THIS CLASS IS IN BRIEF FOR UNDER GRADUATE UNDERSTANDING AND EXAMINATION PURPOSE

1. Dr. RAGHU PRASADA M S
MBBS,MD
ASSISTANT PROFESSOR
DEPT. OF PHARMACOLOGY
SSIMS & RC.

2. Agents or mechanical aids meant for cleanse and polish natural
teeth. Maximum cleansing efficiency with minimum tooth
abrasion.
Properties of an Ideal Dentifrice
–assist the toothbrush to mechanically remove debris, soft
deposits and stains
–impart a polished surface
–Non-poisonous to the body
–pleasant taste, odour, sufficient cleansing property
–reduce caries and mouth odour, healthy gingiva, improve
aesthetics

3. Abrasive agents
–fine dental preparations, help the scouring action
–abrasion -wearing away of a substance or structure through a
mechanical process, such as grinding, rubbing or scrapping
–three categories.
Finishing abrasives hard, coarse abrasives to develop contour
and remove gross irregularities. Coarse stones.
Polishing abrasives Fine particle size and less hard smoothening
the surfaces that have been roughened by coarse stones, pumice,
polishing cakes
Cleansing abrasives Soft materials with small particle size
remove soft deposits that adhere to enamel or restorative material.

4. Humectants
keep paste from drying out
glycerine, sorbitol, propylene glycol
Detergents and foaming agents
cleansing agents and decreases surface tension of dentifrice.
loosening of debris which adhere to teeth and also dissolving
fatty substances and mucous plaques
sodium lauryl sulfate.
Binders –Carboxy methyl cellulose
Sweetening agents
–Artificial sweeteners such as sorbitol saccharin
–More palatable having no food value –diabetics

5. Aqueous concentrated solutions containing one or more active
ingredients and excipients meant for cleansing and deodorising
the oral cavity. They contain astringents, antiseptics obtundents,
flavouring and sweetening agents.
Swishing the liquid in the oral cavity using 15–30 ml for about a
minute
Antiseptic and astringent mouth wash- for soreness under
dentures. They harden the mucous membrane
Obtundent mouth wash- for sensitive oral lesions
Detergent mouth wash- for cleansing and deodorising action

6. Therapeutic use
–reduce plaque, dental caries, gingivitis, stomatitis
Cosmetic purpose
–bad breath and it contains used antimicrobial and/or flavoring
agent
Soreness under dentures
Halitosis
Surgical impaction

7. Astringents are agents which precipitate superficial proteins
when applied to the skin or mucous membrane
Diminish the excretion or exudation of superficial cells
also used as local haemostatics and mummifying agents
TANNIC ACID
–Vegetable –nutgalls
–forms pellicle while hardening the superficial cells
–Used as
astringent mouth wash, 1-5%
Astringent dentrifices,
local haemostatics,
mummifying agent
obtundent

8. Catechu –another vegetative astringent
ZINC CHLORIDE
Caustic 5-10% sol
ulcerative gingivitis, pyorrhoeal pockets and apthous ulcers
ZINC SULPHATE
0.5-1% con, Mouthwash
lotion in mastoiditis, stomatitis and chronic alveolar abscess
COPPER SULPHATE
0.5-2% concentration
indolent ulcer of gums
ALUM -1-2% concentration, astringent, antiseptic and
haemostatic properties. Harden the gum or for inflamed and
ulcerated gums

9. These are the agents that decrease the dentine sensitivity
They are used to make the excavation painless
They act by one of the fallowing mechanisms
Paralyzing sensory nerves-phenol, menthol, thymol, clove oil
Camphor benzyl alcohol
Precipitating proteins- astringents like silver nitrate, zinc oxide
and zinc chloride
Destruction of nervous tissue
Disadvantages with use of obtundants
Pulp may shrink
Irritants may stimulate the formation of secondary dentine
Use of obtundents has declined after use of local anaesthesia

10. ETHYL ALCOHOL (70%)
painless and non toxic to the pulp
penetrates rapidly
applied locally, allow the alcohol to evaporate
PHENOL
Irritation followed by numbness
alone and in combination with chloroform + olive oil in a 2:4:10
Acts rapidly but does not penetrate deeply
protoplasmic poisonous nature
CREOSOTE
same as that of phenol,
in addition its penetrability is relatively more

11. harden and dry tissues of the pulp and root canal so that the
tissues are resistant to infection.
Dental procedures -not possible to completely remove the pulp
form of paste or semi-liquid preparation
PARAFORM (PARAFORMALDEHYDE) combination of zinc oxide
or zinc sulphate, Glycerine and creosote
slow liberation of formaldehyde
S/E penetrate the pulp and can cause inflammation
form of paste with local anaesthetic.
IODOFORM
slow liberation of iodine
antiseptic and local pain relieving properties
Supplied as paste which contains tannic acid, phenol,
eugenol(clove oil), cinnamon oil and glycerine

12. A dye used in dentistry as a diagnostic acid -reveal the presence
of dental plague.
self-examination for dental plaque
harmless vegetable dye -bright red
Disclosing tablets- Erythrosin tablets
Disclosing solution- Fluorescein dyes-viewed under special light
iodine containing solutions
Disclosing swabs.

13. Antiseptics are drugs that are applied on the body surfaces to
prevent infection by killing or inhibiting the growth of pathogenic
bacteria either by oxidation of bacterial protoplasm or
denaturation of bacterial proteins including enzymes
Amongst the various types of antiseptics available,
chlorhexidine a biguanide, is one of the most commonly used.
DISINFECTANTS –are those germicides or chemical substances
which are used to destroy or inhibit the growth of pathogenic
vegetative bacteria (not their spores) on inanimate (nonliving
)surfaces such such as glassware or surgical instruments
Ex. Formaldehyde, phenols, ethyl alcohol, soaps

14. These are Zn -ions and Cu -ions.
It acts by reducing the glycolytic activity in bacteria and hence delays
bacterial growth.
Quaternary Ammonium Compounds:
These are Benzathonium Chloride, Benzallenium Chloride and Cetyl
pyredinum. These are cationic antiseptics and surface active agents
which are effective against gram +ve organisms.
Mechanism of action:
Positively charged molecule reacts with negatively charged
cell membrane phosphates and thereby disrupting the bacterial cell
wall structure.
The side effects
 staining and enhanced calculus formation
 it also causes burning sensation and desquamation.

15. Bacteriostatic and bactericidal actions.
Thymol, menthol, Eugenol, benzoic acid boric acid, calcium and
Megnesium peroxide
Thymol is a powerful antiseptic and de-odourant
Coloring and flavoring agents
–(methylene blue (0.001%), magenta (0.05%) flavoring agents
(peppermint, clove) –attractive, palatable and acceptable.
Preservatives-–preserve the quality and stability
–Methyl paraben

16. Sialogogues are the agents which enhance salivary secretions. They
activate muscarinic cholinergic receptors of the parasympathetic
nervous system to increase salivary flow.
All commercially available preparations have a limited
duration of action, making frequent application necessary.
Pilocarpine- is regularly used
Cevimeline is newly introduced drug enhances salivary secretions by
directly stimulating the muscarinic receptors
They are used to treat sialadinitis that may be seen sialolithiasis
Xerostomia often seen after radiotherapy of head and neck
Sjogren’s syndrome cevimeline is used

17. These are substances that reduces salivary secretions
Propanthaline bromide an atropine substitute is
commonly used
Sialocele –an antisialogogue used to suppress
glandular function during healing or to encourage
spontaneous resolution of the sialocele.
Post surgical- an antisialogogue is used for a short
period following surgeries of salivary gland and ducts
In post traumatic parotid fistulas and sialiceles
Trauma to the salivary gland and salivary ducts

20. Plaque is the soft non mineralised bacterial deposit formed on
inadequately cleaned teeth
All plaques should be removed quickly virulent micro organism of
plaque flora streptococcus mutans, streptococcus sobrinus are
associated with pathogenesis of caries. Scaling is done to remove
plaque.
Anti-bacterial agents
pencillins, tetracyclines, erythromycin are effective in
controlling plaque.
Vancomycin, bacitracin, kanamycin and polymyxin B are topical
mouth rinses
Controlled delivery systems- tetracylines

21. Phenols (Triclosan):
It’s a non ionic bisphenol derivative and a germicide used in
toothpaste and dental preparations. A topical antimicrobial agent
with a broad spectrum of action including against both gram -ve
and gram +ve bacteria. It also has specific action against
mycobacterium and candida species.
Mechanism of Action:
Triclosan acts on cytoplasmic membrane and induce leakage of
cellular contents which leads to bacteriolysis and Cell death.
Triclosan is inducted in toothpaste to prevent plaque formation.
It is used along with zinc citrate or its polymer gantrez to
enhance its retention in the oral cavity.
It also inhibits prostaglandins and leukotrienes thereby it
reduces the degree of inflammation.

22. Bisbiguanides posses anti plaque activity including
Chlorhexidine, Alexidine and Octenidine.
The antiplaque properties of chlorhexidine are
unsurpassed by other agents.
It has much greater and more prolonged effects than
other antiseptics.
The digluconate of chlorhexidine (1: 6 – Di 4 – chlorphenyl –
diguanidohexane) is a synthetic antimicrobial drug which is
effective in vitro against both gram positive and gram
negative bacteria including aerobes, anaerobes, yeast and
fungi

23. Prevents pellicle formation by blocking acidic groups of salivary
glycoprotein’s thereby reducing glycoprotein adsorption on to
tooth surface. Prevents adsorption of bacterial cell wall on tooth
surface. Prevents binding of mature plaque
Antibacterial action of Chlorhexidine consists of two actions, i.e.,
bacteriostatic at low concentration and bactericidal at high
concentration.
Bacteriostatic action at low concentration is mainly due to the
negative energy of the bacterial cell wall reacts with positive
energy chlorhexidine molecule. This alter the integrity of cell
membrane and Chlorhexidine binds to inner membrane
phospholipids and increases permeability. This leads to the vital
elements leaks out resulting in bacterial cell death.

24. It is used as mouth rinses, gels in dentifrices for control of plaque and
gingivitis
Disinfectant of oral cavity
Ulcerative gingivitis
Following oral surgery and denture insertion
Prophylactically in immunocompromised patients
Fluorides- stannous fluoride mouth rinses
-inhibit enzymatic reactions involved in glycolysis
Oxygenating agents-like hydrogen peroxide sodium perborate act by
liberating nacent oxygen is to suppress the bacterial growth
(anaerobes)

25. Cetyl pyridium chloride
Benzalkonium chloride, cetrimide
Sanguinarine:
Sanguinare chloride is currently used in both mouth
rinses and toothpaste.
It is an extract from blood root plant Sanguinare
candensis. The alkaloid converted to active metabolite at
low ph.it is used as antiplaque and antigingivitis mouth
rinse or paste

26. It’s a combination of phenol related essential oil, thymol
and methyl salicylate.
It has shown to have moderate plaque inhibitory effect and
antigingivitis effect.
It has poor oral retention and has burning and bitter taste.
Mechanism of Action:
The action of phenol acid is cell wall disruption and
inhibition of bacterial enzyme.
The phenolic compound are also known to act as
scavengers of oxygen free radical and hence has an effect on
leucocyte activity

27. Steroids play a role in the modulation of the inflammatory
reaction by inhibitory activity affecting the production of mRNA
and thus protein synthesis. Application of topical steroid
preparations provides temporary relief of symptoms associated
with inflammation and ulcerated lesions in the oral cavity
such as recurrent apthous stomatitis.
These topical ointments include
Triamcinolone acetonide 0.1%
Hydrocortisone acetate 1%
Betamethasone dipropionate 0.05%.

28. Topical use of steroids is usually well tolerated but some patients
may develop a secondary erythematous candidiasis or
pseudomembranous candidiasis (thrush) if predisposing conditions
like xerostomia
Systemic and/or topical use of antibiotics
corticosteroid asthma inhalants
prostheses and cigarette smoking are present in them.
Even though clinical experience and laboratory studies have
shown systemic absorption of steroids to be insignificant through
the oral mucosa but caution should be exercised when used in
patients
 Diabetes Hypertension tuberculosis

29. Toothpaste is an excellent vehicle for delivering oral health
benefits and hence many therapeutic agents are added.
These include
Anti caries agents
Anti plaque agents
Anti tartar agents
Anti sensitivity agents.
Therapeutic agents and their mechanism of action:

30. ANTI- 1. Fluoride:
Fluoride is considered to be the most effective caries-
inhibiting agent, and almost all toothpastes today contain
fluoride in one form or the other.
Most common form
- sodium fluoride(NaF).
Mono-fluoro-phosphate (MFP)
Stannous fluoride (SnF) are also used.
The fluoride amount in toothpaste is usually between 0.10-
0.15 %.
Toothpastes are the main vehicle for fluoride.

31. Three main theories considering the positive action of fluoride in
the prevention Of caries:
It is claimed that fluoride, incorporated into the enamel during
tooth development in the form of flurohydroxyapatite (FAP),
reduces the solubility of the apatite .
It is also suggested that fluoride has antibacterial actions. In an
acidic environment, if fluoride is present, hydrogen fluoride (HF)
is formed .
Today the most important anti-caries effect is claimed to be due
to the formation of calcium fluoride (CaF2) in plaque and on the
enamel surface during and after rinsing or brushing with fluoride.
CaF2 serves as a fluoride reservoir .

32. Xylitol is a sugar alcohol that cannot be fermented by oral
microorganisms.
It is considered to be a cariostatic agent since it can
inhibit the carbohydrate metabolism in different oral
microorganisms .
The inhibitory effect on glycolysis has been related to the
uptake of xylitol via a constitutive fructose specific PTS system
and subsequent intracellular accumulation of xylitol-5-
phosphate. Such a mechanism leads to reduced acid formation
from glucose, and a reduction in the streptococcus mutans
content in both plaque and saliva

33. Calcium and phosphate supplementation in a toothpaste will
increase the concentration of these ions in the oral cavity.
This has been reported to improve remineralization and
increase fluoride uptake.
4.Sodium Bicarbonate:
Several studies have shown that bicarbonate is one of the
salivary components that potentially modifies the formation of
caries.
It increases the pH in saliva, and in this way creates a
hostile environment for the growth of aciduric bacteria.
Sodium bicarbonate can also change the virulence of the
bacteria that cause tooth decay

34. Of the anti-calculus agents, the crystal growth inhibitors have
been most extensively tested clinically. These agents act by
delaying dental plaque calcification, thereby promoting plaque
removal with normal tooth brushing
1.Pyrophosphate:
Inhibit the formation of supragingival dental calculus.
Added as tetrasodium pyrophosphate, tetrapotassium
pyrophosphate or disodium pyrophosphate.
It has been shown that pyrophosphate has high affinity to
hydroxyapatite (HA) surfaces, probably by an interaction with
Ca+ in the hydration layer, reduces their protein-binding
capacity.

35. Gum paints are the combination of antiseptics and tanning agents
which precipitate proteins but do not penetrate cells thereby
affecting only the superficial layer making it mechanically stronger
and decreases exudation.
They have germicidal, fungicidal, anesthetic and healing
properties.
When applied, they provide a soothing, cooling and an astringent
effect.
All these preparations contain
Choline salicylate, Tannic acid
Cetrimide, Thymol
Camphor, Cinnamon oil, Iodine
Alum (hydrated potassium aluminumsulfate).