ANTISEPTICS,

ASTRINGENTS,
ANTI-PLAQUE AGENTS
CONTENTS:
• Antiseptics
• Antiplaque agents
• Astringents
• Conclusion
• References
ANTISEPTICS
• Antiseptics:
Chemical disinfectants which can safely applied to living tissues and are
used to prevent infection by inhibiting the growth of microorganisms

• Asepsis:
Technique by which the occurrence of infection into an uninfected tissue is
prevented
Absence of pathogenic organisms

• Disinfection:
Destruction of all the pathogenic organisms or organisms capable of giving rise to
infection but not necessarily bacterial spores
Ideal properties:

Rapid acting

Wide antimicrobial spectrum- against bacteria, virus, fungi, protozoa

Should not be irritating or toxic to tissues

Chemically stable

High therapeutic index

Effective in presence of organic matter such as blood, pus, sputum

Economical
ANTISPECTICS BASED ON CHEMICAL COMPOSITION:

Phenols & phenol Quaternary ammonium

Halogen & halogen Biguanides derivatives compounds
containing compounds - Chlorhexidine - Phenol
- Iodoform, - Cetrimide
- Cresol
iodophores, - Chloroxylenol
chlorophores

Oxidizing agents
Aldehydes Heavy metals & Alcohols - Hydrogen peroxide
- Formaldehyde their salts - Ethanol, - Potassium
Isopropanol permangenate
- zinc, silver salts

Acids Dyes
- Acetic acid - Gentian violet Nitrofurazone
- Boric acid - Acriflavine
• Halogen & halogen containing compounds:
1. Povidone iodine (Iodophore):
- Complex of povidone, hydrogen iodide and elemental iodine

• MOA – ree iodine, slowly liberated from the povidone-iodine (PVP-I) complex kills cells
through iodination of lipids
• Oxidation of cytoplasmic membrane compounds
• Slow release of iodine from PVP-I complex in solution minimizes iodine toxicity
• Kills wet bacterial spores within 15 min

• Indications- Disinfection of skin

- On wounds & abrasions
- Application to mucous membrane (2% iodine in glycerine)
• Side effects- Burning sensation
- Skin irritation
- Staining of clothes, skin & hypersensitivity reactions
• Brand names: Betadine, Piodin

• Available as:
- Ointment- 5%, 10%
- Powder- 5%
- Solution- 10%
- Mouthrinse- 1%, 2%
- Cream- 5%
- Scrub solution- 7.5%
- Spray- 5%
 Chlorophore:
Iodoform:
• Release hypochlorous acid (HOCl)
• Ribbon gauze impregnated with white
• In form of Sodium Hypochlorite
• head varnish (10 g iodoform)
Bactericidal & Virucidal
• Packing of intra oral wounds (Dry
• 0.5% (Dakin’s solution)- Skin & wound
socket)
infections
• Protective dressing for exposed bone
• Disinfectant, Irrigation solution- 5%
surface, osteomyelitis, cystic cavities
• Skin irritation, corrosive to stainless
steel equipments
• Alcohol:
- Broad spectrum (including mycobacteria)
- Not sporicidal
- MOA:
Membrane damage and rapid denaturation of
proteins, with subsequent interference with
metabolism and cell lysis
-  60 to 90% concentration for optimum effect
- Isopropanol- 70% (Bactericidal)
Ethyl alcohol- 60-80% (Virucidal)
- Used on minor cuts & wounds, not on ulcers & MM
- Low conc- Enhance antiseptic activity of iodine &
CHX (when used as a solvent)
- Poor disinfectant, rusting of instruments
• Aldehyde:
- Disinfectant & sterilant
Formaldehyde
- 37% gas in water- Formalin
Diluted to 4-5 % for disinfection,
preservation of dead tissue
- Denatures bacterial proteins
- Broad spectrum germicide; but
restricted due to irritation &
pungent odour
- In the form of Methanamine- in
urinary infections
Formaldehyde is released at acidic
pH (<5.5)
Gluteraldehyde
- Less volatile, less pungent, less
irritating
- Denaturising proteins
- More active in Alkaline pH
- 2% for disinfecting surgical
instruments & endoscopes
- 0.1% - Inhibit germination of spores
- 0.2-0.4%- Inactivation of spores
- 2 %- Sporicidal
• Phenols:
- Antisepctic, disinfectant, preservative
- MOA:
Cell damage, leakage of intracellular components
Coagulation of cytoplasmic constituents at higher concentrations
- young bacterial cells being more sensitive than older cells

- Phenols- 1-2% Microbicidal, 0.2%- Static

- Cresol (Lysol)- 3-10 times more active
50% soapy emulsion for disinfection, washing hands
- Chloroxylenol (4.8%)- Dettol- Non- corrosive, non-irritating
Used for surgical antisepsis
0.8%- Skin cream & soap
1%- Mouthwash (0.45% menthol)- Dettolin
• Oxidizing agents:
- More active against gm +ve bacteria + sporicidal
- Produces nascent oxygen- oxidation of necrotizing
matter & bacteria
- Attack lipids, proteins, and DNA
- Hydrogen peroxide- 3%
Produce 10 volumes of oxygen
Catalase in tissue- increase decomposition- Foaming
Removing slough (ANUG), ear wax
- Available as:- Mouthwash- 3%
- Mucous membrane gel/ Solution- 1.5%
- Cream, spray, solution- 3%
• Silver compounds:
1. Silver nitrate
- Oxidation of thiol group of bacterial enzymes
- Rapid & longer action (slow release of Ag+)
- Active against gonoccoci
- Used in apthous ulcers, tonsillitis
- 1% antiseptic cream/ solution

2. Silver sulfadiazine-
- Synergistic effect of both compounds
- Inhibits DNA transcription
- Highly active against Pseudomonas
- Prevention of burnt surfaces, chronic ulcers from infection
- 1% antiseptic cream
• Zinc salts:
1. Zinc sulfate
- Highly water-soluble
- 0.1-1% for eyewash, in eye/ear drops
4% cream

2. Zinc oxide
- Water insoluble
- Mild antiseptics
- Dermal protectives & adsorbants
Lactocalamine
• Dyes:
1. Gentian violet:
- More active against gm +ve bacteria
- Used for chronic ulcers, thrush, ANUG, bed sores, ring worm
- 0.5-1% solution

2. Acriflavine:
- Against gm +ve bacteria
- Chronic ulcers, wounds
- Do not retard healing, non-irritant
- Impregnated bandages for burn dressing
- 0.1% solution, 1% cream
ANTI-PLAQUE AGENTS
INTRODUCTION:
• Dental plaque is considered as primary etiology for chronic gingivitis

• Although, mechanical plaque control can be an effective strategy for preventing the
progression of disease, most individual do not brush their teeth adequately
Only 11-51% people use dental floss or some type of interdental cleaning device on a
regular basis

• Using an anti-plaque agent to supplement mechanical plaque removal can produce an

antimicrobial effect throughout the mouth

• An anti-plaque agent- the chemical that have an effect on plaque sufficient to benefit
gingivitis and/or caries
Rationale to use of Anti-plaque agents:
• The role of plaque in the initiation and progression of periodontal disease has been
clearly established.
• Formulations based on antimicrobial agents provide a considerably greater preventive
than therapeutic action
- Action of anti-plaque agents could influence plaque quantitatively and qualitatively
through a number of processes
- Based on this they fit into four categories:

Plaque
Anti-adhesive
Anti- removal Antipathogenic
microbial
• Vehicles for the delivery of the agents:

Toothpaste Mouthrinses Sprays

Irrigators Chewing gums Varnishes

• Ideal Properties:

a) Should decrease plaque and gingivitis

b) Prevent pathogenic growth
c) Should prevent development of resistant bacteria
d) Be biocompatible
e) Should not stain teeth or alter taste
f) Should have good retentive properties (Substantivity)
g) Should be economic
• Classification of Antiplaque agents:
- Based on their mechanism of action (Kormann- 1986)

FIRST GENERATION
THIRD GENERATION
SECOND GENERATION
• Plaque reduction upto
20-25% • Block binding of
• Plaque reduction upto
• Poor substantivity micro-organisms to
70-90%
tooth & each other
• Better substantivity
• Poor substantivity
- Triclosan than 1st generation
than 2nd generation
- Antibiotics agents
agent
- Quaternary ammonium
compounds - Bisbiguanides
- Delmopinol
(Chlorhexidine)
- Phenols
- Sanguinarine
1. Triclosan:
• Synthetic, non- ionic phenol derivative
• Broad spectrum antibiotic action
• Acts on cytoplasmic membrane- induce leakage of cellular elements- Bacteriolysis
• Included in toothpaste
• Used along with Zn-citrate/ copolymer Gantrez
• Delays plaque formation
• Inhibits formation of PGE2 & leukotrienes
• Available in: Toothpaste (0.3%)
Mouthwash (0.03%)
2. Quaternary ammonium compound:
• Broad spectrum cationic antiseptics- active against gm +ve
• Equivalent antimicrobial activity to CHX
• Alternate permeability of cell membrane & denatures proteins
• Germicidal action is slow
• Non-irritating (used as antiseptic), disinfectant
Cetrimide (1-3%)
Cleans dirt, grease, congealed blood
Savlon solution- 1.5% CHX + 3% Cetrimide
cream- 0.1% CHX + 0.5% Cetrimide
• Less effective plaque inhibition
Cetylpyridinium chloride (CPC)
0.1% CPC has lowest plaque scores
Colgate plax, Crest
 Anti-plaque agent
3. Metallic ions (Eg- Zn, Cu)
4. Sanguinarine
5. Phenols (Essential oils)
- Thymol, eucalyptol, menthol &
methyl salicylate
- Listerine
6. Antibiotics
Vancomycin, erythromycin
Mechanism of action
- Metal salts reduce the
glycolytic activity in
bacteria
- Delay bacterial growth
& plaque formation
- Chemically reactive iminium
ion that is retained in oral
cavity
- Poor GIT absorption
- Affect metabolic processes
dependent on enzymes within
cell membrane
- Binds with lipid component
- Inhibition of protein synthesis
by binding to 50S ribosome
subunit of organisms
Properties
- Antimicrobial
- Inhibition of plaque
- Halitosis reduction
- Most effective against gram –ve
organisms
- Used at high concentrations,
moderate plaque inhibition
- Antigingivitis
- Anti-inflammatory (antioxidative)
- Prevent/ resolve gingivitis
- Not be used for antiplaque effects
because of side effects
7. Chlorhexidine:
• Cationic bisbiguanide
• Effective against- Gm +ve,
Gm –ve, fungi, yeast,
viruses
• Antiplaque, antimicrobial
MOA:
• Increase in cell membrane
permeability & coagulation
of cytoplasmic
macromolecules
• Prevents adsorption of
bacteria on tooth surface
Substantivity:
• Ability to maintain effective
concentration for long time
• Prolonged action (upto 12
hrs)

Antibacterial action: Gold standard:

Adverse effects:
Bacteriostatic- Low concentration - Superior antiplaque
CHX molecules (+ve charge) reacts • Brownish staining of effect
with Cell wall (-ve charge)- leakage of teeth & restorations - Substantivity
of cytoplasmic molecules (Reversible) • Metallic taste - Pin cushion effect
• Stenosis of parotid duct
Bactericidal- Higher concentration • Mucosal erosion
Irreversible precipitation of • Supragingival calculus
cytoplasmic molecules formation
• Available in:
1. Mouthrinses- 0.2% & 0.12%
2. Gel- 1%
3. Sprays- 0.1% & 0.2%
4. Varnishes
5. Periochip- 2.5 mg
6. Irrigant/ antiseptic- 2-5%
- 10 ml of 0.2% (20 mg dose) OR
- 15 ml of 0.12% (18 mg dose)
inhibits plaque growth & development of gingivitis
8. Delmopinol:
• Morpholino ethanol derivative
• Interferes with plaque matrix formation
• Reduces bacterial adherence
• Aid in easy removal of plaque by mechanical method
Hence, indicated pre-toothbrushing
• 0.2% mouthrinse
• Adverse effects:
- Staining of tooth & tongue
- Taste disturbances
- Mucosal soreness & erosion
 Other antiplaque agents
Enzymes
Properties
1st group: - Dextranase, mutanase,
- Potential to disrupt plaque proteases
matrix
- Poor antimicrobial activity
2nd group: - Glucose oxidase,
- Interfere with bacterial amyloglucooxidase
metabolism
- Antimicrobial

Fluorides Plaque inhibitory activity Stannous fluoride, amine fluoride

Colgate plax
Oxygenating agents Liberation of nascent oxygen Hydrogen peroxide

Detergents Considered to have antimicrobial Sodium lauryl sulphate

activity
Saliflour Antimicrobial 0.12% conc has shown equal
Anti-inflammatory effectiveness with 0.12 CHX in
retarding 4 day plaque growth
ASTRINGENTS
INTRODUCTION:
• Astringents are any group of substances that cause the contraction or shrinkage of tissue &
reduce secretions

• Precipitate proteins, but do NOT penetrate cells hence, affecting superficial layer of mucosa

• Toughen the surface by making it mechanically stronger & reduce exudation

• Also: - Improve blood circulation

- Improves pH of skin
- Tightens the skin, remove excess of oil

• Sources: Legumes, raw fruits & vegetables, berries,

green tea, wine (Tannin- polyphenols)
MECHANISHM OF ACTION:
Contract small blood vessels

Extract water from tissues

Precipitate proteins

Contraction of tissues.

Astringency – property of
causing puckering sensation in
mouth making it feel dry
USES IN DENTISTRY:

To cleanse & detoxify gums

Tighten gums

Remove plaque from teeth surface

Before making impressions & class V restoration

(For Gingival retraction)

To reduce bleeding- as styptics

 For gingival retraction
- To expose finish line
- Create acceptable environment for
impression material
- Retraction cord is impregnated with
solution OR with help of cotton pellets
- Example,
Alum, aluminium chloride, Ferrous
sulphate,
Zinc chloride (8-20 %), tannic acid
Gum astringents
- Gum paints- Antiseptics + tannin agents
- Affects superficial layer & make it mechanically
strong & decrease exudation
- Germicidal, fungicidal, anaesthetic, healing
properties
- Applied on flabby edentulous ridges
- Contents:
Choline salicylate, tannic acid, thymol,
cetrimide, camphor, iodine, alum
ASTRINGENTS USED FOR GINGIVAL RETRACTION:
• ASTRINGENTS USED FOR GINGIVAL RETRACTION:
GUM ASTRINGENTS USED :
• Natural medicines with astringent properties:
1. Myrrh (Cammiphora
molmol)
- Antimicrobial & astringent
- Bleeding gums, ulcers
4. Citric acid
- Dermatology Rx
- Gingival reattachment
- Ehance astringency of
phenolic compounds
2. Aloe vera
3. Oregon grape root
- Antiseptic & astringent
- Bleeding gums
- Antifungal
6. White oak bark
5. Saline water - Clotting & antiseptic
- Astringent
effect
- Accelerates wound
- Swollen, tender gums
healing
- Mucous membrane
CONCLUSION:
• Microorganisms are inevitable part of oral cavity & extra-oral environment
• Antiseptics in a way help to kill & prevent the growth of microorganisms which is in
turn our aim i.e to prevent peri & postoperative infections in periodontal surgery
• Mechanical plaque control is the mainstay for prevention of oral diseases, but it
requires immense patient cooperation and motivation
• The use of anti-plaque agents in controlling plaque formation and preventing gingivitis
can be an adjunct to mechanical plaque removal and should not be a substitute for
mechanical plaque control
• Astringents help dentists in obtaining good gingival & mucosal health without
compromising the quality of work
REFERENCES:
• Lindhe J. Clinical periodontology and implant dentistry. Lang NP, Karring T, editors.
Oxford: Blackwell Munksgaard; 2003 Jun
• Van der Ouderaa EJG: Anti-plaque agents. Rationale and prospects for prevention of
gingivitis and periodontal disease. J Clin Periodontol 1991; 18: 447-454.
• McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance.
Clin Microbiol Rev. 1999 Jan;12(1):147-79. Erratum in: Clin Microbiol Rev 2001
Jan;14(1):227. PMID: 9880479; PMCID: PMC88911.
• Gupta G, Kumar S, Rao H, Garg P, Kumar R, Sharma A, Sachdeva H. Astringents in
dentistry: a review. Asian Journal of Pharmaceutical and health sciences. 2012;2(3).
• Essentials of medical pharmacology- KD Tripathi (7th edition)
THANK YOU