations of chlorhexidine, small molecule weight substances such as potassium and phosphorus will leach out, exerting a bacteriostatic effect. At high concentrations of chlorhexidine, bactericidal effect occurs due to precipitation and coagulation of cytoplasm.

Bactericidal effect is thought to be less important than the bacteriostatic effect, provided by the slow release of chlorhexidine. Chlorhexidine is more effective in preventing plaque accumulation on a clean tooth surface than in reducing pre-existing deposits. In addition to antibacterial properties, chlorhexidine also reduces bacterial colonization on tooth surface by 3 mechanisms: The effective blocking of acidic group of salivary glycoproteins will reduce their adsorption of hydroxyapatite and formation of acquired pellicle.

The ability of bacteria to bind to the tooth surface may also be reduced by the adsorption of chlorhexidine to the extracellular polysaccharides of their capsules or glycocalyces.

Chlorhexidine may compete with Calcium ions for acidic agglutination factors in plaque. Rinsing with 10ml of 0. Subsequent to cessation of drug application salivary count of organisms return to baseline value within 48hrs.

Substantivity of chlorhexidine was first described in s. What gives chlorhexidine its advantage over many other agents is its ability to bind strongly to many sites in the oral cavity. It is this substantivity that enables it to function as a form of slow release device and maintain an ongoing rather than intermittent antibacterial action. The proportion of chlorhexidine retained is directly dependent upon concentration, volume and pH in the mouth. Available as mouthwash- 0.

It is poorly absorbed by the GIT and therefore displays very low toxicity. No evidence of carcinogenic or teratogenic alterations has been found. Although they have greater initial oral retention and equivalent antibacterial action to chlorhexidine but they are less effective than chlorhexidine in inhibiting plaque and gingivitis. One reason for this may be that they are readily desorbed from the oral mucosa.

Phenols and essential oils Phenols, either alone or in combination, have been used as mouthrinses or lozenges. Most phenols exert a non-specific action which is dependent upon the ability of drug. In its non-ionized form, it penetrates through the lipid component of the cell walls of gram-ve organisms and denatures the bacterial proteins.

It has been accepted by ADA to be an aid to home oral hygiene procedures. Phenolic compounds are also known as scavangers of oxygen free radicals and hence should have an effect on leucocyte activity.

Adverse effects are minimal and safety has been established by quite long clinical use. Some patients find an initial burning sensation and bitter taste. Occasional staining of minimal amount has been found.

Triclosan Triclosan, a trichlorahydroxydiphenyl ether, is a nonionic antiseptic which lacks the staining effects of cationic agents. It has been used recently in a number of commercial mouthwashes and toothpastes. It ha a broad antibacterial properties and moderate antiplaque properties when used in combination wit zinc. It has been found to retain in mouth and to have clinical efficacy without side effects.

The primary site of action is bacterial cellular membrane of bacteria. At bacteriostatic conc. At bactericidal conc.

Triclosan itself has little or no substantivity, its substantivity can be increased by its combination with copolymers of methoxyethylene and maleic acid Gantrex, ISP corps. Despite its more rapid clearance, triclosan has been shown to be present in an elevated level in plaque and saliva for 8 hrs. There is evidence that triclosan may also act as an antiinflammatory agent in mouthrinses and toothpastes.

Antigingivitis effect of triclosan is due to its antiinflammatory property. The active ingredient is Sanguinarine. Sanguinarine has been isolated from the alcoholic extract of powdered rhizomes of the blood root plant, Sanguinaria candensis.

Sanguinarine contains the reactive iminium ions, these ions are retained in the plaque for several hours after use. Sanguinarine has cationic nature and acts by inhibiting thiol dependent enzymes.

Acts partly by interferring with the membrane bound metallic constituents, reducing glycolysis and inhibiting the adherence of oral bacteria. Sanguinarine appears to an effective plaque inhibitory agent but is less effective than chlorhexidine in this regard. Also unlike chlorhexidine it is not able to prevent the development of gingivitis. Mouthwash is much more effective than toothpaste. This may be due to binding of other components in the toothpaste to the chemically reactive site of sanguinarine.

Commercial available mouthrinse contains sanguinarine in Zn ions- Viadent 0. Enzyme preparations The rationale of using enzymes as active agents in antiplaque preparations was that they would be able to break the matrix of already formed plaque and calculus.

Furthermore, it was accepted that certain proteolytic enzymes would be bactericidal to plaque microorganisms. However, clinical trials on animals and humans have been disappointing. The initial efforts during were to employ enzymes directly to degrade the intercellular matrix and plaque integrity.

The following preparations were tested: Preparation of dehydrated pancreas Viokase Mucinase Protease-amylase Fungal enzymes Dextranase Mutanase All these preparations are of historic interest and they are not in use now.

Futher investigations are required for these substances to act as antiplaque agent. Antibiotics Penicillins, Vancomycin, Niddamycin and Kanamycin have been used for antiplaque activity.

All of these reduce significant amount of plaque formation. Potential problem with their use is of bacterial resistance. Hypersensitivity reaction on topical application are common. The potential benefit of using long term antibiotics is less than harm. Metallic salts Mainly Zn, Sn, Cu salts are having antiplaque and anticalculus activities. At high concentration they can be bactericidal. At sublethal levels: a. Zn citrate 0. In the laboratory, it can inhibit acid production by oral streptococci and trypsin like protease of P.

This technique was modified by Niles who suggested the use of Nitomuriatic acid. Stones reported that ability of an acid to dissolve tooth structure was greater than its ability to dissolve calculus. Alkalies Badanes noted the beneficial effect of Natural mineral waters on the removal of calculus because of its alkalie content.

It dissolves the three principle constituents of salivary calculus; globulin, mucin and calcium oxalate. But this idea did not find support.

Chelating agents Chelating agents are used to dissolve crystallized calcium salts and are capable of combining with calcium to form stable compounds. Warren et al found that with sodium hexametaphosphate decalcification of cementum was greater than that of calculus. Because of this finding its use was ceased. Enzymes The mode of action of enzyme preparation is to break down plaque matrix or to affect the binding of calculus to the tooth.

The first enzyme to be tested was mucinase Stewart and it was found to reduce caculus formation and calculus which did form was softer and more easily removed.

Viokase was introduced into chewing gums. Enzymes of fungal origin have been found to be superior to Viokase in reducing calculus formation Urea The idea of using urea as a anticalculus agent stems from its solvent action on protein.

Acetohydroxamic acid AHA irreversible inhibitor of urease has been studied as an anticalculus agent but results are not significant and further it leads to increase in caries. Antimicrobials Penicillin, Cetylpyridinium chloride, Niddamycin, Triclosan and chlorhexidine have been studied as an anticalculus agent.

Out of these penicillin and cetylpyridinium chloride have not been found to decrease calculus levels. Although chlorhexidine is a potent antiplaque agent but it leads to increase in calculus levels Loe etal , Lang et al , Grossman et al Niddamycin CC has been found to decrease calculus formation but it is not used because of concern for bacterial resistance.

Triclosan has been found to asist in plaque control and inhibition of calculus formation although to what extent, its not clear. It is predominantly used in combination with other anti-calculus agents.


Anti-plaque & Anti-calculus Agents

Arazilkree Anticalculus agents for the treatment, control, and prevention of periodontal disease. Preferred pyro ions are pyrophosphate ions. After nine weeks, the person has significantly less calculus on his teeth than he did after the first nine weeks. Validating the specifications, value and safety of your raw materials, products and assets. Saccharin salts are preferred. During this week, the person does not brush her teeth.


Anticalculus agents


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