1. July 26, 2013July 26, 2013 11
DentalDental
PharmacologyPharmacology

2. July 26, 2013 2
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 mucousOral hygiene means care of oral mucous
membrane & teeth it includesmembrane & teeth it includes
a)a) SialagougeSialagouge
b)b) DentrifricesDentrifrices
c)c) Mouth washesMouth washes
d)d) Bleaching agentsBleaching agents

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SialagougeSialagouge
 It increases the salivary secretion, itIt increases the salivary secretion, it
includesincludes
1.1. 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 foraids meant for
cleansing the teeth with the help of acleansing the teeth with the help of a
brush.brush.
 Available as toothAvailable as tooth powderpowder or toothor tooth
pastepaste,,
 IdealIdeal tooth paste or powder contains thetooth paste or powder contains the
following ingredients.following ingredients.
1.1. Abrasive agentsAbrasive agents
2.2. DetergentsDetergents
3.3. AntisepticsAntiseptics
4.4. Sweetening agentsSweetening agents

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Abrasive agentsAbrasive agents
 Dental abrasives areDental abrasives are fine powderfine powder
preparationspreparations
 They are used,They are used,
1.1. to help the scouring action of tooth brushto help the scouring action of tooth brush
mechanically andmechanically and
2.2. for cleaning, polishing and filling the teethfor cleaning, polishing and filling the teeth
 Most commonly used dental abrasives areMost commonly used dental abrasives are
pumicepumice andand precipitated calciumprecipitated 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 withTo polish, fill and clean teeth pumice with
glycerin is employed.glycerin is employed.
 Precipitated calcium carbonatePrecipitated calcium carbonate is a mildis a mild
abrasive which is employed to give theabrasive which is employed to give the
final polish to silver amalgam fillings. It isfinal polish to silver amalgam fillings. It is
also used to prepare tooth paste and toothalso used to prepare tooth paste and tooth
powderspowders

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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 proteinsdissolving proteins
 Hydrogen PeroxideHydrogen Peroxide: acts by liberating oxygen: acts by liberating oxygen
 Hard SoapsHard Soaps::

act by dissolving fatty substances mucous plaques andact 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,, EugenolEugenol,,
CinnamonCinnamon up to 1%up to 1%

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Sweetening AgentsSweetening Agents
 SaccharineSaccharine commonly usedcommonly used
 Other agents:Other agents: SucroseSucrose andand LactoseLactose
 Sucrose causes less fermentation.Sucrose causes less fermentation.

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Coloring AgentsColoring Agents
 Make preparations more attractive andMake 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 dentrificeDentrifrices-Ideal dentrifice
 An Ideal preparation should beAn Ideal preparation should be

Non-causticNon-caustic to the mucous membraneto the mucous membrane

Non-decalcifyingNon-decalcifying and non-over abrasive to the teethand non-over abrasive to the teeth

Non-poisonousNon-poisonous to the body as a wholeto the body as a whole

Not inhibit the secretionNot inhibit the secretion and alter the reaction ofand alter the reaction of
salivasaliva

NotNot destroydestroy the ferments of salivathe ferments of saliva

Have pleasantHave pleasant taste,taste, odorodor andand consistencyconsistency

Have sufficient cleaning action.Have sufficient cleaning action.

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MOUTH WASHMOUTH WASH
 These are mechanical agents used forThese 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 WASHTHERAPEUTIC MOUTH WASH
HYDROCORTISONE,HYDROCORTISONE,
NYSTATIN,NYSTATIN,
ANTIHISTAMINE ANDANTIHISTAMINE AND
TETRACYCLINETETRACYCLINE
StomatitsStomatits
PilocarpinePilocarpine xerostomaxerostoma
Tranexamic acidTranexamic acid prevention of bleedingprevention of bleeding
after oral surgeryafter oral surgery
Amphotericin BAmphotericin B oral candidiasisoral candidiasis
Chlorhexidine gluconateChlorhexidine gluconate plaque controlplaque control

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TypesTypes
1.1. AntisepticsAntiseptics: H: H22OO22, KMnO, KMnO44, Phenol and, Phenol and
KClOKClO33, Thymol, Menthol and, Thymol, Menthol and
Sodiumpercholate.Sodiumpercholate.
2.2. AstringentAstringent: ZnO: ZnO22, Alcohol and ZnCl. These, Alcohol and ZnCl. These
make a protective layer over the mucosa ofmake a protective layer over the mucosa of
oral cavity.oral cavity.
3.3. DemulcentDemulcent:: Glycerin, liquoron. They form aGlycerin, liquoron. They form a
protective layer and prevent attack ofprotective layer and prevent attack of
bacteria.bacteria.

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Moth wash (contd…)Moth wash (contd…)
 Generally they contain four groups ofGenerally 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 theand non-over abrasive to the
teethteeth
 Non-poisonousNon-poisonous to the body as a wholeto the body as a whole
 Not inhibit the secretionNot inhibit the secretion and alter the reactionand alter the reaction
of salivaof saliva
 NotNot destroydestroy the ferments of salivathe ferments of saliva
 Have pleasant taste, odor and consistencyHave pleasant taste, odor and consistency
 Have sufficient cleaning actionHave sufficient cleaning action

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BLEACHING AGENTSBLEACHING AGENTS
 They remove the coloring pigments from theThey remove the coloring pigments from the
teeth and these are,teeth 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 chlorinatedBoric acid, Sodiumthiosulphate and chlorinated
soda lime are packed in the oral cavity insoda lime are packed in the oral cavity in
powder form and to hasten the evolution ofpowder form and to hasten the evolution of
chlorine drop of acetic acid is used.chlorine drop of acetic acid is used.

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Special StainsSpecial Stains
StainStain
Bleaching agentBleaching agent
usedused
Iodine stainsIodine stains
Weak ammonia orWeak ammonia or
Sodium thiosulphateSodium thiosulphate
solution.solution.
Silver stainsSilver stains
Hypochlorite or IodineHypochlorite or Iodine
solutionsolution
Iron stainsIron stains HypochloriteHypochlorite
Stains of manyStains of many
daysdays
Chlorinated lime andChlorinated lime and
Acetic acidAcetic acid

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OBTUDENTSOBTUDENTS
 Agents used toAgents used to diminish the dentinediminish the dentine
sensitivitysensitivity so that excavation may becomeso 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: Silver nitrate and Zinc
chloride.chloride.
3.3. By destruction of nerve tissueBy destruction of nerve tissue: Alcohol 70%.: Alcohol 70%.
 At present the use of obtundents has declinedAt present the use of obtundents has declined
due to the availability of local anesthetics (e.g.due to 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 sufficientlyShould penetrate the dentine sufficiently
to remove the sensitivity.to 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 formationIrritative agents may cause the formation
of secondary dentine If applied for longof secondary dentine If applied for long
periods.periods.
 The pulp may shrinkThe pulp may shrink

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MUMMIFYING AGENTSMUMMIFYING AGENTS
 Used toUsed to harden & dryharden & dry the tissue of pulp andthe tissue of pulp and
root canal so that tissue may maintain anroot canal so that tissue may maintain an
asepticaseptic conditions resistant to infection,conditions resistant to infection,
especially in cases where it is impossible toespecially in cases where it is impossible to
remove the pulp and contents of the root canalremove the pulp and contents of the root canal
completely.completely.
 To accomplish the desired goal more than oneTo 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 inMainly Astringents and antiseptics are used in
the form of paste.the form of paste.
 ParaformParaform,, Liquor formaldehydeLiquor formaldehyde,, CresolCresol,,
Amino-silver nitrateAmino-silver nitrate andand IodoformIodoform, T, Tannicannic
AcidAcid can also be used.can also be used.

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Peridontal DiseasesPeridontal Diseases
 Peridontal disease can refer to any conditionPeridontal disease can refer to any condition
that affects thethat affects the gums and other structuresgums and other structures
supporting the teethsupporting the teeth..
 The most common forms of periodontal diseaseThe most common forms of periodontal disease
are caused byare caused by bacterial infectionsbacterial infections..
 The mildest form of infection isThe mildest form of infection is gingivitisgingivitis, which, which
affects only the gums.affects only the gums.
 More severe disease damages the otherMore severe disease damages the other
supporting structures of the tooth. This can leadsupporting structures of the tooth. This can lead
toto tooth losstooth loss..

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Peridontal Diseases- AntibioticsPeridontal Diseases- Antibiotics
 Tetracycline antibiotics, which includeTetracycline 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, butThey not only have anti-bacterial actions, but
also, theyalso, they reduce inflammationreduce inflammation and help blockand help block
collagenasescollagenases, even in low doses., even in low doses.
 In fact, it is theseIn fact, it is these two actionstwo actions, rather than their, rather than their
antibacterial properties, which seem toantibacterial properties, which seem to
contribute most to periodontal protectioncontribute 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 tetracyclinein combination with tetracycline
or amoxicillin. Such combinations may be usedor 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
July 26, 2013 32

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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.
July 26, 2013 33

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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
July 26, 2013 34

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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 unitsJuly 26, 2013 35

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 Chloromphenicol 0.2 g
 Sodium capryltate 0.2 g
 Silicon DC 200.6 millions
July 26, 2013 36

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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.
July 26, 2013 37

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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 beRoot Canal filling material should be
aseptic, non-irritant and able to sealaseptic, non-irritant and able to seal
the apex of the root, the dentinethe apex of the root, the dentine
foramina and tubulesforamina and tubules
 They act as firm barrier againstThey 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 haemostaticThese 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, a1:1000 parts, a
vasoconstrictor can be used locally.vasoconstrictor can be used locally.

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DRUGS USED FOR CAVITYDRUGS USED FOR CAVITY
TOILETTOILET
 Alcohol, HAlcohol, H22S and Tricresol.S and Tricresol.
 HH22S is an oxidizing agent and hasS is an oxidizing agent and has
antiseptic properties.antiseptic properties.
 Not a very strong antiseptic as it liberatesNot a very strong antiseptic as it liberates
OO22 very quickly.very quickly.
 But it inhibits the growth of anaerobicBut 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, 70% solution is used for
dental procedures.dental procedures.
 It penetrates rapidly but not deeply and isIt penetrates rapidly but not deeply and is
not toxic to pulp.not toxic to pulp.
 It acts by precipitating protein in the dentalIt acts by precipitating protein in the dental
tubule.tubule.
 Benzyl alcoholBenzyl alcohol can also be used alone orcan also be used alone or
with Chloroform and Ethyl Alcohol , in ratiowith Chloroform and Ethyl Alcohol , in ratio
5:3:2.5:3:2.