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Antiseptics used in dentistry

  2. Asepsis • Asepsis is the state of being free from disease- causing microorganisms such as pathogenic bacteria, viruses, pathogenic fungi and parasites. • Asepsis is absence of pathogenic microorganisms. 2
  3. Antiseptics • Antiseptics are substances which destroy or prevent the growth of microorganisms, applying to living tissue. 3
  4. Disinfectants • Disinfectants are powerful germicides which are too corrosive or toxic to be applied to tissues but which are suitable for application to inanimate objects. 4
  5. Properties Desirable in Antiseptics • Agents should have high germicidal efficacy • Agents which can destroy or kill microorganisms in obviously superior to one that merely inhibit the growth of microorganisms • A wide antimicrobial spectrum is also desired • Antiseptic which has low surface tension is much more effective for topical application • Agent the lethal action in the presence of organic matter such as blood, sputum and pus 5
  6. Properties Desirable in Antiseptics • Agents must have high therapeutic index the relationship between the concentration that is effective against microorganisms and that produce such as harmful effects as local tissue irritation and interference with the processes of healing and tissue repair • Agents should not be allergenic and toxic to tissues 6
  7. Classification of antiseptics based on chemical compounds 1. Halogens and halogen containing compounds 2. Phenols and phenol derivative agents 3. Oxidizing agent 4. Biguanides compounds 5. Alcohols 6. Aldehydes 7. Acids 8. Quaternary ammonium compounds 9. Nitrofurazone 10. Heavy metals and their salts 11. Dyes 7
  8. 1.Halogens and halogen containing compounds Iodine • Most bacteria are killed within one minute by exposure of 1:20000 solution of iodine • 15 mins to kill wet bacterial spores and dry spores require hours and higher concentration • Indications • Disinfection of the skin • Treatment of wounds and abrasions • Application to mucous membrane (2% solution of iodine in glycerine) • Disadvantages • Iodine burns usually by using 7% tincture. • Irritating when applied to absorbed or raw surfaces • Staining of skin, clothes and hypersensitivity rashes 8
  9. 1.Halogens and halogen containing compounds Iodophore • The most widely used iodophore is povidone-iodine • Its low concentration the immediate bactericidal action is only moderated to that of iodine solution • Very little staining of the skin and burning sensation • E.g. Betadine, Septidine Cholorophore • Chlorine is present in the form of hypochlorite • It is useful for skin and wound infection and irrigation solution for abscess cavities • They are bactericidal and virucidal • They are corrosive to stainless steel equipment 9
  10. 1.Halogens and halogen containing compounds Iodoform • Ribbon gauze impregnated with whit head’s varnish and pack into intra oral wounds such as dry socket • Protective dressing for exposed bone surface • Antiseptic dressing for dry socket • Prevent the entering the food debris into the dry socket 10
  11. 2.Phenols and phenol derivative agents • Phenolic compounds are more bactericidal than phenol itself • It is widely used for disinfecting inanimate objects • It is superiors to and cheaper than phenol • Should not be used as burned or denuded skin • Not be used as an occlusive dressing, wet pack and internal use • Should be used with caution in neonates and infants (brain damage) • Camphorated Paramonochlorophenol (CMCP) – used in root canal treatment but inferior to sodium hypochlorite. • Thymol – antibacterial and antifungal effects and usually contains in the dental cartridge as funigicide. E.g. Listerine mouthwash 11
  12. 3.Oxidizing agent • Hydrogen peroxide is used as oxidizing agent • Can be used as mouth wash in acute necrotizing ulcerative gingivitis and give bactericidal effect on anaerobic organisms • Irrigating solution used in root canal treatment • Irrigating for suppurating wounds are used • Can use as bleaching agent • Prolong use of hydrogen peroxide can cause black hairy tongue but it disappear after the drug is discontinued 12
  13. 4.Biguanides compounds • Chlorhexidine is one of a member of biguanides • Useful as preoperative preparation of surgeon and patient also useful in disinfection of wounds • It is easily contaminated by pathogen • Chlorhexidine mouthwash – contains chlorhexidine gluconate and effective in treatment of apthous ulcer and stomatitis and effect in inhibiting the formation of plaque on tooth and used successfully in prophylaxis of dental caries • Untoward effects – black hairy tongue, changes in taste, loss of appetite, candidiasis, staining of the teeth, burning sensation of oral mucosa and lead to mucositis 13
  14. 5.Alcohols • Bactericidal to all common pathogenic bacteria • Cannot kill the spores • Ethanol is used in alcohols • Skin disinfection – to prevent bed sores in bed ridden patient • As alcohol sponge to reduce fever 14
  15. 6.Aldehydes • Formaldehyde and glutaraldehyde are used in aldehyde group • Effective against bacteria, fungi and viruses • To disinfect inanimate objects such as surgical instruments and gloves • Can be used to sterilize turberculum sputum. • Can not be applied safely to mucous membrane and skin • In high concentration usually use as disinfected, not antiseptic • Glutaraldehyde is less toxic than formaldehyde 15
  16. 7.Acids • Acetic acid – 5% concentration (bactericidal) , lower concentration is bacteriostatic. • Benzoic acid – food preservative • Boric acid – non irritating and do not kill bacteria • Lactic acid – corrosive to tissues after prolonged contact Uses - Surgical dressings as a topical antimicrobial agent - Burn therapy and vaginal douche - Irrigation of lower urinary tract 16
  17. 8.Quaternary ammonium compounds • More effective against gram positive than gram negative microorganisms • More useful as anti-plaque agent which contains predominantly gram positive bacteria • Burning sensation of the oral mucosa • Brownish discoloration of teeth and tongue • Can cause recurrent apthous type ulceration 17
  18. 9.Nitrofurazone • Wide spectrum antibacterial agent • Urinary antiseptic • Furazolidine – shigella, salmonella and trichomonas 18
  19. 10.Heavy metals and their salts • Mercury bichloride - disinfectant for instruments or unabraded skin • Silver Nitrate - precipitation protein, interfere with essential metabolic activities of microbial cells • Silver Sulfadiazine - 1% cream for burns 19
  20. 11.Dyes • Gentian violet • Effective against gram positive bacteria and fungi • Gram negative bacteria and acid fast bacteria are resistant • Permanent pigmentation of skin • Acriflavin • Orange red to red crystalline powder • Incompatible with eusol and other chlorine preparation • Effective against gram positive bacteria 20
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