Dental Pharmacology

---

1. DENTRIFICES

Agents or mechanical aids used with tooth brush or with rubbing for cleaning and polishing accessible teeth surfaces.

Dentrifices may be in the forms of : Tooth paste, powder, gel

Components of a dentrifice:

An ideal dentrifice should contain one each of the following:

1) Abrasive [Calcium carbonate, (Prepared chalk), dibasic CaCO3, MgCO3, Stannic Oxide]

2) Antacids [NaHCO3, Mg(OH)2]

3) Antiseptic

4) Binding Agent

5) Humectant

6) Soaps / Detergents

7) Flavouring Agents (Peppermint oil) / Sweetening Agents (Glycerin, Sorbitol) 8) Liquid vehicle.

Tooth pastes or powders or gels may contain additional ingredients such as obtundents which are used to decrease the pain and sensitivity associated with exposed hypersensitive dentin.

---

2. ABRASIVES

Fine preparations used to help the scouring/rubbing action mechanically by grinding, rubbing or scrapping. They are usually insoluble substances/powders and are usually inorganic salts of low solubility. They mechanically remove food particles and stains, after friction. They polish the surface.

The abrasive should have fine particles to avoid scratching of the teeth surfaces. Generally powders are more powerful abrasives than the pastes.

Examples:

1. CaCo₃ (Prepared chalk): Precipitate form is preferred because it is finer and less gritty (strength: 40-60%). It is also an antacid property. It is the first and most essential constituent of dentrifice.
2. Dibasic CaCo₃: Good abrasive, polishing agent
3. MgCo₃: This forms the second largest constituent of the dentrifice. It has antacid properties.
4. Mg(OH)₂: 7.5% Suspension in water. Works as abrasive, has antacid property and is called Milk of Magnesia.
5. Stannic Oxide: It is a fine amorphous powders which is an abrasive and polishing agent. It gives glossy appearance to teeth.
6. Calcium phosphate
7. Charcoal
8. Silicates
9. Powder pumice
10. Kaolin
11. Stannic oxide

Uses of abrasives:

1. Polishing the teeth and the fillings
2. Cleaning the teeth
3. As constituents of tooth powders and pastes

Types of Abrasives:

(i) Finishing abrasives- Hard, coarse – Used initially – to develop contour and remove gross irregularities e.g. coarse stones.

(ii) Polishing abrasives- Fine particles, less hard than finishing abrasive, Used for smoothening the surfaces that have been roughened by coarse stones e.g. pumice, polishing cakes, calcium carbonate

(iii) Cleansing abrasives- Soft material, small particle size, Used to remove soft deposits that adhere to enamel or restorative material

---

3. BINDING AGENTS

Agents added to pastes/Tooth Pastes to keep the solid and liquid phase together. These are mostly suspending or emulsifying agents.

1. Gums: Acasia, Tragacanth and Caraya.
2. Bentonite: Colloidal aluminium silicate, forms a stable tooth paste. But powder is gritty and may stain pale gray.
3. Sodium Alginate: Strong binding agent, incompatible with soluble calcium salts.

---

4. HUMECTANTS:

Substances added to the Tooth Paste to retain the moisture of the preparation, so that when exposed to air, the preparation does not get dried up or does not harden.

E.g. Glycerin, Propylene Glycerin, Sorbitol.

Glycerin and Sorbitol are also sweetening agents. Propylene Glycerin (Propylene glycol) has a bad taste and is usually not employed.

---

5. DETERGENTS AND FOAMING AGENTS

They are cleansing agents. They act by:

-Decreasing surface tension, thus they possess emulsifying properties.

-Dissolving fatty substances and mucous plaques

-Foaming – on scrubbing the teeth, detergents foam and act as lubricants.

-Loosening the debris that is adhered to teeth

-Some of them liberate oxygen, and have antiseptic properties.

-They act as deodorants.

Example: Sodium lauryl sulfate and soaps

Sodium lauryl sulfate is a pale yellow powder, and is effective in acidic as well as alkaline medium, and also in hard water. It is also used as a skin cleansing agent, and also in mediated shampoos.

---

6. OBTUNDENTS

Substances which are used to reduce or abolish the sensitivity of exposed dentin so that the excavation becomes painless.

Mechanisms of action:

I  – Destroy the nervous tissue:  Absolute alcohol

II – Paralyze the sensory nerve endings:

Phenol, Creosote, Benzyl alcohol, Benzocaine

Volatile oils: Camphor, Thymol, Menthol, Eugenol (Clove oil) (Clove oil may produce staining)

III – Precipitate proteins from odontoblastic fibrils and destruction of sensitive tissue:  Silver nitrate, Zinc chloride, Ethyl alcohol (70%), Phenol

-Alcohol- (80-95%) penetrates easily into the dry cavities. Does not have very deep penetration. Does not stain the teeth.

-Benzyl Alcohol- Produces dehydration and possesses local anesthetic activity. It may be used alone or with chloroform in the ratio 1:2.

-Phenol- C6H5OH – (Carbolic acid) (Same as benzenol or hydroxybenzene) – is an aromatic organic compound, and a petroleum product, and is a protoplasmic poison. It paralyzes the nerves. It produces initial irritation followed by numbness. It has a rapid action. Its penetrability is poor, and it can be increased by combining with KOH and glycerin. It does not stain healthy dentin; however, can darken the infected dentin.

-Eugenol- Is the active constituent of Clove oil. May increase the pain slightly (initially), but later on paralyses nerve fibers. Does not penetrate deep. May cause slight yellow staining of dentin.

-Chlorbutanol- Also called chloritone. Strength – 10%. It is a volatile oil, Produces paralysis of nerve fibers.

-Menthol, Thymol, Camphor, Clove oil- All are volatile oils, and produce paralysis of sensory nerve fibrils just as chlorbutanol. There is some initial irritation followed by numbness. Clove oil may stain the dentin yellow.

-Formaldehyde- (4-10% solution). It is volatile. Penetrates deep, action is slow. No staining of teeth. May penetrate the pulp and cause inflammation, and pulp damage This is called caustic action.

-Paraformaldehyde – acts by release of formaldehyde. It is painless and nonstaining. Pulp damage due to penetration and inflammation is possible (caustic action).

-Silver Nitrate- (10-30%) Penetration not more than ½ mm. It precipitates Proteins (Astrigent action). It has rapid action, but the penetrability is poor, and it stains black. It is used for posterior Teeth / Milk teeth.

-Zinc Chloride- (10%) Same action as silver Nitrate, but during precipitation of proteins, liberates acid, which may cause an initial sharp pain. This is temporary phenomenon. It has rapid action, and there is no staining of teeth. Used for anterior teeth.

An Ideal obtundent –

-should penetrate the dentin sufficiently

-should not stain the dentin

-should be free from local irritation or pain

The disadvantages of obtundents include:

1. The pulp may shrink.
2. The irritants may stimulate formation of secondary dentin.

---

7. DENTAL DESENSITIZING AGENTS

Dentine hypersensitivity is a common problem affecting millions of people. Pain is evoked by mechanical, chemical or thermal stimuli. Eg. On eating hot or cold, sweet or sour food, or while brushing. Hypersensitivity is due to loss of enamel or exposure of the root surface. Loss of enamel may follow mechanical wear or chemical erosion due to acidic food. The root surface gets exposed due to recession of gums as seen in old age, incorrect toothbrushing technique or chronic periodontal diseases.

An ideal desensitizing agent should be nonirritant, nontoxic, painless, rapidly acting, easy to use, and have a long-lasting effect.

(a) Agents occluding dentinal tubules / nerve desensitizing: Potassium nitrate (5%), potassium oxalate, calcium hydroxide, sodium fluoride, strontium fluoride, strontium chloride, K oxalate (28%), calcium phosphate, calcium chloride, sodium citrate, formaldehyde, bioactive glass (SiO2-P2O5-CaO-Na2O), sodium monofluorophosphate

(b) Agents precipitating proteins:

— Astringents: Silver nitrate, Zinc chloride

–Precipitating tubule proteins causing occlusion: Strontium chloride, formaldehyde, glutaraldehyde, strontium chloride hexahydrate

(c) Tubule sealents: 4- metha cryloxy ethyl trimellitate / Hydroxy-ethyl-methacrylate (HEMA)

(d) Physical method: Restorations – Glass ionomers cements / composites / fluoride varnishes, dentin bonding agents, oxalic acid and resin, adhesive resins, Benzalkonium chloride

(e) Lasers: Neodymium yttrium al-garnet (Nd-YAG) laser, GaAIA (gallium-al-arsenide) laser, Erbium-YAG laser

---

8. DISCLOSING AGENTS

Since the dental plaques may be relatively invisible, disclosing or revealing agents are needed.

Disclosing agent is a

–A dye / diagnostic acid

–Applied to the teeth to reveal the presence of dental plaque (bacterial deposits) on teeth, tongue, saliva.

Formulations:

–ChewableTablet / wafers

–Painting the teeth with a cotton swab dipped in the disclosing agent

-Rinsing the mouth with the solution of a disclosing agent

–Solution

–Floss

Examples”

-Erythrosine (6 mg tab): Most commonly used. Erythrosin makes the plaque area red, but also may stain soft tissues.

-Fluorescein dye: stains the plaque yellow. It does not stain the soft tissues, but a special light is required to see the stained plaque. Fluorescein dye is more expensive.

-Two-tone dyes: a solution containing combination of two dyes. Mature plaques are stained blue and the new plaques are stained red. The advantage is differentiation between mature and immature plaques. In addition these two-tone dyes do not stain the soft tissues.

-Iodine containing solutions: Their disadvantages are: High incidence of allergic reactions and unacceptable taste. Hence not preferred.

The disclosing agents make the supragingival plaques visible.

The tablets, sold over-the-counter in many countries, contain a dye (typically a vegetable dye, such as Phloxine B that stains plaque a bright color (typically red or blue). After brushing, one chews a tablet and rinses. Colored stains on the teeth indicate areas where plaque remains after brushing, providing feedback to improve brushing technique. For self-examination, a dental mirror may be needed. More sophisticated varieties contain several dyes, which selectively stain plaque of different ages. With the most common variety, immature plaque stains red, mature purple, and pathological acidic plaque blue. This is owing to the blue dye washing off immature plaque, and acid degrading the red dye.

An example of a dye with a patented use as a “Dental Plaque Disclosing Agent” is Erythrosine.

---

9. BLEACHING AGENTS

Bleaching is a process of removing discolouration of teeth by application of drugs. Bleaching agents are the agents used to remove pigmentation of teeth.

Examples:

1. Oxidizing agents e.g. Hydrogen peroxide – perhydrol (30%), sodium peroxide(50%), pyrozone
2. Reducing agents e.g sodium thio-sulphate: it removes iodine stains.
3. Chlorinated lime: removes stains by aniline dyes
4. Weak ammonia, hypochlorite, acetic acid
5. Ultraviolet rays

Individual Agents:

1. Hydrogen Peroxide (H₂O₂): Strong Oxidising agent. Liberates nascent oxygen and produces bleaching of organic colours. The various strengths used are:

— 3% (weak as bleaching agents but it is safe.)

—30% in water

—25% ether diluted: Stronger bleaching agent. Solution is applied with cotton

wool pellete and tooth is exposed to ultraviolet light for few minutes to           accelerate the action.

2. Sodium Hypochlorate: Chlorine releasing bleaching agent. Used as 5% solution. After application, cavity should be washed thoroughly with distilled water to remove residual chlorine. Hypochlorites remove silver and iron stains.

3. Oxalic Acid: Organic acid. Strong corrosive action. Soft tissues may be damaged. Preferable saturated solution sealed into the tooth cavity for 24 hours. Repeated applications may be required to remove whole of the staining.

4. Hydrochloric acid (dilute-10%): Especially used to remove silver staining. Strong bleaching agent. May destroy normal tooth tissue as well.

 The factors producing discolouration or staining of teeth are:

1. Tobacco
2. Iron Salts
3. Moulds/ fungi
4. Infilration by decomposition of products of Tooth Pulp

(E.g. Methemoglobin- Yellowish stain, Hematin – Gray or Brown stain)

1. e) Systemic administration of Tetracyclines.

Procedure for bleaching:

1. Tooth Brushing with a suitable abrasive. Suitable for staining by exogenous factors like tobacco/ fungus or if staining is superficial.
2. Use of Bleaching Agents: They are needed if staining is caused by exogenous factors depositing decomposition products, and for nearly permanent, deep stains.

---

10. MUMMIFYING AGENTS

Mummifying agents harden and dry the soft tissues in tooth pulp and root canal. Drying makes the tissues resistant to infections. Mummifying agents mummify or fix the pulp. Due to drying effect, the pulp becomes resistant to entry of bacteria

Mummifying agents are used during pulpotomy. They are used when the tooth pulp is devitalized or there is malformation of roots and the root canals are inaccessible

Mummifying agents may be astringents or antiseptics.

Examples:

1. Beta- naphthol: Crystalline powders with phenolic odour. 1% solution in alcohol is used. Alcohol gets evaporated and residual Beta naphthol penetrates the pulp tissue. Solution has a buffy colour.
2. Cresol: Coal-tar product. Turns brown on air exposure. Can be incorporated into a paste with equal parts of thymol and zinc oxide.
3. Liquid formaldehyde: 40% strength. It is diluted with 3 parts of water, due to its severe penetration with irritation. Instead of using alone, it is combined with other agents like thymol, cresol, zinc oxide, glycerin in the form of paste. Formaldehyde fixes the exposed pulp.
4. Paraform / paraformaldehyde: acts by release of formaldehyde and combined with zinc oxide and glycerin.
5. Iodoform: Acts by liberation of iodine. Has additional local anesthetics and antiseptic activity. A mixture of Iodoform and Tannic acid in the ratio of 6:1 can be combined with a volatile oil to be used as mummifying agent. Iodoform is often made into a paste with eugenol, phenol, tannic acid, and glycerol.
6. Tannic Acid: has astringent effect. So it precipitates proteins and hardens the tissue. It may also cause shrinking of the tissue. It may be used alone or in combination,

---

11. ASTRINGENTS

Precipitate superficial proteins

They are used to diminish the excretion or exudation of superficial cells, for healing of ulcers, reduce capillary permeability, exudation, edema, and inflammation. They are also used as Hemostatics and mummifying agents. They are used in the form of gum paints, mouth washes, lotions.

 Astringents produce following actions:

1. Astringents precipitate superficial proteins
2. Form a protective layer which prevents the penetration of food particles and bacteria
3. The protective layer promotes healing
4. It diminishes the excretion or exudation of superficial cells
5. Adsorb and trap the noxious substances and bacteria and their toxins.
6. Decrease the capillary permeability, exudation, edema, and inflammation
7. Also act as Local Hemostatics and mummifying agents

 Astringents – Uses:

1. Gingival Ulcers (Ulcerative gingivitis), pyorrhea, bleeding gums
2. Apthous ulcers
3. Glossitis, stomatitis
4. Chronic alveolar abscess

Astringents: Examples:

Tannic Acid, Catechu, Zinc Chloride, Zinc Sulfate, Copper Sulfate, Alum

Others: Ferric Chloride, Lead Acetate, Silver Nitrate, Mercuric Chloride

---

12. ANTISEPTICS IN DENTISTRY

The term antiseptic implies the prevention of septic influence or putrefaction in wounds, and the healing of wounds by first intention or without suppuration

Antiseptics prevent infections and promote healing of wounds.

Antiseptics possess the capacity to arrest the process of putrefaction,

Antiseptics include:

Organic (vegetable) acids: Carbolic acid (Phenol), salicylic acid, benzoic acid: Applied to tooth structures and tooth tissues

Inorganic (mineral) acids: Nitric acid, sulfuric acid, hydrochloric acid, boric acid, chromic acid: Application restricted to tooth tissues

Iodides: Tincture iodine, iodoform, iodol, potassium iodide, aseptol, aristol

Mercurials: Bichloride and Biniodide of mercury

Oxidizing agents: Hydrogen peroxide, potassium permanganate

Essential oils: cajuput, cassia, peppermint, cloves, thyme, turpentine, caraway, mustard, eucalyptus, juniper, gaultheria, cinnamon, eugenol, sassafras, pennyroyal, valerian

Wood and coal-tar derivatives: Creasote, hydronaphthol, resorcinol, lysol

Heat

METHODS OF USING ANTISEPTICS

-Irrigation or Antiseptic dressings

-Washing out cavities in teeth

-Applications to inflamed and infected surfaces

-Syringing abscesses

-Using mouth washes or lotions

ANTISEPTICS – CHOICE AND FORMS

-Choice of antiseptic depends on–

-Anatomical structure of the part on which they are to act

-Type of inflammation present (acute or chronic)

-Condition of the tissue: (septic or putrescent state)

Forms of antiseptic dressings or applications

-Powders

-Solutions

-Pastes, or

-Mixed with filling materials, such as the zinc preparations

---

13. FLUORIDES IN DENTISTRY

The total concentration of fluorides required in drinking water is less than part per million (ppm). The optimal level is 0.5-1 ppm and is found to be safe and effective.  More than 1-2 ppm may result in toxicity – dental fluorosis.

The surface enamel can concentrate the fluoride ions and become resistant to the attack of the acid and dissolution. This is how fluorides are helpful in preventing caries. Fluorine is the most electronegative of all elements and is therefore highly reactive. The efficacy of fluorides in prevention of caries has been well established.

The total action of 2% Sodium Fluoride applied to the teeth once a week can prevent the incidence of caries. The course of treatment is one application per week for 4 weeks. It is to be continued once in every 2-4 weeks for the age group 3 to 13 years. Other salts are

Stannous Fluoride (8%) or Stannous Flurofluoride. Fluoridation of drinking water is the most effective measure in preventing caries.

The exact mechanism of action of fluorides may be related to physical or chemical combination of fluorides with enamel to make it resistant to entry of acid and also inhibition of bacterial enzymes which reduces the chance of fermentation. Their actions include:

1. Inhibition of bacterial enzymes which produce acids and therefore prevent decalcification of teeth
2. Conversion of hydroxyapatite of dentin and enamel to fluorapatite, which is more resistant to destruction by acids. Fluorides make outer layer of enamel harder and more resistant to demineralization.
3. Stimulating remineralization of enamel

Topical use of high dose of fluorides prevents caries. It may be used as:

1. Fluoride dentrifices
2. Fluoride mouthrinses: Stannous fluoride containing 900 ppm of fluoride retained in mouth for 1 minute to be used twice a week
3. Topical application by a dentist of 2% sodium fluoride or 8% stannous fluoride once a week for 4 weeks

Fluoride toxicity

Chronic toxicity: Mottling of enamel, brownish-black discoloration of teeth, joints pain and swelling, osteosclerosis of spine and pelvis. Crippling fluorosis is characterized by thickening of cortex of long bones and bony exostoses especially in the vertebrae.

Acute toxicity: Accidental or suicidal overdose due to ingestion of fluoride-containing rat poisons. Lethal dose: 2-2.5 g in adults. The manifestations include nausea, vomiting, diarrhea, hypotension, hypocalcemia, hypomagnesemia, cardiac arrhythmias, and acidosis. Treatment includes gastric lavage with calcium containing fluids, forced alkaline diuresis, treatment of hypocalcemia and cardiac arrhythmias.

---

14. DENTAL CARIES

Caries is a degenerative condition characterized by decay of hard and soft parts of the teeth.

Dental caries is the most commonly occurring illness, affecting the teeth. Infection begins in enamel and if progresses, may extend deeper into the tooth, affecting the dentin pulps. The starting point is fermentation of carbohydrates in the mouth especially in the crevices between the teeth. This causes production of organic acids like lactic acid, which react with calcium phosphate in the enamel and dissolve and remove it. Acids convert insoluble calcium salts of the teeth into soluble salts (=decalcification=removal of calcium). The micro-organisms are mostly streptococcus and lactobacillus, which convert glucose into lactic acid. The oral microflora produces proteolytic enzymes which digest the organic enamel matrix. Thus both the inorganic and organic matter of the teeth are destroyed. With the continuation of the process, the pulp is penetrated and the infection may gain access into systemic circulation.

 Dental plaque is a soft, non-mineralized bacterial deposit and a characteristic of dental caries. The plaque is the material that adheres to the teeth and consists of bacterial cells (mainly Streptococcus mutans and Streptococcus sanguis), salivary polymers, and bacterial extracellular products. Plaque is a biofilm on the surfaces of the teeth. The accumulation of microorganisms subjects the teeth and gingival tissues to high concentrations of bacterial metabolites which results in dental disease. If not taken care of, via brushing or flossing, the plaque can turn into tartar (the hardened form) and lead to gingivitis or periodontal disease.

 Measures for Prevention and Control:

1) Dental care at home: use of mouth washes, Regular and proper brushing of teeth and rinsing to remove the fermentable carbohydrates from mouth cavity.

2) Dietary restrictions of carbohydrates (especially soluble carbohydrates in ice creams, chocolates, sweets), avoiding too frequent eating

3) Immediate cleaning and brushing the teeth after carbohydrates intake.

4) Using antiseptic and detergents (present in many oral preparations), thought to be beneficial in prevention.

5) Urea: Gets converted to Ammonia and it Prevents the growth of acid producing organisms.

6) Antibiotics: Penicillins, Macrolids (e.g. erythromycin, azithromycin), and Tetracyclines are effective. Vancomycin, Kanamycin, Chloramphenicol, Bacitracin, and Polymyxin – B are useful as topical mouthrinses or gels or controlled delivery systems containing tetracyclines for intra pocket insertion. These are helpful for temporary Correction and by local treatment. Overuse may produce super-infection or resistance.

7) Alkaline salts: 60% NaHCo₃ may neutralize acidity and help to control the disease.

8) Fluorides used cautiously may reduce entry of microorganisms and chances of fermentation

9) Educating on proper brushing techniques

ANTIPLAQUE AGENTS

The agents acting against the plaque are called Antiplaque agents. They may act by:

1. Antimicrobial action

Antibiotics: Penicillin, Vancomycin, Kanamycin, Niddamycin, Spiromycin, tetracyclines, macrolids (erythromycin/azithromycin)

Enzymes: Protease, lipase, nuclease, dextranase, mutanase, glucose oxidase, amyloglucosidase.

Bisbiguanide antiseptics: Chlorhexidine, Alexidine, Octenidine.

Quaternary ammonium compounds: Cetylpyridium chloride, Benzoalconium chloride

Phenols and essential oils: Thymol, hexyl resorcinol, Ecalyptol, Triclosan plus

Natural products: Sanguinarines

Fluorides: Sodium fluoride, sodium monofluorophosphate, stannous fluoride, amine fluoride

Metal salts: Tin, zinc, copper

Oxygenating agents: Hydrogen peroxide, sodium peroxiborate, sodium peroxycarborate (liberate nascent oxygen)

Detergents: Sodium lauryl sulfate

Amine alcohols: Octapinol, delmipinol

2. Plaque removing action

Enzymes: Protease, lipase, nuclease, dextranase, mutanase, glucose oxidase, amyloglucosidase.

Oxygenating agents: Hydrogen peroxide, sodium peroxiborate, sodium peroxycarborate

Detergents: Sodium lauryl sulfate

3. 3. Plaque matrix inhibition

     Amine alcohols: Octapinol, delmipinol

---

15. MOUTH WASHES

Mouth washes are aqueous solution containing one or more active ingredients, used for topical action on mouth, throat and pharynx.

Types:

• Antiseptic mouth wash
• Astringent mouth wash
• Demulcent / smoothening / emollient mouth wash
• Anodyne / obtundent mouth wash
• Alkaline mouth wash
• Flavouring / sweetening mouth wash

1) Antiseptic mouth washes:

Condy’s Lotion (KMNO₄), H₂O₂ , Zinc sulphate, Chlorhexidine, providone iodine (betadine)  a combination of menthol + thymol + methyl salicylate + eucalyptus

2) Astringent Mouth Washes:

Tannic acid, Zinc sulphate, Zinc chloride.

These substances precipitate superficial proteins and form a protective layer, which protect the ulcer from external irritation and helps healing (Astringent action).

They also adsorb bacteria /bacterial proteins / bacterial toxins and render them ineffective. Addition of AgNo_3, Alcohol, phenol, peppermint oil, menthol, thymol, camphor, chlorbutanol can serve an additional purpose of precipitation of proteins in nerve fibrils and producing destruction of sensitive tissues in the tooth. Addition of glycerin, liquid paraffin to the mouth washes may produces additional smoothening effect.

Uses:

• Bacterial stomatitis
• Gingivitis/ Ulcerative gingivitis / spongy gums
• Aphthous stomatitis
• Glossitis
• Dental caries
• Acute necrotizing ulcerative Gingivitis(ANUG)

3) Demulcent / Smoothening / Emollient Mouth Washes:

Glycerin, liquid paraffin, menthol, peppermint, camphor.

4) Anodyne / Obtundent Mouth Washes:

Produces either local anti-inflammatory action and relieves by reducing inflammation or relieves the pain by producing paralysis of nerve fibrils and destruction of sensitive tissue.

E.g. Menthol, Phenol, Thymol, Camphor, Alcohol, Silver nitrate, Chlorbutanol, sodium salicylate.

5) Alkaline Mouth Washes:

-NaCl (2%)

-NaHCO₃ (2%)

-NaCl+NaHCO₃+ Amaranth + Peppermint water

-NaHCO₃ + NaCl + Peppermint water

-Double strength chloroform water, NaCl+NaHCO₃+ Amaranth + Peppermint water,

 These neutralize the acid in the oral cavity and help to maintain the alkaline medium which may be lethal or oral anaerobic bacteria. These mouth washes also reduce pain and irritation.

6) Flavouring / sweetening mouth washes:

Peppermint oil, peppermint water, camphor, menthol, thymol.

USES OF MOUTH WASHES:

• Cleansing the oral cavity
• Inflammation / infections of mouth, pharynx, throat:

Bacterial stomatitis, gingivitis, Vincent’s stomatitis, dental caries, spongy gums, pharyngitis, glossitis

• Employed in dental practice as a part of post-operative treatment, for prevention of infection, better healing and soothing effect
• Used during the course of operative procedures ,when such use adds to the oral hygiene
• For overcoming mouth odors in the management of halitosis
• Soreness under dentures
• Sensitive oral lesions
• In bedridden patients for deodorizing the oral cavity and to maintain oral hygiene

---

16. LOCAL HEMOSTATICS (STYPTICS)

Agents used to arrest bleeding, or to control oozing of blood from minute blood vessel / local approachable sites

They act by —

1. Formation of an artificial clot, or

2. Providing a matrix which facilitates bleeding

Tooth extraction / dental procedures may lead to disruption of arterioles. The bleeding occurs from too small blood vessels which cannot be surgically repaired or sutured. Hence local hemostatics or styptics play an important role in such situation. In the tooth socket, a cotton gauze pressure pack which may be aided by use of local hemostatics.

Not only in dentistry, at all other places where suturing is not possible to control the bleeding, local hemostatics / styptics are useful.

N	Styptic agent	Source	Way to use	Uses
1.	Thrombin – Human /bovine	Obtained from Human plasma or Bovine plasma	Used as dry powder/solution	Hemophilia, neurosurgery, skin grafting.
2.	Fibrin	From human plasma	As sheets and foams, also may be combined with fibrin	Covering/ packing surfaces
3	Oxidized cellulose	Cellulose is obtained from wood pulp or cotton	Sterile absorbable knitted fabrics prepared by controlled oxidation of regenerated cellulose	Only as surface hemostatic for capillary, venous and small arterial bleeds
4.	Gelatin	From collagen that comes from body parts of various animals	Spongy tablets/foams of different shapes moistened with Saline/Thrombin	Packing wounds
5.	Russel viper venom	From Russel viper (acts like thromboplastin	As a solution	Hemophilia, for local application
6.	Vasoconstrictor	Adrenaline/nor adrenaline	As sterile cotton guaze	Epistaxis, Tooth sockets
7.	Astringents	Tannic acid 20% in glycerin	Solution	Bleeding piles, Bleeding gums

The drugs used in the form of oral tablets to control bleeding are:Tranexamic acid, ethamsylate – To stop capillary bleeding in epistaxis, after tooth extraction.