Chemical Plaque Control and Local Delivery Agents Chlorhexidine Digluconate
Introduction Mode of action
Microbial plaque biofilm control is an effective way of Reduction in pellicle formation ( bind to
treating and preventing gingivitis and is an essential part of Hydroxyapatite & Glycoprotein )
all the procedures involved in the treatment and Reduction of bacterial attachment to teeth
prevention of periodontal diseases. Disruption of bacterial cell wall
Methods of plaque control:
Chemical. Chlorhexidine Digluconate Uses
Mechanical. 1. Pre-op rinse to reduce aerosol contamination
Chemical inhibitors of plaque biofilm: 2. Post surgery ( after 24- 48 hours) for 1-2 weeks
Toothpastes. 3. Recurrent oral ulcers (ROU)
Mouthwashes. 4. Jaw fixation
Other Products. 5. Medically compromised /susceptible to infections
Toothpastes: 6. Increased caries rate ( with fluorides)
“Calculus control toothpastes,” also referred to as “tartar Other Products:
control toothpastes,” contain pyrophosphates. A preparation containing triclosan has shown some
The inhibitory effects reduce the deposition of new effectiveness in reducing plaque biofilm and gingivitis. It is
supragingival calculus but do not affect existing calculus available in toothpaste form.
deposits. Other oral rinse products on the market have shown some
To achieve the greatest effect from calculus control evidence of plaque biofilm reduction These include
toothpaste, the patient’s teeth must be cleaned and stannous fluoride, cetylpyridinium chloride (quaternary
completely free of supragingival calculus when adding ammonia compounds), and sanguinarine.
these products to the daily home care regimen. Nonprescription Essential Oil Rinse:
Chemical Plaque Biofilm Control with Oral Rinses: Essential oil mouthrinses contain thymol, eucalyptol,
To date, the ADA has accepted two agents for treatment of menthol, and methyl salicylate.
gingivitis: These preparations have been evaluated in
1. Prescription solutions of chlorhexidine digluconate oral long term clinical studies and demonstrated
rinse. plaque biofilm reductions of 20% to 35%
2. Nonprescription Essential oil mouthrinse. and gingivitis reductions of 25% to 35%.
Prescription Chlorhexidine Rinse: Listerine
The agent that has shown the most positive antibacterial Listerine is an essential oil mouth rinse with thymol,
results to date is chlorhexidine. menthol, eucalyptol, methyl salicylate,
alcohol upto 27%, so should be used with caution.
Plaque reduction -20-35%
Gingivitis reduction 25-35%
Mechanism of action- Alteration of bacterial cell well
Used 10ml bid after brushing
Several clinical investigations confirmed the initial finding Side effects include Burning sensation , bitter taste
that two daily rinses with 10 ml of a 0.2% aqueous solution and staining of teeth
of chlorhexidine digluconate almost completely inhibited Used with caution in patients with xerostomia,
the development of microbial plaque biofilm, calculus, and alcoholics, smokers and children
gingivitis. Anti-infective Therapy:
Locally, reversible side effects to chlorhexidine use occur, Local anti-infective therapy (placing anti infective agents
primarily brown staining of the teeth, tongue, and silicate directly into the periodontal pocket).
and resin restorations and transient impairment of taste Systemic anti-infective therapy (oral antibiotics).
perception. Local Delivery Agents:
Locally delivered antimicrobial agents are available as
Chlorhexidine agent adjuncts to scaling and root planing and as aids for the
Advantages control of growth of bacteria .
1. High substantivity remains 8-12 hours in mouth When they are placed into periodontal pockets, they
2. Broad spectrum- gram +ve and gram –ve, fungi and viruses reduce the subgingival microflora, the probing depths, and
( HIV & HBV ) the clinical signs of inflammation.
3. No bacterial resistance
4. Reduce the plaque by 55%, reduce gingivitis by 45%
5. Very poorly absorbed through skin or GIT , so reduced
systemic toxicity
Introduction Mode of action
Microbial plaque biofilm control is an effective way of Reduction in pellicle formation ( bind to
treating and preventing gingivitis and is an essential part of Hydroxyapatite & Glycoprotein )
all the procedures involved in the treatment and Reduction of bacterial attachment to teeth
prevention of periodontal diseases. Disruption of bacterial cell wall
Methods of plaque control:
Chemical. Chlorhexidine Digluconate Uses
Mechanical. 1. Pre-op rinse to reduce aerosol contamination
Chemical inhibitors of plaque biofilm: 2. Post surgery ( after 24- 48 hours) for 1-2 weeks
Toothpastes. 3. Recurrent oral ulcers (ROU)
Mouthwashes. 4. Jaw fixation
Other Products. 5. Medically compromised /susceptible to infections
Toothpastes: 6. Increased caries rate ( with fluorides)
“Calculus control toothpastes,” also referred to as “tartar Other Products:
control toothpastes,” contain pyrophosphates. A preparation containing triclosan has shown some
The inhibitory effects reduce the deposition of new effectiveness in reducing plaque biofilm and gingivitis. It is
supragingival calculus but do not affect existing calculus available in toothpaste form.
deposits. Other oral rinse products on the market have shown some
To achieve the greatest effect from calculus control evidence of plaque biofilm reduction These include
toothpaste, the patient’s teeth must be cleaned and stannous fluoride, cetylpyridinium chloride (quaternary
completely free of supragingival calculus when adding ammonia compounds), and sanguinarine.
these products to the daily home care regimen. Nonprescription Essential Oil Rinse:
Chemical Plaque Biofilm Control with Oral Rinses: Essential oil mouthrinses contain thymol, eucalyptol,
To date, the ADA has accepted two agents for treatment of menthol, and methyl salicylate.
gingivitis: These preparations have been evaluated in
1. Prescription solutions of chlorhexidine digluconate oral long term clinical studies and demonstrated
rinse. plaque biofilm reductions of 20% to 35%
2. Nonprescription Essential oil mouthrinse. and gingivitis reductions of 25% to 35%.
Prescription Chlorhexidine Rinse: Listerine
The agent that has shown the most positive antibacterial Listerine is an essential oil mouth rinse with thymol,
results to date is chlorhexidine. menthol, eucalyptol, methyl salicylate,
alcohol upto 27%, so should be used with caution.
Plaque reduction -20-35%
Gingivitis reduction 25-35%
Mechanism of action- Alteration of bacterial cell well
Used 10ml bid after brushing
Several clinical investigations confirmed the initial finding Side effects include Burning sensation , bitter taste
that two daily rinses with 10 ml of a 0.2% aqueous solution and staining of teeth
of chlorhexidine digluconate almost completely inhibited Used with caution in patients with xerostomia,
the development of microbial plaque biofilm, calculus, and alcoholics, smokers and children
gingivitis. Anti-infective Therapy:
Locally, reversible side effects to chlorhexidine use occur, Local anti-infective therapy (placing anti infective agents
primarily brown staining of the teeth, tongue, and silicate directly into the periodontal pocket).
and resin restorations and transient impairment of taste Systemic anti-infective therapy (oral antibiotics).
perception. Local Delivery Agents:
Locally delivered antimicrobial agents are available as
Chlorhexidine agent adjuncts to scaling and root planing and as aids for the
Advantages control of growth of bacteria .
1. High substantivity remains 8-12 hours in mouth When they are placed into periodontal pockets, they
2. Broad spectrum- gram +ve and gram –ve, fungi and viruses reduce the subgingival microflora, the probing depths, and
( HIV & HBV ) the clinical signs of inflammation.
3. No bacterial resistance
4. Reduce the plaque by 55%, reduce gingivitis by 45%
5. Very poorly absorbed through skin or GIT , so reduced
systemic toxicity
