1. Chemical plaque control

2. Chemical plaque control
Chemical plaque control should always be regarded as a need supplement to, & not a substitute for mechanical plaque control.
It should be related to the individual patients with predicted risk for oral disease.
It includes the transport of anti-microbial agents to the oral cavity using dentifrices, mouth rinses etc. to reduce & control microorganisms

3. Success of local drug delivery system depends on :
1- accessibility: Delivery the antimicrobial agents to site of action.
2-concentration: Maintaining a bacteriostatic or bactericidal concentration.
3-substantivity : Maintaining the agent at the diseased site for a sufficient duration of time

4. Chemotherapeutic agents for control of bacterial plaque
Antiplaque effects of agents may be through:
1- inhibition of bacterial colonization
2- inhibition of bacterial growth & metabolism
3- disruption of mature plaque
4- alteration of bacterial composition of plaque biofilm.
5- alteration of surface energy of the tooth to reduce plaque adherence.
6- inhibition of the release of virulence factors

5. Chemotherapeutic agents
A- chlorohexidine (Chx):
It the most effective antiplaque &anti-gingivitis agent which reduces plaque by 55% & gingivitis by 45%
It is a gold standard against which other antiplaque & anti-gingivitis agents are measured.

6. Clinical applications of chlorhexidine:
It is used as an adjunct to oral hygien and professional prophylaxis
It is used post oral surgery in periodontal surgery or root planning.
Daily use of mouth rinse combined with tooth brushing resulted in reduced interproximal plaque when compared with brushing and daily brushing.
It is used in patient with inter proximal fixation & in patients who are under high risk of caries.

7. 5- It is used in medically compromised patients who are predisposed to oral candidiasis.
6- It is used to limit the bacteremia &operatory contamination by oral bacteria & as an adjunct prophylaxis.
7- It enhance wound healing.
Side effect:
Staining of teeth , tongue, & tooth colored rests.
Bitter taste & transient loss of taste
Not recommended for children or alcoholics

8. B- Stannous Fluoride (SnF2)
It has more antiplaque properties than (NaF) as it is the stannous part not the fluoride part that produces the antimicrobial effect.
Mode of action:
Tin form of the stannous ion enters the cell, impairs the metabolism & affect the growth & adherence properties of bacteria.
Reduction in gingival inflammation (20%) is due to the ability of the agents to improve gingival health by reducing plaque virulence rather than reducing plaque volume.
0.4% SnF2 gels are available for caries prevention.

9. Clinical application of SnF2 :
Used in patients who cannot utilize CHx , such as recovering alcoholics or patient with dentinal hypersensitivity.
Side effects:
SnF2 dentifrice result in extrinsic tooth staining

10. C- phenolic compounds 1- triclosan: 2-listerine mouth rinses:
Is chlorinated phenol available as mouth rinses & dentifrices.
2-listerine mouth rinses:
Are mixture of thymol, menthol, eucalyptol.
It contains 26.9% alcohol.
It decreases gingivitis by 30%.
It causes burning sensation, bitter taste

11. PROBIOTICS Definition:
Probiotics can be defined as living microbes, or as food ingredients containing living microbes, that beneficially influence the health of the host when used in adequate numbers
The most commonly used probiotic bacterial strains belong to the genera Lactobacillus and Bifidobacterium
These bacterial genera are regarded as a part of the normal human microbiota.

12. both lactobacilli and bifidobacteria can be found in breast milk, suggesting early exposure of the oral cavity to these bacteria.
both lactobacilli and bifidobacteria are also associated with dental caries. In addition, caries-associated lactobacilli and bifidobacteria have been characterized as exogenous and opportunistic colonizers possibly acquired from food.

13. POTENTIAL MECHANISMS OF PROBIOTIC EFFECTS IN THE ORAL CAVITY
The general mechanisms of probiotics can be divided into three main categorie:
normalization of the intestinal microbiota.
modulation of the immune response.
metabolic effects

16. Mechanism of Action
modifying gut pH (normalization of intestinal microbiota).
antagonizing pathogens through production of antimicrobial compounds.
stimulating immune modulatory cells, and producing lactase.
In oral cavity, probiotics tend to create a biofilm, acting as a protective lining for oral tissues against oral diseases.

17. Caries vaccine
Vaccines are immuno-biological substances designed to produce specific protection against a given disease. They stimulate the production of a protective antibody and other immune mechanisms. Vaccines are prepared from live modified organisms, inactivated or killed organisms, extracted cellular fractions, toxoids, or a combination of these substances.

18. Ways of caries vaccine administration
Oral, nasal,, tonsillar (topical) antigen administration were safe..
Nasal spray vaccine induced antigen specific mucosal IgA responses.
Response appeared to be dose related mucosal IgA responses.
Re-immunization (18 months after first immunization) resulted in higher responses compared to newly immunized group.
IgA response appears to be associated with delayed recolonization of oral cavity with S. mutans.

19. Mechanism of Action of Vaccine
Saliva contains approximately 1-3% of immunoglobulin concentration, a majority of which is secretary IgA. However, saliva also contains the humeral immunoglobulin IgG and IgM from the gingival sulcular fluid. In addition, cellular components of the immune system such as lymphocytes, macrophages, and neutrophils are also present in gingival sulcus.

20. Some of the possible ways antibodies might control bacterial growth are :
The salivary immunoglobulin may act as a specific agglutinin interacting with the bacterial surface receptors and inhibiting colonization and subsequent caries formation.
The salivary glands produce secretory IgA antibodies by direct immunization of the gut associated lymphoid tissue (GALT), from where sensitized B-cells may be home to the salivary glands.

21. Risks of Using Caries Vaccine
The gingival crevicular mechanism involves all the humoral and cellular components of the systemic immune system, which may exert its function at the tooth surface
Risks of Using Caries Vaccine
Unwanted antibody response & allergy reactions, associated with non-human source monoclonal antibodies