Mouthwashes are chemotherapeutic agent which is used in home care system by the patient to maintain the oral hygiene. Oral bacteria and their products play a significant role in the etiology of both gingivitis and periodontal diseases. Elimination of disease causing pathogens or at least reduction of their no. to a non pathogenic level is therefore necessary for the management of disease.

The removal of dental plaque is a necessary prerequisite for the dental and gingival health in the long term. Dental plaque is a living organized community of microorganism consisting of numerous species embedded in the extracellular matrix. It undergoes growth and maturation with passage of time. The main role played by bacteria colonizing the teeth in the initiation of dental caries and periodontal disease is well established and removal of plaque is therefore most important to maintain periodontal health.

Many chemical antiplaque agents in various formulations have been tried for improving oral health. Mouth washes, a safe effective delivery system for antimicrobials have been evaluated for antiplaque properties and have been the subject of considerable research.

 

Mouth washes, when used in conjunction with a regime of effective tongue cleaning, tooth brushing and flossing can play a role in the treatment of bad breath. Both Mechanical and Chemical method of plaque control can provide a double action. If one use chemical methods of plaque control along with mechanical then the results are quite good. Challenge for us today is to remove the formed microbial plaque on the tooth surface and also to inhibit the formation of this microbial plaque.

In this attempt several agents are used like’

  1.  Antibiotic
  2. Antimicrobial
  3. Chemical  

These agents are used either as the mouth washes or one takes it orally for systemic effect. Best way is to use it as mouthwash.

Use of Antimicrobials as Homecare

The use of antimicrobial mouthwashes as home care programme has the effect in the management of gingival diseases and periodontal diseases. It helps in maintaining the good oral hygiene by maintaining the level of microbes in the oral cavity after the professional cleaning. It has some additional benefit n aiding the physical removal or suppression of bacteria causing the gum diseases.
  

Limitations of Therapeutic Agents in Home Care Preparation

The therapeutic agents which are used for home care has some limitations. These are:- 
  1. Poor patient’s compliance results in poor distribution of agents to affected sites.

  2. High level of manual dexterity is required to place agents into affected site effectively.

  3. Plaque bacteria form substances such as dextran that resists the effect of antimicrobial substance from the oral environment.

  4. Agents are diluted by oral fluids such as saliva.

  5. Agents are rapidly eliminated from the oral cavity by the washing effect of saliva and gingival fluids.

  6. Agents have poor substantively except chlorhexidine and therefore are not often present in the oral cavity, when they would be most beneficial.

 Agents Commonly Used In Home Care Preparation

 

Requirements for topically applied adjunctive agents to be clinically effective

 
 
 
Efficacy: Requires the agent to be effective against specific organisms causing oral diseases, such as dental caries, gingivitis and periodontitis.
 
Substantivity: Require that the agent to be in contact with the tissues for long enough to be effective against the pathogenic bacteria.
 
Concentration: Requires that the agent to be available at levels that ensure that its antimicrobial action is actually effective when applied to diseased sites.
 
Specificity: Requires that the agent to be specifically active against pathogenic bacteria and be ineffective against normal commensal organism in the oral cavity.
 
Safety: Requires that the agent may be used in the oral cavity without any detrimental effects to the tissues and also that the material is stable at normal room temperature and not degrades spontaneously over a reasonable period of time.
 

Types of Antiplaque Agents

 

First Generation -These are antibiotics, quaternary ammonium compound, sanguanarine, fluorides, and peroxides.
 
Second Generation - Chlorhexidine are second generation antiplaque agents.
 
Third Generation - These are the drugs which have selective effect on specific bacteria or plaque product that are essential for disease development.

 

Varieties of Mouthwashes

 
Mouth Washes having contain Chlorine dioxide or Sodium Chlorite
 

Chlorine dioxide is an oxidizing agent and as most of the bacteria that cause bad breath are anaerobic, exposing them to an oxidizing agent can help to minimize their number.
 
Chlorine dioxide has the ability to neutralize the volatile surface compounds. It also has the ability to degrade the precursor components utilized by bacteria. The net effect is that the overall concentration of volatile surface compound found in a person’s bad breath is reduced and as a result there breath will be more pleasant.

 
Mouth washes having Zinc
It reduces the concentration of volatile surface compounds found in person’s breath. This action is presumed to be related to the fact that zinc ions bind to the precursor compounds that anaerobic bacteria require to produce volatile surface compounds.
 
Antiseptic mouthwashes
These have the ability to kill anaerobic oral bacteria that produce volatile surface compounds.
  
Cetylperadium Chloride Mouthwashes
It serves as an antibacterial agent, thus helping to control the number of anaerobic bacteria that are found in a person’s mouth.
 
Ranges of Herbal Mouthwashes are also available:

Examples are Hypercal, Myrrh, Propolis and Weleda, medicinal gargles are useful. Natural Dental Herbal mouth and gum therapy rinse reduce the plaque composed of following herbal extracts in a non-alcoholic base:

 

Components and their functions

 

Echinacea: Analgesic, Antibiotic and anti inflammatory.

Goldenseal: Antiseptic and Antibiotic    
Bloodroot: Antibiotic and Anti inflammatory
Grapefruit seed extract: Antifungal and Antibiotic  
Aloevera gel: Analgesic, Anti inflammatory, Moisturizer
 

Chlorhexidine Mouthwash

It is a second generation anti plaque agent.
 
Advantages are
 
High concentration of antimicrobial agent can be delivered at the local site. It is easy to use.
 
Uses                                                  
  1. It has been widely used in Ophthalmic, Skin preparation, with high degree of    effectiveness.

  2. Low toxicity,                                                    

  3. When topically applied in rinse twice daily with 10ml of 0.2% Chlorhexidine Gluconate completely inhibited the plaque formation for up to 40 days and produces 85 to 90% reduction in tooth adherent bacteria.

  4. Studies show that 30% of agent is retained in the mouth after rinse where it is active in inhibiting bacteria adsorption and growth.

  5. It is slowly released such that antimicrobial persists in saliva and several hours after rinse.

  6. Chlorhexidine was first available as savlon manufactured by imperial chemical industry England.

  7. It is potent antiseptic used in gynecology for over 100yrs.

Uses in Dentistry

  1. Adjunctive in Supragingival Plaque Control

  2. It helps in management of recurrent or persistent Gingivitis.

  3. Following oral surgery and gum surgery.

  4. Following crown preparation and during period that provisional restoration is worn.

  5. Medically compromised patient.

  6. For physically and mentally handicapped.

  7. Geriatric and terminally ill patients.

  8. Treatment and control of Oral Mucosal Surface infection

  9. Rampant caries.

  10. Giving in immumo compromised patient [HIV Gingivitis]

  11. Apthous ulceration.

  12. Prevention and control of mild Candidiasis in immunocompromised patient.

  13. Adjunctive control of bacterial colonization

  14. In association with treatment of Periodontitis.

  15. Denture wearers and ortho patients.

  16. In association with systemic controlled release antibiotic treatment of subgingival bacteria.

  17. Implant dentistry.

 

Action;

It acts in 3 ways i.e.
  1. Adsorption
  2. Substantivity.
  3. Bacterial action.
 
How the Fluoride Mouthwash acts?
  Daily and weekly are available.
 
  1. Contain 0.05% [225ppm] OR 0.2% [900ppm] respectively of Sodium fluoride.

  2. Advise for patient to use mouthwash on separate occasion to their usual tooth brushing to increase no of fluoride exposures.

  3. All ortho patients should be advised to use fluoride rinse to minimize risk of demineralization and white spot lesions at appliance margins.

  4. Mouth rinses are widely considered a safe method of fluoride application but caution should be exercised with young children under the age of 6yrs where there is more chances of ingestion.

 
Side Effects:
 
 
  1. They can cause staining of teeth, tongue, and anterior restoration in about 15% of subjects.

  2. Some show slight increase in supragingival calculus especially on the lingual surface of Mandibular anterior.

  3. Thus calculus appears to have different components from routine calculus deposits and it’s easily removed and appears to have no harmful effects

  4. Taste alteration is also experienced in 5% patients.

The most common dental diseases are the dental caries and the gum diseases. The culprit for both of them is the bacteria. Bacteria causes the caries and they are responsible for the formation of plaque which in turn causes most of the gum diseases and the bad breath. Use of mouthwash is the answer to control the number of bacteria in the mouth and indirectly to control most of the dental diseases. if we want to keep our mouth free of dental diseases the use of appropriate mouth wash becomes a must.

 

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