Antiseptics and

Periodontology

Definition
An antiseptic is a substance which
inhibits the growth and development of
microorganisms. It:
Is a chemical antimicrobial agent
Destroys microorganisms & inhibits
their reproduction or metabolism.

Functions
For practical purposes, antiseptics are
considered as topical agents:
1. For application to skin, mucous
membranes, and inanimate objects.
2. In periodontology, applied topically or
subgingivally to mucous membranes,
wounds, or intact dermal surfaces

Antibiotics
Chemical substances that:
kill and stop the growth of bacteria.
act by interfering with the cell wall &
protein synthesis and nucleic acid
metabolism.
are broadly classified as bacteriostatic,

What is the difference between

Antibiotics and Antiseptics?

Antibiotics acts against bacteria while

antiseptics are effective against a wide
variety of microorganisms.
Antibiotics kill and stop the growth of
bacteria while antiseptics prevent the growth
and development of the microorganisms
without necessarily killing them.
Antibiotics are used internally as well as
externally, but antiseptics most often used
externally.

Classifications
Bis-biguanides
Quaternary Ammonium Compound
Phenolics
Iodophores
Amine-Alcohols
Oxygenating Agents
Natural Products
Pyrimidines

Bis-biguanides

The most common Bis-biguanide is Chlorhexidine.

It binds to different surfaces within the mouth including

teeth , mucosa, pellicle and saliva.

Chlorhexidine has been formulated in a number of

products including, mouth rinses, gels, tablets, varnishes
and chewing gum.

Bis-biguanides

Chlorhexidine (CHX) is a broad-spectrum

biocide effective against Gram(+) &
bacteria, Gram(-) bacteria and fungi.
Mechanism of action -CHX is a
positively-charged molecule that binds to
the negatively-charged sites on the cell
wall; it destabilizes the cell wall and
interferes with osmosis.
The bacterial uptake of the chlorhexidine is
very rapid, typically working within 20
seconds. In low concentrations it affects
the integrity of the cell wall.

Structure of Chlorhexidine

Anti-plaque Activities

The effective blocking of acidic groups of

salivary glycoproteins will reduce their
adsorption to hydroxyapatite and
formation of acquired pellicle.
The ability of bacteria to bind to tooth
surfaces may be reduced by adsorption of
CHX to the extracellular polysaccharides
of their capsules or gylcocalyces.
The CHX may compete with calcium ions
for acidic agglutination factors in plaque.

Without brushing, Chlorohexidine will

reduce plaque by 60 % and gingivitis
by 50-80% using 10 ml of 0.2% mouth
rinse twice daily
Gel-1%, .2% and .12% are now
available

Commercially Available
Examples

Mouth Rinses
Aqueous alcohol solutions of 0.12% and 0.2% chlorhexidine
rinses.
Also available are alcohol-free chlorhexidine rinses.
Corsodyl
Savacol

Gels
1% Chlorhexidine gel product is available.

Tablets
Lozenges with 2mg chlorhexidine gluconate for
disinfecting the oral cavity . Usually prepared as sugar
free , making it suitable for diabetics
Varnishes
Available varnishes cannot maintain a significant
suppression of Strep. Mutans for 6 months. ( repeated
application needed)
Clorzoin, EC40 and Cervitec

Biodegradable Chip
Slow release chip for controlled delivery of
chlorhexidine directly to the periodontal pocket. Chip
biodegrades and releases chlorhexidine within the
pocket over 7-109 days, used as an adjunct to scaling
and root planning.

Quaternary Ammonium
Compounds

This is a group of cationic surface

active agents that possess the ability
to bind with the bacterial cell
membrane, that have the ability to
affect its permeability with subsequent
loss of cell content.
They are bactericidal to both gram
positive and gram negative , but are
thought to be more effective against
gram positive bacteria.

Structure

Formulations

Two of the groups Cetylpyridinium chloride

(CPC) usually at 0.05% with and without
domiphen bromide and benxethonium
chloride at a similar concentration have
been used in mouthwahses.
They work by disrupting membrane
function, causing leakage of cytoplasmic
material and ultimately this leads to
collapse of intracellular equilibrium.

Formulations contd
Mouthrinses combining Cetylipyridium
chloride with Chlorhexidine (CHX 0.05%
+ CPC 0.05% + Zinc lactate 0.14% or
Chlorhexidine 0.12% + CPC 0.05% nonalcoholic formulation) are available and
compare well with established
Chlorhexidine products.
Both significantly reducing plaque and
gingivitis as well as monitoring halitosis
with a decreased number of side effects.

Commercially Available
Examples

Formulations contd

A non-degradable osmotic slow-release

dosage form containing 6.6 mg CPC
(Mucosal oral therapeutic system) and
CPC lozenges Cepacol (each containing
1.6 mg CPC).

Phenols

Phenolic compounds are used as both

antispetics and antibiotics.
Triclosan, a bisphenol and nonionic
germicide with low toxicity and broad
antibacterial activity spectrum, is
available in dentrifices and
mouthwashes.

Phenolics

High killing activity and broad

spectrum of effect against bacteria ,
spores ,viruses and fungi (10-25 %
sporicidal)
250-500ppm-bacteria
300-3000ppm bacterial spores
2000ppm 15-20mins in activate
enterovirus

Structure

Mechanism of Action

The mechanism of action is not clearly

understood. Due to its hydrophobic and lipophilic
nature, triclosan adsorbs to the lipid portion of
the bacterial cell membrane and in low
concentrations interferes with vital transport
mechanisms.
Inhibitory effect on primary enzymes
(cyclooxygenase and 5-lypoxygenase) in the
pathways of arachidonic acid metabolism and
this leads to a decreased production of
proinflammatroy metabolites such a PGE2 and
Leukotriene B4

Formulations

1.
2.

3.

Tricolosan in dentrifices
Since it does not bind well to oral sites due to its
lack of strong positive charge, formulations have
been developed to enhance its ability to bind to
plaque and teeth. These include:
Combinations with Zinc Citrate to take advantage of
potential anti-plaque and anti-calculus properties.
Incorporation of triclosan in a copolymer of
methoxytheylene and maleic acid to increase its
retention time
Combinations with pyrophosphates to enhance its
calculus reducing properties

Commercially Available
Examples

Formulations

Triclosan in mouthwashes
Reduction in plaque and gingivitis
ranges from 24-36% and from 23-46%
respectively.

Iodophores

12.5 ppm sanitizing solution. Used to sterilize

instruments
Optimal concentration 3.5% beyond which
additional effect negligible
Povidone-iodine is most widely used, it is a
complex of elemental iodine and the surfactant
povidone

Idophour (active)
pyrolidone

N-vinyl

Mechanism of Action

Iodination of lipids and oxidation of

compounds (protein and nucleic acid)

Iodophores

When used as a component in a rinse with hydrogen

peroxide it can decrease the levels of gingivitis.
Can be used as an adjunct to scaling and root planning in
the treatment of periodontitis.
Also used as a subgingival irrigation by means of a syringe.

Amine-Alcohols

Mode of action- Alcohols denature

proteins by breaking the hydrogen
bonds that link oppositely charged
hydrogen and oxygen atoms on different
parts of the chain-like molecules.
Works best against microorganisms at
about 70% concentration, as it is easily
absorbed by cells, which allows optimal
penetration into the cell.

Structure of AmineAlcohols

Isopropanol is more effective against

bacteria

Delmopinol offers 0.1-0.2%

Oxygenating Agents

Most common: Hydrogen Peroxide 3% concentration

It releases nascent oxygen which is highly reactive. It

combines with and oxidizes necrotic matter and
bacteria.

Oxygenating Agents

Sodium peroxyborate / Sodium peroxycarbonate

Available in mouthwash and gel forms .

Sodium peroxyborate products show evidence of efficacy in the

treatment of acute ulcerative gingivitis.

Natural Products

Sanguainarine:
Structure

The mechanism of action is not clearly

understood.

Natural Products

Herb and plant extracts have been used in oral hygiene

products for years.
Sanguinarine and zinc toothpaste and mouth rinses have
shown some antimicrobial action.
But Studies show that these products increase the
likelihood of developing oral precancerous lesions.

Detergents

Sodium lauryl sulfate (SLS) is one of the

most widely used synthetic detergents in
dentrifices.
In general, surface active agents are thought
to lower the surface tension and penetrate
and loosen surface deposits, emulsify or
suspend the debris, which the abrasive in a
dentrifice removes from the tooth surface.
Sodium lauryl sulfate is an anionic molecule
with a high affinity for protein molecules.

Detergents contd

Concentration in dentrifices usually range

from 0.5-2.0%
It may have an antagonistic effect with CHX.
This is due to an ionic attraction of CHX, a
cationic bis-biguinide symmetrical molecule,
to SLS, a molecule with an anionic nature and
a high affinity for protein molecules.
Recommended time between brushing with a
SLS containing dentrifice and a CHX rinsing is
30 mintues, if a reduction in anti-microbial
effect is to be avoided.

Relate the application of

antiseptics to concepts of
bacterial biofilm and plaque
hypotheses.

Basic Plaque Formation

The mechanisms of plaque formation include:
Adsorptionof proteins and bacteria to form a film
on the tooth surface.
The effect ofvan der Waalsandelectrostatic
forces between microbial surfaces and the film to
createreversibleadhesionto the teeth.
Irreversible adhesion due to intermolecular
interactions between cell surfaces and the pellicle.
Secondary colonizers attach to primary colonizers
by intermolecular interaction.
The cells divide and generate a biofilm.

Antimicrobials used in periodontal treatment

can be divided into two main groups:
Agents directed against supragingival
plaque development
Agents directed against subgingival
bacteria.

SUPRAGINGIVAL PLAQUE CONTROL

Terminology
Plaque Inhibitory Effect- reducing plaque to levels
insufficient to prevent the development of gingivitis.
Anti-Plaque Effect- one which produces a prolonged
and profound reduction in plaque sufficient to prevent
the development of gingivitis.
Anti-Gingivitis- an anti-inflammatory effect on the
gingival health not necessarily mediated through an
effect on plaque.
Substantivity- the ability of drugs to adsorb on to and
bind to soft and hard tissues. It is affected by the
concentration of the medicine, the pH and temperature
and the length of time of contact of the solution with the
oral structures.

Bisbiguanide Antiseptics
They kill a wide range of microbes by damaging the cell wall.

Chlorhexidine

The anti-plaque properties of Chlorhexidine has much

greater effects than other antiseptics of similar or greater
antibacterial activity.
Probably due to the adsorption of the dicationic
Chlorhexidine molecule on to the oral surfaces and its
release at bacteriostatic levels for prolonged periods.
Chlorhexidine is a synthetic antimicrobial agent effective in
vitro against Gram-positive and Gram-negative bacteria,
yeasts, fungi, aerobes and anaerobes.
A study by Noiri et al(2003) investigated the effects of
Chlorhexadine and P. Gingivalis in artificial biofilms in an
intraoral device.

Chlorhexidine reduces the adherence of Porphyromonas

Gingivalis to epithelial cells by affecting the bacterial outer
membrane and was therefore effective in reducing the
viability of P. Gingivalis biofilms.
Its antibacterial action is due to an increase in cellular
membrane permeability followed by coagulation of the
cytoplasmic macromolecules.
It has been shown to be an effective anti-plaque and antigingivitis agent.
When used as an adjunct to normal oral hygiene practices, it
is more effective in reducing plaque accumulation on a clean
tooth surface than in reducing pre-existing plaque deposits.
Thus, Chlorhexadine mouthwash should be given to patients
only after the necessary periodontal treatment has been
performed.
Chlorhexidine has high substantivity since it maintains
effective concentrations for prolonged periods of time thus
suitable for inhibiting plaque formation.

Quaternary Ammonium
Compounds
Cetylpyridinium Chloride (CPC)

Although they have greater initial oral retention and equivalent

antibacterial activity to Chlorhexidine, they are less effective in
inhibiting plaque and preventing gingivitis.
This may be due to the rapid desorption of the compounds from
the oral mucosa.
It has also been found that the antibacterial properties of these
compounds are reduced once adsorbed on to a surface, which
may be related to its monocationic nature.
The cationic group of each molecule bind to the receptors on
the mucosa producing mucosal retention but because of the
monocationic nature of these molecules, there are few
unattached sites available for antibacterial function.
A CPC pre-brushing mouthrinse used as an adjunct to
mechanical oral hygiene has not been found to have a
beneficial effect on plaque accumulation (Moran and Addy
1991).

Conventional use, according to Jenkins et al (1994),

compared plaque inhibitory effect of 0.05% and 0.1%
CPC and 0.05% Chlorhexidine and control mouthrinses
used twice daily for four days with non-brushing.
The 0.1% CPC had lowest plaque scores and produced
limited but statistically significant inhibitory plaque
growth but 0.05% CPC and Chlorhexidine had too low a
total dose to yield an effect.
The short duration of the study made it impossible to
detect anti-plaque effect on gingivitis.
A slow release system with CPC has been tried to
increase the retention time of CPC in the mouth. This
showed no change on the efficacy of the CPC.
A study by Sheen et al 2001 showed that toothpaste use
before and particularly after mouthrinses, significantly
reduce tooth staining and plaque inhibitory effects. Thus
antiseptics should best be used about 2-3 hours after
tooth brushing.

Phenolic Antiseptics

They may be used alone or in combinations, in mouthrinses or

lozenges for a considerable time.
When used at higher concentrations relative to other
compounds, they have been shown to reduce plaque
accumulation(Lusk1974).
Listerine has been shown to have moderate plaque inhibitory
effects; possibly due to poor oral retention. It has some antiinflammatory effects which may reduce the severity of gingivitis.
Thus it has been accepted by the American Dental Association
to be used as aid in home oral hygiene measures.
A study by Moran 1995 compares the effects of Listerine on 4day plaque regrowth during abstinence from mechanical oral
hygiene, from Chlorhexidine and anti- adhesive mouthwashes.
0.2% Chlorhexidine mouthwash was more effective than
Listerine which in turn was more effective than anti-adhesive
mouthwash.

PyrimidineHextidine

It has some plaque inhibitory activity but this is low in

comparison with Chlorhexidine.
Its substantivity is between 1-3 hours which accounts
for the plaque inhibitory effect of Oraldene.
It can cause oral ulcerations with concentrations
more than 0.1%.
Hextidine combined with zinc improves its plaque
inhibiting activities by acting synergistically with it.

IodophoresPovidone-Iodine

Appears to have no significant anti- plaque activity

when used as 1% mouthwash.
The absorption of significant levels of iodine is
unsatisfactory for prolonged use within the oral cavity
and may cause iodine sensitivity.

Triclosan

A non ionic antiseptic which lacks the staining effect

of cationic antiseptics.
Moderate plaque inhibitory effect when used with zinc
as a mouthwash or toothpaste, due to possible
synergistic effects.
Triclosan itself has little or no substantivity but oral
retention can be increased by combination with
copolymers of methoxylene and maleic acid.
May act as an anti-inflammatory agent in mouthrinses
and toothpaste. This depends on its ability to
penetrate the gingival tissue and the nature of the
solvent in the mouthwash formulation.
Shown to reduce gingival inflammation better than
mechanical brushing alone(Saxton 1986).

Oxybenzone

A phenolic compound similar to triclosan.

Tested in vitro for its ability to inhibit prostaglandin E2
(PGE2) following oxybenzone exposure.
Aids in reducing gingivitis.

Amine AlcoholDelmopinol

Amine Alcohols like Octapinol Hydrochloride has shown

to inhibit plaque accumulation and reduces gingivitis
( Colleart 1992).
Limited substantivity compared to Chlorhexidine and
inhibits salivary bacteria for only 30 minutes as
compared to several hours for Chlorhexidine(Moran
1992).
It may be plaque inhibitory since it interferes with
plaque matrix formation and reduces bacterial
adherence. It also inhibits the growth of dextran
producing streptococci. Thus producing loosely
adherent plaque that is more easily removed upon
mechanical brushing.
Thus should be used as pre-brushing mouthwash.

Salifluor

An effective anti-plaque agent but the mechanisms

for it being an effective anti-microbial and antiinflammatory agent is not fully understood.
Further studies need to be done before released for
clinical usage.

Natural Products Sanguinarine

Contains the chemically reactive iminium ion, which

appears to be retained in plaque for hours after its
use.
Sanguinarine mouthwashes has significant plaque
inhibitory effects but no effect on gingivitis.
Toothpastes used without mouthwash, have shown no
detectable plaque inhibition or anti-inflammatory
effects. This may be due to the other components of
the toothpaste binding to the chemically reactive site
of the sanguinarine molecule.

Oxygenating Agents

Hydrogen peroxide, buffered sodium peroxyborate

and peroxycarbonate in mouthwashes have beneficial
effects on acute ulcerative gingivitis, possibly by
inhibiting anaerobic bacteria.
There is some retardation of plaque growth and is
useful against the development of obligate anearobes
in formation of gingivitis and periodontitis.

SUBGINGIVAL PLAQUE
CONTROL

They are applied locally into the periodontal pocket

via slow release agents and are an adjunct to scaling
and root planing.
Gingival crevice and periodontal pockets are not
reached by chemical agents in mouthwashes or
toothpastes, whose main activity occurs with
supragingival plaque and not really in treatment of
gingivitis and periodontitis.
Recently there has been local drug placement of
antibiotics and antiseptics into the periodontal
pocket.

Chlorhexidine

Most common antiseptic to be used via pocket

irrigation using 5ml syringe and blunt needle in either
a liquid or gel form.
It may be delivered via slow release agents but these
are not commercially available.
Comparative studies have shown that Chlorhexidine
is not as effective as opposed to tetracycline or
metronidazole(Joyston- Bechal 1986) in changing the
bacterial microflora and reducing gingivitis.
However, it does not allow for bacterial resistance
and may be suitable for repeated use.
Chlorhexidine pocket irrigation is useful as an adjunct
to scaling and root planing deep pockets, especially
when there is marked inflammation.

Applications of Antiseptics
in Periodontology

Antiseptics, delivered via rinsing and

irrigation, have been shown to be
effective in controlling gingivitis, but not
periodontitis. The agents generally are
not retained at the site long enough for
their antimicrobial effect to provide a
measurable benefit to pocket depth
and/or attachment levels. They are best
used for short periods of time to
efficiency and to minimise side effects.

Chlorohexedine

As an adjunct to oral hygiene and professional prophylaxis of periodontal

patients.
Improving oral hygiene and gingival health of medically and physically
handicapped groups.
In patients with intermaxillary fixation where oral hygiene is difficult.
Medically compromised patients predisposed to oral infections with
particular reference to oral candidiasis.
In patients with oral complications associated with cancer chemotherapy
(stomatitis, mucositis) chlorohexidine.
In patient receiving fixed appliance orthodontic treatment.
High risk caries patients
Treatment of Candida associated infections
Oral malodour management
Immediate preoperative ultrasonic scaling
Post-op periodontal surgery and root planing
In patient with recurrent oral ulcerations
Well-localized acute periocoronitis
Acute necrotizing ulcerative gingivitis
Acute periodontal abcess

Essentials Oils

Supports gingival health around implants

After periodontal surgery in the early postoperative phase.
Reduces bacteremia following ultrasonic scaling
Reduces malodour for up to 3hrs.

Iodophores

Used as plaque disclosing agents

Severe gingivitis to reduce bacteremia
Post-op scaling and root planing in medically compromised patients
As an adjunct to mechanical scaling in periodontal infections

Discuss the side effects

of antiseptics and
methods of minimizing
the side effects.

Bis-Biguanides
TOOTH, TONGUE & DENTURE
STAINING <10%
Possible causes:
1.
Degradation of the CHX molecule
to release parachloroaniline
2.
Catalysis to Maillard reactions
3.
Protein denaturation with metal
sulfide formation
4.
Precipitation of anionic dietary
chromogens
5.
Exacerbated by smoking, heavy
plaque and calculus
By-products bind to the surfaces of
tooth, denture & tongue and cause
brown pigmentation.

MINIMIZATION OF EFFECTS

1.

Addition of different products such as peroxiborate, polyvinyl

pyrrolidone or sodium metabisulfate, ascorbic acid and an antidiscolouration system to CHX in order to reduce brown pigmentations.

2.

Limiting the intake of foods and beverages (tea, red wine & coffee)
during treatment with CHX especially if its just the CHX formulation
present in agent.

3.

Brushing of teeth with conventional toothpaste just before use of CHX

mouth rinse.

4.

Clean denture with denture cleanser before use of CHX.

5.

Removal of stains by scaling and in this regard ultrasonic scaling is the

most effective method.

6.

Severely restriction of CHX use in patients with visible anterior

composite and glass-ionomer restorations.

7.

Reduction of the concentration of CHX.

8.

Use for short periods. No longer than 2 weeks.

9.

It is also worth stating that chlorhexidine formulations which donot


1.
2.
3.

4.

HYPOGEUSIA <10%
Reduced ability to taste
Concerns only salt and bitter,
not sweet and sour.
Thought to involve blockage of
taste receptors for affected taste
modalities.
Will last for days after
interruption of mouthrinses.

1.
2.

3.
4.
5.

MINIMIZATION OF
EFFECTS
Usually diminishes with
continued use.
Chlorhexidine concentration
in mouthwashes till 0.12%
and mucosa exposure not
exceeding 60" twice a day,
seem the best procedure to
protect tastes in clinical
practice.
Used after meals for better
food appreciation.
Addition of flavour agents.
Do not rinse with water
after use to avoid washing
away of flavour masking
agents.

IRRITATION OF MUCOSAL
MEMBRANES (<1%)
1. This includes burning, epithelial
desquamation, erythema and
peeling.
2. Rare

MINIMIZATION OF EFFECTS
1.Burning will ease after continued
use.
2.Dilution of the mouthwash using
5ml water with 10ml mouthwash,
freshly mixed, will often allow
continued use of the mouthwash.
3.Discontinue use if ulceration and
peeling present.
.

TOOTHACHE
Peridex has caused mild to
moderate toothache, which often
resolved spontaneously and
required no further treatment.


1.
2.
3.
4.

HYPERSENSITIVITY REACTIONS
Includes allergic reactions or
anaphylaxis.
Persons may experience urticaria,
dyspnea, and anaphylacticshock.
Very RARE.
Usually due to accidental ingestion of
the chlorhexidine formulation.

1.
2.
3.
4.

MINIMIZATION OF
EFFECTS
Discontinue use.
Seek medical attention
immediately.
Do not give to teens or
children.
3-5mls of 1:1000 epinephrine
given to avoid death from AS.

PAROTID GLAND SWELLING

1. Swelling of the parotid glands
during the use of oral
chlorhexidine has been reported.
2. Very RARE

MINIMIZATION OF
EFFECTS
1. Discontinue use.
2. Spontaneous resolution has
occurred on discontinuing
treatment.

ENHANCED SUPRAGINGIVAL
.
CALCULUS FORMATION
(Varied)
1.
1. Thought to be due to precipitation
of salivary proteins onto tooth
surface, thereby increasing pellicle
thickness &/or inorganic salts
precipitation on pellicle layer.
.

MINIMIZATION OF
EFFECTS
Studies indicate need for
biofilm disruption prior to
the start of CHX
mouthrinses in order to
reduce side effects. Is
currently debatable.

QUATERNARY AMMONIUM
COMPOUNDS

1.

2.

3.

TOOTH STAINING
All CPC formulations produced tooth
staining and this was worst with the
CPC lozenges.
Agents are categorized as cationic,
which favors their attraction to tooth
surfaces and bacterial plaque.
Clearance of the Cetylpyridinium
chloride is rapid from oral cavity.
Appears to last only 3-5 hours due to
either loss of activity once adsorbed
or rapid desorption. Thus CPC
frequency of use must be doubled to
4 times daily to ensure adequate
efficacy. However this results in an
increase in tooth staining.
Side effects can also include oral
ulceration and a mild burning
sensation of the tongue. Quaternary
ammonium compounds may also
have a lingering bitter taste.

1.

2.

3.
4.

5.
6.

MINIMIZATION OF EFFECTS
Use of mouthrinses with
combination formulations of
CHX (0.05, 0.12%) and CPC
(0.05%) have shown reduced
staining and other side effects.
Brushing
of
teeth
with
conventional toothpaste just
before use of CPC mouth
rinse.
Clean denture with denture
cleanser before use of CPC.
Removal of stains by scaling
and in this regard ultrasonic
scaling is the most effective
method.
Other side effects are mild
and transitory.
Flavouring agents added to
mask bitterness.

Phenolics & Essential Oils

Triclosan is generally non-toxic to

humans. However the FDA had
stated evidence from studies
which show that triclosan may
cause photoallergic contact
dermatitis (PACD), which occurs
when the part of the skin
exposed to triclosan is also
exposed to sunlight.
Concern that widespread
triclosan use is leading to
antimicrobial resistance.
The disadvantage of Listerine is
its high alcohol conc. (21.626.9%) which, may exacerbate
xerostomia. Side effects also
include transient tingling/burning
sensation and bitter taste.

MINIMIZATION OF
EFFECTS
1. Side effects are of Listerine
are transient and usually
disappear quickly after use.
2. Ensure proper removal of
triclosan containing
dentrifices from skin
surfaces that may be
exposed to sun.
3. Discontinue use.

Iodophores

Povidone-iodine may give rise to

allergic reactions, including itching,
burning, and reddening and blistering
in the area of application, so a
patient's history of allergy to iodine or
shellfish must be evaluated. Prolonged
iodide intake can inhibit thyroid
hormone synthesis and cause goiter,
myxedema, or hyperthyroidism.
Transient hyperthyroidism

MINIMIZATION OF
EFFECTS
1. Povidone-iodine should not
be used in patients with
thyroid dysfunction;
pregnant woman, infants, or
in routine patient self-care
as it may lead to iodine
induced hypothyroidism.

Pyrimidines: Hexetidine
Side effects are usually mild. Very MINIMIZATION OF
rare hypersensitive rxns; very rare, 1. EFFECTS
Discontinue use if any of
transient changes in taste; erosive
these side effects occur.
effects on enamel; staining of tooth
& composite restorations; erythema,
slight epithelial desquamation and
burning.
Concentrations greater than 0.1%
will cause oral ulceration.

Amine Alcohols

Use of 0.2% delmopinol hydrochloride

includes tooth & tongue staining,
taste disturbance, transitory
numbness of the tongue and rarely
mucosal soreness and erosion.
Octapinol has toxic effects. No longer
on market.

MINIMIZATION OF
EFFECTS
1. Discontinue use.
2. Side effects lessen with
continued use.

Salifluor
Mechanism behind antimicrobial
effects are not yet properly
understood and as such further
studies should be carried on
salifluor to determine possible side
effects.

Natural
Sanguinarine:
No effects
Products
known.

Chlorine Compounds

Frequent rinsing with 0.2%

sodium hypochlorite may
produce a brown-black extrinsic
discoloration of the teeth.
Irritation of mucous membranes
at high concentrations.

1.

2.

MINIMIZATION OF EFFECTS
Patients are also advised to rinse
orally with 0.2% sodium
hypochlorite for 30 seconds, 2 or
3 times per week. This is
equivalent to 8 mL (2 reduced
teaspoonfuls) of 6% household
bleach in 250 mL (a full glass) of
water.
If irritation occurs, reduce the
concentration or discontinue use.

Oxygenating Agents
Chronic use of hydrogen peroxide causes serious side effects such as
carcinogenesis, tissue damage, hyperkeratosis, oral ulceration and
hyperplasia.
To minimize effects use for short periods or discontinue use.

References

Periodontics 6th ed. B.M.Eley, M. Soory, J.D. Manson.

Antibiotics and Antiseptics in Periodontal Therapy. A. L.
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