ANTIPLAQUE AGENT


ANTIPLAQUE AGENT

DENTAL PLAQUE :
It is defined as a highly specific variable structural entity formed by sequential colonization of microorganism on the tooth surface, epithelium and restorations. 
PLAQUE CONTROL:
It is the removal of the microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues. it also deals with the prevention of calculus formation.
It is used as an adjunct to mechanical plaque control. 

 Many vehicles may be used to deliver anti plaque agents such as:

¡  MOUTH RINSES, 
¡  TOOTHPASTES, 
¡  SPRAY, 
¡  IRRIGATORS, 
¡  CHEWING GUM, 
¡  VARNISHES.
Approaches to chemical supragingival plaque control:
1.     ANTIADHESIVE: Prevention of attachment of bacterial biofilm.
2.     ANTIMICROBIAL : by inhibition of bacterial proliferation and as bactericidal.
3.     PLAQUE REMOVAL
4.     ANTIPATHOGENIC

Properties of an ideal antiplaque agent
1.     Should eliminate only the pathogenic bacteria.
2.     Prevent development of resistant bacteria.
3.     Exhibit substantivity i.e. ability of an agent to bind to tissue surfaces and to be released over time to deliver an adequate dose of active principal ingredient the agent carries. (CHX gets adsorbed to oral tissues).
4.     Safe to oral tissues at concentrations and dosages recommended.
5.     Significantly reduce and gingivitis and prevent colonization of microorganisms.
6.     Should not stain the teeth or alter taste.


Classification
Depending on the antimicrobial efficiency and relative substantivity.
1st generation:
decreases plaque scores by 20-50%, but efficacy is decreased by poor retention in the mouth. E.g. antibiotics , phenols etc.
2nd generation :
70-90% more effectively retained by oral tissues and release slowly. E.g. Bisbiguanides (chlorhexidine).
Various chemical agents are:

1.     Antibiotics: penicillin, vancomycin

2.     Enzymes: proteases, lipase, dextranase

3.     Bisbiguanide: chlorhexidine, alexidine

4.     Quaternary ammonium compounds: cetylpyridinium chloride, benzalkonium chloride

5.     Phenols and essential oils: thymol, triclosan

6.     Natural products: sanguinarine

7.     Fluorides: sodium fluoride, stannous F

8.     Metal salts: tin, zinc, copper

9.     Oxygenating agents: Hydrogen peroxide

10.    Detergents: sodium lauryl sulfate
11. Amine alcohols: octapinol, delmopinol

FIRST GENERATION AGENTS

TRICLOSAN
ž Phenol derivative.
ž Is synthetic and ionic.
ž Used as a topical antimicrobial agent.
ž Broad spectrum of action including both gram positive and gram negative bacterias .
ž It also includes mycobacterium spores and Candida species.
ž Triclosan is included in tooth paste to reduce plaque formation.
ž Used along with Zinc citrate or co-polymer Gantrez to enhance its retention within the oral cavity.
ž Triclosan delay plaque formation.
ž It inhibits formation of prostaglandins & leukotrienes there by reduces the chance of inflammation.

SANGUINARINE
ž It is a benzophenanthredine alkaloid.
ž It is most effective against gram –ve organisms.
ž Used in mouth rinse .


ANTIBIOTICS
ž Vancomycin,erythromycin,Niddamycin and Kanamycin. 
ž Due to bacterial resistance problems the use of antibiotics has been reduced.

Bisbiguanides
ž Considered to most effective antiplaque agents.
ž Second generation agents exhibiting substantivity and broad antimicrobial properties.


CHLORHEXIDINE GLUCONATE(0.2%)
ž It is a cationic bisbiguanide .
ž Effective against gram +ve, gram –ve organisms, fungi, yeasts and viruses.
ž Exhibit antiplaque & antibacterial properties.
žCHX due to its dicationic nature, binds to enamel pellicle or tooth surface and salivary proteins. This adsorbed CHX is released of a period of time.


ADVERSE EFFECTS OF CHLORHEXIDINE
1.     Brownish staining of tooth or restorations
2.     Loss of taste sensation
3.     Rarely hypersensitivity to chlorhexidine has been reported
4.     Stenosis of parotid duct has also been reported

                                                                                   DR. ANJUSHA SHARDA 

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