“DETERMINATION OF EFFICACY OF ANTI- PLAQUE AGENTS - A CLINICAL TRIAL” A research project by: Dr.Muhammad Wasif Haq, Dr.Mehwish Batool, Dr.Syed Hammad Ahsan.

“DETERMINATION OF EFFICACY OF ANTI-PLAQUE AGENTS - A CLINICAL

TRIAL”

A research project by: Dr.Muhammad Wasif Haq,

Dr.Mehwish Batool, Dr.Syed Hammad Ahsan.

Introduction

• Plaque control & prevention still stand as a challenge for modern day dentistry.

• Adequate plaque control related to optimal oral health & reduction in pathologies e.g. Gingivitis, Periodontitis, Caries and Peri-implantitis.

• Tooth brushing in conjunction to mouthwashes reported to impart superior plaque control.

Introduction

• Antiplaque agents:• The common antiplaque agents used are:• Chlorhexidine.• Fluoride.• Chlorhexidine + Fluoride.• Cetylpyridinium Chloride + Fluoride.

Introduction

• Chlorhexidine:• Cationic, bacteriostatic & bactericidal agent.• Inhibits bacterial Glucosyltransferase, causes

cytoplasmic precipitation & bacterial cell wall disruption.

• Inhibitor of Matrix metalloproteinases, pro-inflammatory cytokines, interleukins & salivary Cathepsin C.

Introduction

• Fluoride:• Anionic, bacteriostatic & bactericidal agent.• Remineralizes tooth structure, formation of

acid resistant and larger Fluoroapatite crystals.

• Inhibits Glucosyltransferase, Enolase, Glucose uptake & utilization.

• Inhibits salivary Cathepsin C.

Introduction

• Cetylpyridinium Chloride:• Bactericidal, quartenary ammonium

compound.• Inhibits metabolic pathways, denatures

bacterial proteins & damages cell wall.• Bioaccumulation in dental plaque.

Introduction

• Matter of debate:• Inconclusive results on combination of

Chlorhexidine with Fluoride.• Some report synergistic interaction while

others report negative interaction.• Very few studies have evaluated the

combination of Cetylpyridinium Chloride with Fluoride.

Aims & Objectives

• Primary aim to determine efficacy of antiplaque agents:

• Chlorhexidine.• Sodium Monofluorophosphate.• Chlorhexidine + Sodium

Monofluorophospahte.• Cetylpyridinium Chloride + Sodium Fluoride.

Materials & Methods

• A 5 day study conducted at L.C.M.D. Karachi.• Informed consent was taken.• Random allocation into 4 test groups & 1

control group ( 6 subjects/group).• Plaque levels estimated prior to & at the

completion of the study using Turesky et al modification of Quigley Hein plaque index.

Materials & Methods

• Inclusion criteria: 18-50 years. Complete dentition till 2nd Molar in all the four

quadrants.

Exclusion criteria: Any teeth with active dental caries or signs of

periodontal involvement . Subjects with any systemic disease or using

medication. Undergoing orthodontic treatment. Subjects wearing prosthetic appliances.

Materials & Methods

• Participants instructed to:• Brush teeth1 time (1 minute)with Fluoride

toothpaste.• Mouthwash (5 ml with 10 ml water) 2 times

(30 Seconds).• Control group brushed teeth with water.• Follow routine dietary habits.• One way ANOVA & Bonferroni test for

Multiple Comparisions applied.

Materials & Methods

Name of group Number of subjects Active ingredients

Group 1 6 0.2% Chlorhexidine gluconate.

Group 2 6 0.05% Sodium Monofluorophosphate

Group 3 6 0.12% Chlorhexidine gluconate & 0.05% Sodium Fluoride.

Group 4 6 0.05% Cetylpyridinium Chloride & 0.05% Sodium Fluoride.

Control 6 Water.

Results

Group Pre-test Post-test Reduction Significance

Group 1 11.89 11.0 0.89 p=0.032

Group 2 11.22 10.59 0.27 p=0.146

Group 3 13.37 13.41 -0.04 p=0.271

Group 4 13.36 12.34 1.02 p=0.023

Control 11.61 14.23 2.62 -

Discussion

• Compared to control group, all study groups decreased plaque levels.

• Statistically significant difference only in Chlorhexidine (group 1) & Cetylpyridinium Chloride + Fluoride(group 4)compared to control group (p < 0.05).

• Only Chlorhexidine & Fluoride combination did not decrease plaque levels.

Plaque inhibitory action • Group 4 (Cetylpyridinium Chloride &

Sodium Fluoride)• Group 1 (Chlorhexidine)• Group 2 (Sodium Monofluorophosphate)• Group 3 (Chlorhexidine and Sodium

Flouride))• Control Group (Water)

Discussion

Discussion

• Cetylpyridinium Chloride + Fluoride seems to offer best anti plaque activity,more effective than Chlorhexidine or Chlorhexidine with Fluoride.

• Increasing Fluoride concentration did not offer increased antiplaque effect.

• Synergistic effect reported for Chlorhexidine with Fluoride not observed in this study.

Discussion

• New Research Challenges:• Few or no side effects.• Chlorhexidine : Stains, taste alteration,

supragingival calculus,cytotoxic to odontoblasts, fibroblasts & osteoblasts.

• Sodium Fluoride: Cytotoxicity to fibroblasts, oral mucosal cells & odnotoblasts.

• Cetylpyridinium Chloride: Staining.• Toothpaste compatible mouthwashes.

Limitations

• Small sample size.• Inability to eliminate tooth brushing. • Possibility of lack of compliance & non-

uniformity of diet.• Alternatively experiments utilizing

antimicrobial isolates on teeth of laboratory animals & assessing inhibitory effect of antiplaque agents on microbial colonies could provide better results.

Conclusion

• Antiplauque effect : Cetylpyridinium Chloride + Sodium Fluoride> Chlorhexidine> Sodium Monofluorophosphate.

• Chlorhexidine + Sodium Fluoride combination did not reduce plaque levels.

• Increasing Fluoride concentration did not improve antiplaque effect.

Special Thanks

• Our courteous thanks to:• Teachers: Dr. Naheed Najmi (L.C.M.D., Karachi). Dr.Asif Hussain(L.C.M.D., Karachi). Dr.Nadeem Chand (L.C.M.D., Karachi). Team Members: Dr.Mehwish Batool. Dr.Syed Hammad Ahsan.• All the participants of the study.

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