Dental plaque and antiplaque agents Dental caries Fluorids and other anticaries agent Dentifrices Mouthwash

1. WELCOME TO OUR
PRESENTATION

2. Presented by
Group -04 (Abstract)
Members:
MD Sabbir Ahmed ………………(PHA-19021)
Hafizur Rahman ………………….(PHA-19022)
MD Shobuj Ahmed ……………..(PHA-19023)
M.M.Abdullah-Ibna-Tareq …..(PHA-19024)
Shaira Khandaker ………………..(PHA-19025)

3. Presenting to
Our honorable teacher
Ishrat Jahan Ira
Chairman
Department of Pharmacy
Mawlana Bhashani Science And Technology University

4. COURSE TITLE :Inorganic Pharmacy II
COURSE CODE :PHAR-1203
Contants
 Dental plaque and antiplaque agents
 Dental caries
 Fluorids and other anticaries agent
 Dentifrices
 Mouthwash

5. Introduction of Dental Products
The inorganic compounds and their formulations which are used in
maintaining the oral and dental hygiene are known as dental products.
Dental products include anticaries agents, polishing agents, and
desensitizing agents.
 Dental Products
1. Antiplaque agents
2. Anticaries agents
3. Dentifrices
4. Mouthwash
5. Dental fluorides

6. Introduction of tooth
*The tooth are accessory digestive organs. People use their tooth to
bite and chew food.
*So, The teeth are hard calcified structure fixed in upper and lower jaw.
Types of tooth
1. Incisors
2. Canine
3. Premolar
4. Molar
Figure: 1.0

7. Structure of tooth:
They are anatomically divided into two parts:
1.The crown portion
2.The root portion
*The junction of the crown and root portion is called the neck and the
visible line at the junction is called the cervical line.
A tooth is composed of 4 tissue-
1.Enamel 3.Cementum
2.Pulp 4.Dentine

8. 1. Enamel: Hard calcified (consists primarily of
calcium-phosphate and calcium carbonate)
tissue covering dentin of the crown of tooth.
2. Crown: The crown is the visible portion of
tooth above the level of the gums.
3. Gingiva (gums): Soft tissues overlying the
crowns of unerupted teeth and encircling
the necks of those that have erupted.
4. Pulp Chamber: The space occupied by the
pulp.
5. Neck: The area where the crown joins the
root.
6. Dentin: That part of the tooth that is
beneath enamel and cementum.
Figure no : 1.1

9. 7. Alveolar Bone (jawbone) : The part of the jaw that
surround the roots of the teeth.
8.Root Canal: The portion of the pulp cavity inside the
root of a tooth; the chamber within the root of the
tooth that contains the pulp.
9.Root: Embedded in the socket are one to three roots.
10.Cementum: Hard connective tissue covering the
tooth root, giving attachment to the periodontal
ligament.
11.Periodontal Ligament: A system of collagenous
connective tissue fibers that connect the root of a tooth
to its alveolus.
Figure no: 1.2

10. CLASSIFICATION OF DENTAL PRODUCTS
Dental products includes:
Anticaries agents: These are the agents which help in prevention of dental decay
e.g. Sodium fluoride, stannous fluoride, sodium monofluorophosphate Cleaning
agents (Dentifrices/ Polishing agents): Dentifrices are agents used along with a
toothbrush to clean and polish natural teeth. They must be abrasive to some
degree to remove the stains from the teeth. They are supplied in paste, powder,
gel or liquid form. e.g. Calcium carbonate, Dibasic calcium phosphate, calcium
phosphate, sodium metaphosphate.
Desensitizing Agents: These reduce sensitivity of teeth to heat and cold.
Examples : include strontium chloride and zinc chloride.

11. Antiplaque agents
Dental plaque: Dental plaque is a whitish soft accumulation of bacteria and
their substrate which deposits on the teeth while not cleaned adequately.
Plaque formation
• Plaque formation does not take place haphazardly but in a reasonably orderly
manner.
• A pellicle derived from the saliva or gingival fluid first forms on the teeth. This
pellicle is a thin, clear cuticle and is composed mainly of glycoproteins.

12. Very soon after its formation, bacteria of the coccus type streptococci largely)
are attached to the pellicle which has a sticky' surface, i.e. one which enables
colonies of organisms to beanchored. These organisms divide and form colonies.
Attachment of the microorganisms is further enhanced by the production of
dextrans by the bacteria as by-products of metabolic activity. Later other types of
organisms are attracted to the massand a dense mixed flora of filamentous forms
i.e.plaque results. Plaque may attach to the teeth supragingivally, or subgingivally
in the gingival crevice, or in periodontal pockets.

13. Antiplaque agents:
Antiplaque agents are the agents or drugs that are used to prevent or inhibit
plaque formation in the mouth, e.g. chlorhexidine, povidone iodine etc.
Ideal properties of an antiplaque agent:
1. It should be non-toxic, non-allergic and non-irritating.
2. It should have a broad spectrum of antimicrobial activity
3. It should specifically affect only the pathogenic flora.
4. It should not have any induced drug resistance,
5. It should have an acceptable taste.

14. 6. It should possess sufficient chemical stability, so that it can
be stored for a reasonable length of time.
7. It should be of low price and available.
Chlorhexidine
Chemistry: It is a chlorophenyl bisbiguanide that has been used as the acetate and
more commonly the gluconate salt in mouth rinses, gels and dentifrice for control
of plaque and gingivitis. It is highly cationic antiseptic. It has fungicidal activity and
bactericidal action against both gram positive and gram negative microorganisms.
Figure no: 1.3

15. Mechanism of action
Due to its high cationic nature chlorhexidine binds the anionic groups on the
bacterial surface, i.e. phosphate group of terchoic acid in gram-positive bacteria
and phosphate group of lipopolysaccharides in gram negative bacteria .
When the bisbiguanide binds to the organism, the cell membrane becomes
permeable allowing the cytoplasmic contentsto leak out of the cell. At higher
concentration chlorhexidine causes precipitation of cytoplasmic proteins.
By virtue of their cationic properties the bisbiguanides also bind
electrostatically to the hydroxy-apatite of teeth and forms a pellicle (film or
surface) against plaque and to buccal mucosa. This is how it acts as an anti-
plaque agent.

16. Uses: Chlorohexidine is used in the following vehicles:
1. Mouth rinse:
a) 0.12% chlorhexidine gluconate solution is used as a mouthwash for oral
hygiene and oropharyngeal infections, especially aphthous ulcers.
b) 0.2% chlorhexidine gluconate solution prevents the accumulation of plaque.
It is absorbed onto tooth enamel, where it exerts a persisting action to decrease
the growth of dental plaque.
2. Irrigator: 400 ml of a 0.02% solution of chlorhexidine (80 mg totally) applied
once daily in an oral irrigator will give complete plaque inhibition.
3. Gels: 1% gel of chlorhexidine gluconate applied for a period of five minutes,
once or twice a day is effective in the inhibition of bacterial plaque particularly
in the treatment of denture stomatitis.

17. 4. Antiseptics: 4% aqueous solution of chlorhexidine is effectively used as a
surgical scrub, it decreases the cutaneous bacterial population more than
either hexachlorophene or povidone iodine.
Clinical indication of chlorhexidine
1. Short term application:
a) Healing phase in periodontal surgery
b) Healing phase in oral surgery
i) Mandibular fracture
ii) Third molar extraction
c) Pre-surgical use to reduce bacteremia (bacteria in the blood)
d) Therapy for apthus ulceration

18. e) Therapy for denture stomatitis
f) Therapy for acute necrotizing ulcerative gingivitis.
2. Intermediate short term application
a) Repeated denture stomatitis
b) Adjunct to periodontal maintenance care.
c) Dental implants
Side effects or adverse reaction of chlorhexidine
1. The most common side effect of chlorhexidine is the formation of staining or
an extrinsic yellowish or brownish discoloration of the tooth surface and
gum. Stain may appear on the natural teeth, artificial teeth and composite
filling though it depends on the concentration and varies greatly from one
individual to another.

19. 2. It has an unpleasant bitter taste and may cause irritation to the oral mucosa
and disturbance in the taste buds.
3. Regular use of chlorhexidine may sometimes block the salivary duct of the
parotid gland and lead to a painful condition.
4. Local tissue damage may occur if the drug is applied to abraded epithelium.
5. Hypersensitivity reaction may occur in some individuals.
Precaution:
(i) Chlorhexidine rinses should be performed after meals to minimize taste
alteration.
(ii) Patients should not rinse with water following a chlorhexidine rinse.

20. Anticaries agents
Dental caries: Dental caries is gradual decay and disintegration of tooth
tissues, i.e. progressive decalcification of the enamel and dentin of a tooth.
The ultimate effect of caries is to break down enamel and dentine and thus open
a path for bacteria to reach the pulp. The consequences are inflammation of the
pulp and, later, of the periapical tissues. Infection can spread from the periapical
region to the jaw and beyond.
Types of carries according to location:
(i) Pits and fissure caries
(ii) Smooth surface caries
(iii) Root caries
(iv) Deep dentinal caries

21. Factors involved in the initiation of dental caries/ Essential
requirements for development of dental caries
Dental caries is a multifactorial disease and the following four factors
are involved in the initiation of dental caries:
1. Susceptible tooth surface to acid attack:
Generally caries is initiated in the enamel but it may also begin in
dentine or cementum.
2. Plaque attached to the tooth surface:
Plaque is a tenaciously adherent deposit that forms on tooth surface.
It consists of an organic matrix containing a dense
concentration of bacteria.

22. 3. The bacterial activity in the plaque:
Plaque contains bacteria that are acid producing. Mutans streptococci are
believed to be the most important bacteria in the initiation and progress of
dental caries.
4. Substrates:
Bacteria utilize fermentable carbohydrates for energy and the end-points of the
glycolytic pathway in bacterial metabolism are acids. Sucrose is the fermentable
carbohydrate most frequently implicated but bacteria can use all fermentable
carbohydrates, including cooked starches.
The interaction of these factors is illustrated by the simplified
equation
(Plaque)
Bacteria + Sucrose = Acid+ Susceptible tooth surface = Caries

23. Caries initiation is the action by microorganisms in the plaque which is in
intimate relationship with the tooth surface. These organisms act on sucrose
products entering the plaque after carbohydrate ingestion, and form acids
which at the critical pH level (below 5.5) bring about enamel dissolution.
Prevention of dental caries/ Preventive efforts relative to caries
(i) Increasing the resistance of the tooth surface enamel against acid products:
The resistance of the tooth surface enamel to acid attack can be very greatly
enhanced by the incorporation of minute amounts of fluoride ion so that the
hydroxyapatite crystals become fluoroapatite. The principal mode of action of all
fluorides (tooth pastes, rinses, gels and community water fluoridation) is its
topical effect on enamel.

24. (ii) Diet modification: Minimizing intake of dietary refined carbohydrates and
good dental hygiene prevent growth of bacteria that contribute to the
development of caries. Sweets etc. should be limited to mealtimes.
Frequency of intake is more important than overall quantity.
Grazing' or 'snacking' between meals should be avoided.
The frequent consumption of soft drinks is a major problem, these being not
only cariogenic but extremely erosive.
(iii) Plaque removal: Proper brushing of the teeth is effective in preventing
and removing dental plaque in all areas except those between the teeth and
deep fissures. Ideally, tooth brushing should be carried out twice a day and
emphasis should be placed on brushing just before bed.

25. Parents should be advised to begin cleaning their children's teeth from when
they first erupt. Gauze or a cloth on a finger, or a small very soft toothbrush may
be used to remove the plaque.
(iv) Early detection and dental restorations offer the best form of control once
caries has formed.
Fluorides in the prevention of dental caries/Effects of fluorides/
Mechanism of action of fluorides
The principal mode of action of all fluorides (tooth pastes, rinses, gels and
community water fluoridation) is its effect on enamel. The resistance of the
tooth surface enamel to acid attack can be very greatly enhanced by the
incorporation of minute amounts of fluoride ion so that the hydroxyapatite
crystals become fluoroapatite. The formation of this solubility resistant form
explains the mode of action of fluorides as preventive agents.

26. Fluoride therapy (Systemic fluoridation and topical fluoridation)
In the child, the developing tooth will receive its necessary building materials
from the blood plasma and thus the enamel fluorine content will at this point
be completely dependent on systemically absorbed fluorine. After tooth
eruption, maturation of the enamel takes place and a great deal of fluoride
uptake is a topical one. Hence it may be assumed that fluoride acts in two
complementary ways- by 1. Systemic fluoridation
2. Topical fluoridation.
1.Systemic fluoridation
A) Fluoridation of public water supplies: An optimal level of fluoride in the
water supply provides significant protection against caries. The optimal
concentration depends on the annual average temperature of the community
as temperature influences the amount of daily water intake.

27. Temperature ranging between 14.7'C to 17.7°C, the optimal level of fluoride is 1 part per
million (ppm). The adjustment of the fluoride concentration of public water supplies to 1
ppm is necessary in low-fluoride areas. Most commonly, fluoride is added in the form of
hexafluorosilicic acid or sodium hexafluorosilicate, but sodium silicofluoride and sodium
fluoride have also been used.
In a warmer climate slightly less than 1 ppm is sufficient. The effect of fluoride in drinking
water persists in between 8 to 18 years of age i.e. during tooth formation and mineralization.
B) Fluoride supplement: Fluoride supplements like tablet, drops lozenges,
table salt etc. offer an alternative source of systemic fluoridation where water
fluoridation is not feasible. These supplements are usually administered
continuously on a daily basis from birth to the pre-eruptive maturation of
permanent teeth.
*If fluoride tablets are prescribed they should be chewed rather than swallowed whole.
This will increase the topical benefit of fluoride.

28. 2.Topical fluoridation:
A lifetime protection against dental caries results from the continuous use of
low-concentration fluoride. In addition to their use in caries prevention, topical
fluorides may be used to control established caries lesions. This is effective for
both adults and children.
(a) Fluoride tooth paste: The use of fluoride toothpastes has led to a 25%
reduction in the prevalence of caries in industrialized countries.
Conventional tooth pastes
*Contain approximately 1 mg F/g paste (1000-1100 ppm of fluoride)
*Added as sodium fluoride such as sodium monofluorophosphate (MFP) or
stannous fluoride.
(b) Fluoride mouth rinses: Studies showed that supervised fluoride-rinse
programs reduce caries by 20-50%. Weekly 0.2% NaF and daily 0.05% NaF rinses
were considered to be ideal public health measures.

29. (c) Fluoride varnishes: Fluoride vamishes were developed to prolong contact
times between fluoride and enamel with a view to increasing the formation of
fluoroapatite. Although fluoride varnishes firmly bind fluoride in enamel more
than other topical fluoride preparations, the reduction of caries has been of the
same order (approximately 30%).
Example: Duraphat- An alcoholic solution of natural vamishes containing 50 mg
NaF/mL.
(d) Concentrated fluoride gels and solutions APF gels: Acidulated phosphate
fluoride (APF) gels, containing 1.23% fluoride are used for professional
applications and consist of a mixture of NaF, HF and orthophosphoric acid. The
incorporation of a water-soluble polymer (i.e. sodium carboxymethyl cellulose)
into aqueous APF produces a viscous solution that improves the ease of
application. APF gels are mainly used for the prevention of caries development.

30. Dental fluorosis
Dental fluorosis is chronic fluorine poisoning, sometimes marked by mottling of
tooth enamel. It may result from excessive exposure to fluorides from a wide
variety of dietary, water-borne, and supplemental sources.
There is evidence to show that mild fluorosis will occur with ingestion of 2 mg or
more of fluoride per day.
Sodium fluoride (NaF)
Preparation-By interaction of 40% HF with an equivalent quantity of NaOH or
Na2CO3 .
Stannous fluoride (SnF2)
Preparation- Stannous oxide is dissolved in 40% HF and the solution is evaporated
out of contact with air.

31. Uses of NaF , SnF2:
NaF or SnF2 is used as a dental carries prophylactic. Ingested fluoride is
effective only while teeth are being formed. The fluoride is incorporated into
tooth salts asfluoroapatite.
Topical application results in changes only in the outer layers of enamel or
exposed dentin. It alters the composition and crystalline structure of the
hydroxyapatite-like salts that make up the bulk of enamel and dentin, so that
the tooth material is more resistant to acidic erosion and dental caries (decay).

32. Dentifrices
Dentifrices are the substances used with a toothbrush for the removal of
bacterial plaque, food debris, stain and calculus only from the accessible
surfaces of the tooth.
Ideal properties of a dentifrice:
1. It should not be harmful to the oral tissue and fluid.
2. If it is ingested it should not be harmful to the G.I.T
3. It should not stain teeth.
4. It should not be scratching to the enamel surface of tooth.
5. It should have pleasant odour and taste.
Types of dentifrices
Commercial dentifrices are generally available in two forms :
1. Powder , 2. Paste or gel.

33. Ingredients of powder dentifrices:
*Abrasives
*Foaming agent
*Flavoring agent.
Ingredients of paste dentifrices:
*Abrasive
*Foaming agent
*Humectants
*Binders or thickening agents
*Preservatives
*Therapeutic agents
*Flavoring agent
*Sweetening agents
*Coloring agents
*Water.

34. Therapeutic agents: The majority of dentifrices contain
therapeutic agents such as fluoride salts. Fluoride salts inhibit
caries. Common fluoride salt, which are used in the paste are-
i. Sodium monofluoro phosphate (SMFP)
ii. Monofluoro phosphate (MFP)
iii. Stanous fluoride.
Triclosan: Triclosan (trichloro hydroxydiphenyl ether, C12H7Cl3O2) is
white or off-white, crystalline powder. It has broad-spectrum
antibacterial activity.

35. Composition of "Crest" tooth paste
Stanous fluoride 0.4%
Stanous pyrophosphate 1.0 %
Calcium pyrophosphate (Ca2P2O7) 39 %
Glycerirn 10 %
Sorbitol (70% solution) 20%
Water 29.6%
Miscellanous formulating agents

36. Composition of "Colgate" tooth paste
Sodium monofluorophosphate (MFP) 0.76 %
Insoluble sodium metaphosphate 41 .85 %
Anhydrous dicalcium phosphate 5 %
Sorbitol 11.9 %
Glycerol 9.9 %
Sodium N-lauroyl sarcosinate 2 %
Water 24.4 %
Miscellanous formulating agents 4.2 %

37. Mouth wash
Definition
1 .Non-sterile aqueous solution.
2 .Used mostly for its: deodorant, refreshing or antiseptic effect
3 .Mouthwashes or rinses are designed to:
 reduce oral bacteria,
 remove food particles,
 temporary reduce bad breath and
 provide a pleasant taste
Classification
1. Cosmetic
2. Therapeutic
3. Combination of both

38. Cosmetic:
1. commercial OTC products
2. help to remove oral debris before or after brushing,
3. temporary suppress bad breath
4. diminish bacteria in the mouth and
5. refresh the mouth with a pleasant taste.
Classification
Therapeutic:
 may be sold as OTC product.
 have the benefits of their cosmetic counterparts.
 help remove oral debris before or after brushing .
 temporarily suppress bad breath.

39.  diminish bacteria in the mouth.
 refresh the mouth with a pleasant taste.
 contain an added active ingredient that helps protect against some oral
diseases.
 e.g. fluoride or chlorhexidine, that help protect against some oral diseases.
Types of Mouthwashes
1. Containing antibacterials ,
2. Containing fluoride ,
3. Containing minerals (astringent)

40. Components of Mouthwash
 Antibacterial agents,
 Alcohol,
 Humectants,
 Surfactants,
 Flavoring agents,
 Coloring agents,
 Fluorides,
 Sweetening agents,
 Minor ingredients,
 Other antibacterial agents:
- Cinnamon oil, cassia, clove, eucalyptus, thyme, peppermint, anise.
- Menthol, thymol and methyl salicylate.

41. References
1.Modern Inorganic Chemistry : R.D. Madan
2.Inorganic Medicinal and Pharmaceutical Chemistry:Block and
Roche
3.www.google.com

42. THANK YOU