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Dental Dental PharmacologyPharmacology

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Dental PharmacologyDental Pharmacology Oral HygieneOral Hygiene ObtudentsObtudents Mummifying agentsMummifying agents Drugs used for cavity toilets & Drugs used for cavity toilets &

periodontal diseaseperiodontal disease

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Oral hygieneOral hygiene Oral hygiene means care of oral mucous Oral hygiene means care of oral mucous

membrane & teeth it includesmembrane & teeth it includesa)a) Sialagouge Sialagouge

b)b) DentrifricesDentrifrices

c)c) Mouth washesMouth washes

d)d) Bleaching agentsBleaching agents

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SialagougeSialagouge It increases the salivary secretion, it It increases the salivary secretion, it

includesincludes1.1. BitterBitter

2.2. Autonomic Cholinergic drugsAutonomic Cholinergic drugs

3.3. Autonomic Ganglion blocking drugsAutonomic Ganglion blocking drugs

4.4. Stimulant substancesStimulant substances

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DentrifricesDentrifrices Therapeutic mechanicalTherapeutic mechanical aids meant for aids meant for

cleansing the teeth with the help of a brush.cleansing the teeth with the help of a brush. Available as tooth Available as tooth powderpowder or tooth or tooth pastepaste, , IdealIdeal tooth paste or powder contains the tooth paste or powder contains the

following ingredients.following ingredients.1.1. Abrasive agentsAbrasive agents2.2. DetergentsDetergents3.3. AntisepticsAntiseptics4.4. Sweetening agentsSweetening agents5.5. Coloring agentsColoring agents

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Abrasive agentsAbrasive agents Dental abrasives are Dental abrasives are fine powder fine powder

preparationspreparations They are used,They are used,

1.1. to help the scouring action of tooth brush to help the scouring action of tooth brush mechanically and mechanically and

2.2. for cleaning, polishing and filling the teethfor cleaning, polishing and filling the teeth Most commonly used dental abrasives are Most commonly used dental abrasives are

pumicepumice and and precipitated calcium precipitated calcium carbonate. carbonate.

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Abrasives (contd….)Abrasives (contd….) PumicePumice consists of silicates of aluminum, consists of silicates of aluminum,

potassium and sodium. potassium and sodium. To polish, fill and clean teeth pumice with To polish, fill and clean teeth pumice with

glycerin is employed.glycerin is employed.

Precipitated calcium carbonatePrecipitated calcium carbonate is a mild is a mild abrasive which is employed to give the final abrasive which is employed to give the final polish to silver amalgam fillings. It is also used polish to silver amalgam fillings. It is also used to prepare tooth paste and tooth powdersto prepare tooth paste and tooth powders

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DetergentsDetergents These are cleaning agents. These are cleaning agents. Sodium bicarbonateSodium bicarbonate: it is mild alkali, acts by : it is mild alkali, acts by

dissolving proteins dissolving proteins

Hydrogen PeroxideHydrogen Peroxide: acts by liberating oxygen: acts by liberating oxygen

Hard SoapsHard Soaps:: act by dissolving fatty substances mucous plaques and act by dissolving fatty substances mucous plaques and

lowering surface tension. lowering surface tension. causes loosening of debris adhering to teethcauses loosening of debris adhering to teeth acts as lubricants when scrubbed over the teeth and gumsacts as lubricants when scrubbed over the teeth and gums proportion in most tooth paste varies from 5 – 25%.proportion in most tooth paste varies from 5 – 25%.

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AntisepticsAntiseptics Value is limitedValue is limited

Volatile Oils: Volatile Oils: Thymol,Thymol, MentholMenthol,, Eugenol Eugenol,, CinnamonCinnamon up to 1% up to 1%

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Sweetening AgentsSweetening Agents SaccharineSaccharine commonly used commonly used

Other agents: Other agents: SucroseSucrose and and LactoseLactose

Sucrose causes less fermentation.Sucrose causes less fermentation.

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Coloring AgentsColoring Agents Make preparations more attractive and Make preparations more attractive and

acceptableacceptable

Red colorRed color: Azorubri, Liquor rubri, liquor : Azorubri, Liquor rubri, liquor caramini or tincture coci.caramini or tincture coci.

Blue colorBlue color: Methylene Blue.: Methylene Blue.

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Dentrifrices-Ideal dentrifice Dentrifrices-Ideal dentrifice An Ideal preparation should be An Ideal preparation should be

Non-causticNon-caustic to the mucous membraneto the mucous membrane Non-decalcifyingNon-decalcifying and non-over abrasive to the teeth and non-over abrasive to the teeth Non-poisonousNon-poisonous to the body as a whole to the body as a whole Not inhibit the secretionNot inhibit the secretion and alter the reaction of and alter the reaction of

saliva saliva Not Not destroydestroy the ferments of saliva the ferments of saliva Have pleasant Have pleasant taste,taste, odorodor and and consistencyconsistency Have sufficient cleaning action.Have sufficient cleaning action.

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MOUTH WASHMOUTH WASH These are mechanical agents used for These are mechanical agents used for

gargles.gargles. Types:Types:

Therapeutic:Therapeutic: to reduce plaque, gingivitis, to reduce plaque, gingivitis, dental caries and stomatitis.dental caries and stomatitis.

Cosmetic:Cosmetic: are used to reduce bad breathare used to reduce bad breath

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THERAPEUTIC MOUTH WASH THERAPEUTIC MOUTH WASH HYDROCORTISONE, HYDROCORTISONE, NYSTATIN, NYSTATIN, ANTIHISTAMINE AND ANTIHISTAMINE AND TETRACYCLINE TETRACYCLINE

Stomatits Stomatits

PilocarpinePilocarpine xerostoma xerostoma

Tranexamic acid Tranexamic acid prevention of bleeding prevention of bleeding after oral surgery after oral surgery

Amphotericin BAmphotericin B oral candidiasisoral candidiasis

Chlorhexidine gluconateChlorhexidine gluconate plaque control plaque control

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TypesTypes1.1. AntisepticsAntiseptics: H: H22OO22, KMnO, KMnO44, Phenol and KClO, Phenol and KClO33, ,

Thymol, Menthol and Sodiumpercholate.Thymol, Menthol and Sodiumpercholate.

2.2. AstringentAstringent: ZnO: ZnO22, Alcohol and ZnCl. These make , Alcohol and ZnCl. These make

a protective layer over the mucosa of oral cavity.a protective layer over the mucosa of oral cavity.

3.3. DemulcentDemulcent: : Glycerin, liquoron. They form a Glycerin, liquoron. They form a

protective layer and prevent attack of bacteria.protective layer and prevent attack of bacteria.

4.4. AntacidAntacid: Like Sodium bicarbonate: Like Sodium bicarbonate

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Moth wash (contd…)Moth wash (contd…) Generally they contain four groups of Generally they contain four groups of

excipients:excipients: AlcoholsAlcohols: used as solublizing agent for some : used as solublizing agent for some

flavoring agents as well as preservatives.flavoring agents as well as preservatives. SurfactantsSurfactants: used to reduce debris by providing : used to reduce debris by providing

foaming agentsfoaming agents FlavorsFlavors Coloring agentsColoring agents

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Ideal Mouth washIdeal Mouth wash Non-causticNon-caustic to the mucous membraneto the mucous membrane Non-decalcifyingNon-decalcifying and non-over abrasive to the and non-over abrasive to the

teethteeth Non-poisonousNon-poisonous to the body as a whole to the body as a whole Not inhibit the secretionNot inhibit the secretion and alter the reaction of and alter the reaction of

saliva saliva Not Not destroydestroy the ferments of saliva the ferments of saliva

Have pleasant taste, odor and consistencyHave pleasant taste, odor and consistency Have sufficient cleaning action Have sufficient cleaning action

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BLEACHING AGENTSBLEACHING AGENTS They remove the coloring pigments from the teeth They remove the coloring pigments from the teeth

and these are,and these are,

1.1. Oxidizing AgentsOxidizing Agents: like perhydrol, pyrozone, sodium : like perhydrol, pyrozone, sodium peroxide hyderogenperoxide.peroxide hyderogenperoxide.

2.2. Chlorinating AgentsChlorinating Agents: like chlorinated Soda lime.: like chlorinated Soda lime.

3.3. Reducing AgentsReducing Agents: like Sodiumthiosulphate.: like Sodiumthiosulphate.

Boric acid, Sodiumthiosulphate and chlorinated soda Boric acid, Sodiumthiosulphate and chlorinated soda lime are packed in the oral cavity in powder form and lime are packed in the oral cavity in powder form and to hasten the evolution of chlorine drop of acetic acid to hasten the evolution of chlorine drop of acetic acid is used.is used.

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Special StainsSpecial Stains

StainStain Bleaching agent Bleaching agent usedused

Iodine stainsIodine stainsWeak ammonia or Weak ammonia or

Sodium thiosulphate Sodium thiosulphate solution.solution.

Silver stainsSilver stains Hypochlorite or Iodine Hypochlorite or Iodine solutionsolution

Iron stainsIron stains HypochloriteHypochlorite

Stains of many Stains of many daysdays

Chlorinated lime and Chlorinated lime and Acetic acidAcetic acid

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OBTUDENTSOBTUDENTS Agents used to Agents used to diminish the dentine sensitivitydiminish the dentine sensitivity so so

that excavation may become that excavation may become painlesspainless.. Classification is according to mode of action.Classification is according to mode of action.

1.1. By paralyzing sensory nerve endingsBy paralyzing sensory nerve endings: Phenols, : Phenols, Camphor, Thymol, Clove oil & Alcohol.Camphor, Thymol, Clove oil & Alcohol.

2.2. By precipitating proteinBy precipitating protein: Silver nitrate and Zinc chloride.: Silver nitrate and Zinc chloride.3.3. By destruction of nerve tissueBy destruction of nerve tissue: Alcohol 70%.: Alcohol 70%.

At present the use of obtundents has declined due to At present the use of obtundents has declined due to the availability of local anesthetics (e.g. the availability of local anesthetics (e.g. xylocainexylocaine))

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Properties of good ObtudentsProperties of good Obtudents Should not produce any irritation or pain.Should not produce any irritation or pain.

Should not stain the denture.Should not stain the denture.

Should penetrate the dentine sufficiently to Should penetrate the dentine sufficiently to remove the sensitivity.remove the sensitivity.

CLOVE OIL is an ideal obtudentCLOVE OIL is an ideal obtudent

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Draw backsDraw backs Irritative agents may cause the formation Irritative agents may cause the formation

of secondary dentine If applied for long of secondary dentine If applied for long periods.periods.

The pulp may shrinkThe pulp may shrink

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MUMMIFYING AGENTSMUMMIFYING AGENTS Used to Used to harden & dryharden & dry the tissue of pulp and the tissue of pulp and

root canal so that tissue may maintain an root canal so that tissue may maintain an asepticaseptic conditions resistant to infection, conditions resistant to infection, especially in cases where it is impossible to especially in cases where it is impossible to remove the pulp and contents of the root canal remove the pulp and contents of the root canal completely.completely.

To accomplish the desired goal more than one To accomplish the desired goal more than one drug will be employed in the form of a paste.drug will be employed in the form of a paste.

Mainly Astringents and antiseptics are used in Mainly Astringents and antiseptics are used in the form of paste.the form of paste.

ParaformParaform, , Liquor formaldehydeLiquor formaldehyde, , CresolCresol, , Amino-silver nitrateAmino-silver nitrate and and IodoformIodoform, T, Tannic annic AcidAcid can also be used. can also be used.

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Peridontal DiseasesPeridontal Diseases

Peridontal disease can refer to any condition Peridontal disease can refer to any condition that affects the that affects the gums and other structures gums and other structures supporting the teethsupporting the teeth. .

The most common forms of periodontal disease The most common forms of periodontal disease are caused by are caused by bacterial infectionsbacterial infections. .

The mildest form of infection is The mildest form of infection is gingivitisgingivitis, which , which affects only the gums. affects only the gums.

More severe disease damages the other More severe disease damages the other supporting structures of the tooth. This can lead supporting structures of the tooth. This can lead to to tooth losstooth loss. .

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Peridontal Diseases- AntibioticsPeridontal Diseases- Antibiotics

Tetracycline antibiotics, which include Tetracycline antibiotics, which include tetracycline hydrochloridetetracycline hydrochloride, , doxycyclinedoxycycline, and , and minocyclineminocycline, are the primary agents used. , are the primary agents used.

They not only have anti-bacterial actions, but They not only have anti-bacterial actions, but also, they also, they reduce inflammationreduce inflammation and help block and help block collagenasescollagenases, even in low doses. , even in low doses.

In fact, it is these In fact, it is these two actionstwo actions, rather than their , rather than their antibacterial properties, which seem to antibacterial properties, which seem to contribute most to periodontal protection contribute most to periodontal protection

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Peridontal Diseases- AntibioticsPeridontal Diseases- Antibiotics

MacrolideMacrolide antibiotics (e.g., antibiotics (e.g., roxithromycinroxithromycin). ).

QuinoloneQuinolone antibiotics (e.g., antibiotics (e.g., moxifloxacin, moxifloxacin, ciprofloxacinciprofloxacin) may specifically target ) may specifically target A. A. actinomycetemcomitansactinomycetemcomitans, an important bacteria , an important bacteria in periodontal disease. in periodontal disease.

MetronidazoleMetronidazole in combination with tetracycline in combination with tetracycline or amoxicillin. Such combinations may be used or amoxicillin. Such combinations may be used for severe and chronic periodontal disease. for severe and chronic periodontal disease.

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ROOT CANAL THERAPY (RCT)

It is the treatment of non vital tooth in which pulp is damaged & exposed due to trauma injury or caries. In this pulp is removed & canal is sealed with suitable drugs.

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Pulp tissue dies due to caustic drugs or infection

Necrosis -> Gangrene -> Putrefaction

tissues liquefied and gas often evolves, the gangrene spreads rapidly involving the whole pulp

If pulp cavity is not opened the increased pressure in pulp chamber may force bacteria through the apical foramen where they will cause the

peridontitis or alveolar abbesses

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STEPS FOR CARRAYING RCT Removal of micro organism form the

cavity Use of obtudent Use of mummifying agents Use of filling material Prophylaxis

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REMOVAL OF MICROORGANISM FROM PULP CAVITY

For this patient must take antibiotic course pirior to pulpectomy cavity. Drugs of choice are penicillin, sulphonamide these are used to prevent the growth of microorganism, reduces pain & irritation & stimulates perapical repair H2O2 is also used it is an antiseptic but not potent one.

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ANTISEPTIC USED TO STERILIZE ROOT CANAL

The ideal drug used for root canal therapy should.

Germicidal to all organism Rapidly effective Capable of deep penetration Effective in presence of organic matter Non injurious to peripecial tissues Non staining to the teeth

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THE PHENOL GROUP

Beech wood, cresol, tricresol, cresatine, paramonochlorphenol, paramonochlorophenol is dissolved in portion of three part with 7 parts of camphor.

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POLYANTIBOTIC PASTES

POLYANTIBIOTIC PASTE Consist of penicillin bacteriacin chlorophenicol,

strephtomycin & sodium caprylate.

 The antibiotic used are sulfonamide used are baetercostatic, Penicillin alone or combination of penciling & Streptomycin have limited effects on the organism of root canal so the polyantibiotic pastes was introduced in 1955 by Grossman this paste contain many antibiotics. It consists of

 

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10,0000 units of Penicillin G (Effective against gram +ve organism

)

10000 units of bacteriacim Effective against gram +ve organism

RESISTANCE TO PENCILLIN

1 G of Streptomycin Effective against gram +ve organism

1 G of Sodium Caprylate destroy fungi

3 cc D. C fluid silican A similar paste supplied by the Boots drug comp Penicillin G. 0.2 mega units Streptomycin 0.2 mega units

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Chloromphenicol 0.2 g Sodium capryltate 0.2 g Silicon DC 200.6 millions

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QUATERNARY AMMONIUM COMPOUND

Compounds such as certimide non injurious to tissues act in the presence of organism

Monaern is active against gram –ve & gram +ve bacteria but not against ps pyocyanus slight active aginst candida

cetrimide belongs to quaternary ammonium compound, detergent active ataisnt gram –ve the & gram +ve organism as well as ps pyocyanus but it has only limited effect on Candida.

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 HALOGEN DERIVATIVES

There are two salts of(a)Chloramine

(b)Chloramide in a strength of 1 in 125.

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Root Canal Filling Materials Root Canal filling material should be aseptic, non-irritant

and able to seal the apex of the root, the dentine foramina and tubules

They act as firm barrier against moisture, and bacteria. They are Permanent filling e.g Gold, silver, copper amalgam Semi permanent filling e.g cements composits Temporary filling e.g gutta-percha points, calium

hydroxide cements

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Root Canal Filling MaterialsRoot Canal Filling Materials Root Canal filling material should be Root Canal filling material should be

aseptic, non-irritant and able to seal aseptic, non-irritant and able to seal the apex of the root, the dentine the apex of the root, the dentine foramina and tubulesforamina and tubules

They act as firm barrier against They act as firm barrier against moisture, and bacteria. moisture, and bacteria.

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Prophylaxis

Stanous flouride 80% after every six months to avoide formation of caries

Fissure sealents applied on over the occlusal surface to prevent food particals ot an other narcotic material into dangerous zone.

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Drugs for local haemostasisDrugs for local haemostasis StypticsStyptics:: These are local haemostatic These are local haemostatic

agents.agents. The preparation used is,The preparation used is,

1.1. Human FibrinogenHuman Fibrinogen

2.2. Human fibrin foamHuman fibrin foam

3.3. Human Thrombin.Human Thrombin.

AdrenalineAdrenaline 1:1000 parts, a 1:1000 parts, a vasoconstrictor can be used locally. vasoconstrictor can be used locally.

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DRUGS USED FOR CAVITY DRUGS USED FOR CAVITY TOILETTOILET

Alcohol, HAlcohol, H22S and Tricresol.S and Tricresol.

HH22S is an oxidizing agent and has S is an oxidizing agent and has antiseptic properties.antiseptic properties.

Not a very strong antiseptic as it liberates Not a very strong antiseptic as it liberates OO22 very quickly. very quickly.

But it inhibits the growth of anaerobic But it inhibits the growth of anaerobic bacteria.bacteria.

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AlcoholAlcohol Distinct smell and burning taste.Distinct smell and burning taste. Ethyl AlcoholEthyl Alcohol, 70% solution is used for dental , 70% solution is used for dental

procedures.procedures. It penetrates rapidly but not deeply and is not It penetrates rapidly but not deeply and is not

toxic to pulp.toxic to pulp. It acts by precipitating protein in the dental It acts by precipitating protein in the dental

tubule.tubule. Benzyl alcoholBenzyl alcohol can also be used alone or with can also be used alone or with

Chloroform and Ethyl Alcohol , in ratio 5:3:2.Chloroform and Ethyl Alcohol , in ratio 5:3:2.