Anti Plaque Agent

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Anti-plaque agent

Dr.Foysal Sirazee

BDS(DU),MS(FI

BDS(DU),MS(FINAL NAL PART),PART), BSMMU,DHAKA.

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Dental plaque

Dental plaque can be Dental plaque can be

defined as the soft defined as the soft

deposits that form the deposits that form the biofilm adhering to the biofilm adhering to the tooth surfaces or

tooth surfaces or

other hard surfaces in other hard surfaces in the oral cavity,

the oral cavity,

including removable and including removable and fixed restoration.

fixed restoration.

It also termed as biofilm. It also termed as biofilm.

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Dental plaque

Dental plaque can be Dental plaque can be

defined as the soft defined as the soft

deposits that form the deposits that form the biofilm adhering to the biofilm adhering to the tooth surfaces or

tooth surfaces or

other hard surfaces in other hard surfaces in the oral cavity,

the oral cavity,

including removable and including removable and fixed restoration.

fixed restoration.

It also termed as biofilm. It also termed as biofilm.

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Biofilm community is initially formed

through bacterial interaction with the

tooth and then through physical and

physiological interactions among

different species within the microbial

mass. Bacteria found in the

plaque-biofilm mass are strongly influenced by

biofilm mass are strongly influenced by

external environmental factors that

may be host mediated.

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Types of dental plaque

DENTAL PLAQUE

SUPRAGINGIVAL

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#Supra-gingival plaque…..

It is formed at or above the gingival margin, the

supra-gingival plaque that is in direct contact with the gingival margin is

referred as marginal plaque. It is mainly

responsible for marginal gingivitis.

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#Sub-gingival plaque…..

It is formed below the gingival margin, between the tooth and gingival sulcular tissue. Supra-gingival plaque and

tooth associated sub-gingival plaque are critical in calculus formation and root caries, whereas tooth associated sub-gingival plaque is

important in the soft tissue destruction that

characterizes different forms of periodontitis.

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The major differences between supra-gingival

and sub-gingival plagues

SUPRAGINGIVAL PLAQUE.

• _{Contains 50% matrix} • _{It contains mostly}

gram+ve

• _{Has few motile bacterial} • It’s aerobic unless it’s

thick

• _{It metabolizes} predominantly carbohydrates.

SUBGINGIVAL PLAQUE.

• _{Has little or no matrix} • _{Mostly gram-ve}

• _{Motile bacterial is} common

• _{Highly anaerobic area is} present

• _{Predominantly}

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MACROSCOPIC STRUCTURE OF DENTAL

PLAQUE

Plaque may be

differentiated from

other deposits that

may be found on the

tooth surface such

Materia alba and

Calculus.

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• Materia alba :

It

refers to soft accumulations of

bacteria and tissue cells that lack the

organized structure of dental plaque and are

easily displaced with a water spray.

• Calculus :

It is

a hard deposit that forms by

mineralization of dental plaque and is

generally covered by a layer of unmineralized

plaque.

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COMPOSITION OF DENTAL PLAQUE

#Microorganisms (70%of plaque mass) ….. Definition

• Primarily of microorganisms .In 1gm of plaque contains approximately 2x1011 bacteria.

• More than 500 distinct microbial species are found in dental plaque.

• Non-bacterial microorganism that are found in plaque include ---Mycoplasma, yeast, protozoa and viruses.

• Few host cells such epithelial cells, macrophages and leukocytes are also found.

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#Intra-cellular matrix (20-30%0f plaque mass) ….

*Organic………Polysaccharide, Lipid, Protein, Glycoprotein. *Inorganic……Calcium, Phosphate,

Trace amounts of other

minerals such as Na ,K ,Fl. As the mineral content increases plaque mass become calcified to form calculus.

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Formation of dental plaque

The process of plaque formation can be

divided into 3 phases :

A. FORMATION OF PELLICLE COATING ON

THE TOOTH SURFACE

.

B. INITIAL COLONIZATION BY BACTERIA

C.

SECONDARY COLONIZATION & PLAQUE

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Formation of acquired pellicle

*Initial phase of plaque

development. All the surfaces of the oral cavity, including all

tissue surfaces as well as surfaces of teeth, fixed and removable

restorations are coated with a glycoprotein

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*Pellicle is derived from components of

saliva, crevicular fluid as well as bacterial and

host tissue cell products and debris.

*Pellicles function as a protective barrier,

providing lubrication for the surfaces and

preventing tissue desiccation. However, they

also provide a substrate to which bacteria in

the environment attach.

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Initial colonization on the tooth

surface

*It is a transient stage .With in a few hours

initial bacteria are found on the tooth surfaces.

*The initial bacteria colonizing the pellicle coated tooth surface are predominantly Gram +ve such as Actinomyces viscosus &

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*These initial colonizers adhere to the

pellicle through specific molecules,

termed adhesions, on the bacterial

surface that interact with receptors in

the dental pellicle.

*The plaque mass then matures

through the growth of attached species

,as well as colonization and growth of

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Secondary colonization & plaque

maturation

*Secondary colonizers are the

microorganisms that do not initially

colonize clean tooth surfaces, including

Prevotella intermedia, P. loescheii,

Capnocytophaga sp., Fusobacterium

nucleatum and Porphyromonas gingivalis.

*These microorganisms adhere to

cells of bacteria already in the plaque

mass, this

Co aggregation.

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*

Well characterized interactions of

secondary colonizers with early

colonizers include the co

aggregation of F.nucleatum with S.

sanguis, P.loescheii with A. viscosus.

*In the later stages of plaque

formation, co aggregation between

different Gram

–

ve species is likely

to predominate.

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WHY IS PLAQUE FORMATION ON THE TOOTH SURFACE AND NOT ON OTHER ORAL SOFT

TISSUES

The first stage in pellicle formation

involves adsorption of salivary protein

to apatite surface. This formation

results from electrostatic ionic

interaction between hydroxyapatite

surface which has negatively charged

phosphate group that interacts with

opposite charged groups in the salivary

macromolecules.

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Mechanical plaque control

# Toothbrushes,

# Inter-dental cleaning aids,

# Inter-dental brushes….

*Single tufted brush,

*Dental floss, # Gum stimulators, # wooden tips,

# Oral irrigation device, # Dentifrices.

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Anti-plaque agent

Anti-plaque agents are the drugs or agents,

which are used to prevent or inhibit plaque

formation on the surface of teeth of the

oral cavity.

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Ideal properties of anti-plaque

agents

#It should remove pathogenic bacteria only.

# It should prevent development of resistance

bacteria.

# It should decrease plaque formation and

gingivitis.

# It should inhibit mineralization of plaque to

calculus.

# It should not harm the oral epithelium at

recommended dose.

# It should not stain the enamel surface of the

teeth.

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#It should not have any adverse effect on

the tooth surface.

#

It should be non toxic, non allergic and

non irritating.

# It should have pleasant taste, flavor

and color.

# It should be inexpensive, available and

easy to use.

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Classification of anti-plaque

agents

#Cationic surfactant (+ve charged)

* Bisbiguanids……

---Chlorhexidine gluconate.

---Alexidine.

*Quaternary ammonium compound…

---Benzalkonium chloride.

---Cetylperidinium chloride.

#Anionic surfactant (-ve charged)

*Plax.

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#Enzymes *Mucinase. *Mutanase. *Dextrinase. *Lactoperoxidase. #Phenolic compound *Triclosan. *Listerine. #Herbal extracts *Sanguinarine. #Others *Povidone iodine.

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Chlorhexidine

#It is a cationic surfactant.

#It binds with teichoic acid in gram positive bacteria and lipopolysaccharide in gram negative bacteria. # Chlorhexidine causes precipitation of cellular

protein.

# Chlorhexidine is a chlorophenyl bisbiguanids that has been used as acetate and more commonly

gluconate salts.

#It has both disinfectant and antiseptic properties. #It has also bactericidal and bacteriostatic in

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Mechanism of action

# As a disinfectants……

*Bactericidal action…..

CHX binds with teichoic acid in gram

positive bacteria and lipopolysaccharide in gram negative bacterial cell membrane.

↓

Enter inside the bacterial cell. ↓

Increase permeability of the cell. ↓

Out flux of cell organelles. ↓

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*Intracellular coagulation of protein……

High concentration of CHX cause intracellular coagulation of protein and pathogenic cell die.

#As an antiseptics……

*Binds with phosphate and sulphate of salivary glycoprotein and prevents its absorption on the tooth surface. Thus slow down acquired pellicle formation.

*Binds with bacterial surface and reduces adhesion of bacteria to the tooth surface.

*Incase of dental plaque , it cause agglutination of plaque ,so it becomes less sticky for adhesion of bacteria to tooth surface .

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Adverse effects of CHX

As a long time use of CHX causes the followings

effects…..

1.Change the taste sensation due to thickening or make a cover over the dorsal surface of tongue.

2.Block the opening of the parotid or stanson’s duct of

parotid gland and causes swelling and severe pain of that gland.

3.May causes hypersensitivity reaction.

4.High concentration of CHX has an unpleasant bitter taste and causes irritation of oral mucosa.

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5.Local tissue damage occurs if used in open wound and abraded skin.

6.If CHX is ingested ,it may produce systemic toxicity like nausea, vomiting.

7.Staining of the tooth surface.

* “Millard reaction” occurred due to condensation

reaction between CHX and amino acid

CHX + amino acid → millanoid pigment.

*Formation of metallic sulfate.

*Ketone or aldehyde binds with CHX which precipitated on the tooth surface.

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Toothbrushes

The first true bristled

brush was invented

in China in……..

• 1498 for the

Emperor using animal

hair (pigs)

• Nylon bristles were

introduced around

1938

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Requirements of a Satisfactory Toothbrush

1. Have good cleaning ability.

2.Cause minimal damage to soft and hard dental tissues.

3. Having a reasonable lifespan (good wear characteristics)

4. Non-toxic.

5. Handle size appropriate to the user’s age and dexterity. 6.Head size

---appropriate for the user’s mouth Adult – 2.5 cm

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7.Compact arrangement of soft, end rounded nylon filaments not larger than 0.009 inches in diameter 8.Hard brushes should never be recommended

*Lacerate the gingiva , gingival recession and tooth abrasion.

*Diameter is too large to enter the gingival crevice.

9.Bristle patterns that enhance plaque removal in a proximal spaces and along gum margin.

Filaments arranged at different heights and angles significantly more effective at reducing plaque and gingivitis than flat trim brushes.

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Brushing Techniques

1. Vertical

2. Horizontal

3. Roll Technique

4. Vibrating (Bass, Stillman, Charter) 5. Circular 6. Scrub #NOTE…..Bass technique most recommended by dentists.#