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QUATERNARY BISBIGUANIDE METALLIC
AMMONIUM S SALTS
COMPOUNDS
Benzethonium Chlorhexidine Zinc(mentadent P)
chloride
Benzalkonium Alexidine Copper
chloride
Domiphan bromide Bispyridine Zinc
Therapies used
Short term therapy – 2 teaspoons in a cupful of water twice
daily for 8-10days(10ml of 0.2% chlorhexidine)
Long term therapies – 1 teaspoon of chlorhexidine in 1%
dilution for 15-20days.Patient is instructed to rinse his
mouth and not to eat or drink for ½-1 hour.
Stannous Fluoride
Stannous fluoride(SnF2) has more antiplaque properties
than sodium fluoride(NaF).
It is the stannous ion,not the fluoride that has greatest
antimicrobial effect.Tin from the stannous ion enters the
cell,clogs the metabolism,and affects the growth and
adherence properties of the bacteria.
Numerous animal and clinical studies demonstrated that
stannous fluoride reduces dental plaque and some have
also indicated a decrease in gingivitis.
Several 0.4% stannous fluoride gels carry the ADA Seal of
Acceptance for anticaries activity and safety.
Phenolic Compounds(Essential
Oils)
Listerine has received the ADA Seal of Acceptance ,an agent for
reduction of bacterial plaque and gingivitis.
Listerine is a mixture of three phenolic-derived essential oils –
thymol,menthol, and eucalyptol,which is combined with
methylsalicylate.
The mechanism of action appears to be related to alteration of
the bacterial cell wall.This product has a low substantivity and
is safe.
Adverse effects reported have been a burning sensation,bitter
taste,and a possible staining of teeth.
Studies indicate that bacterial plaque can be reduced by 25 to
28% and gingivitis can be reduced by an average of 30%.
Sanguinarine
Sanguinarine, a benzophenathridine alkaloid,is an alcohol
extract from the root of the plant Sanguinaria canadensis.
It is marketed as a mouth rinse and a dentrifrice.
The activity os sanguinarine is attributedits ability to
interfere with bacterial glycolsis and bind to plaque to
prevent adherence of microorganisms.
Sanguinarine is retained for about 2 to 4 hours in the
mouth.It is less effective than chlorhexidine and no side
effects are observed.
However, a consistent degree of efficacy has noy been
documented.
Effectiveness is enhanced when both the mouth rinse and
the dentifrice are used.
Quaternary Ammonium
Compounds
Quaternary Ammonium Compounds have been evaluated
an average plaque reduction of 35% less than baseline
scores has been reported.
Cepacol and Scope are well-known representatives of this
group with concentrations of 0.05 and 0.045%
cetylpyridinium chloride(CPC).
The mechanism of action is related to increased bacterial
cell wall permeability that favors lysis,decreased cell
metabolism,and a decreased ability for bacteria to attach to
tooth surfaces.
They alter surface tension and have a low substantivity.
Oxygenating Agents
Several products containing oxygenating agents are
available.
The American Academy of Periodontology has published a
review of oxygenating agents.
Long term studies have shown no beneficial effects on
reductions in bacterial plaque and gingivitis when
compared to controls.
Safety is an issue with hydogen peroxide.Chronic use of
hydrogen peroxide has been to cause serious side effects
including carcinogenesis,tissue damage,hyperkeratosis.oral
ulcerations,hyperplasia,and black hairy tongue syndrome.
Short-term use of oxygenating oral rinses is intended for
oral wound cleansing.A soothing effect has been reported.
Prebrushing Rinses
Plax is a prebrushing mouth rinse containing sodium
benzoate and other nontoxic surfactants.It contains 7.5%
alcohol.
Short-term studies have shown some reductions in
bacterial plaque,however, a number of investigations have
shown effect no plaque reduction when compared to a
placebo.
Reductions in gingivitis have not been documented.
Sodium content contraindicates use for clients on sodium-
restricted diets.