Locally Acting Drugs: Seba Hassan Abdelhady

LOCALLY
ACTING
DRUGS
Presented by
Seba Hassan Abdelhady

Lecturer of clinical pharmacology
Faculty of Medicine
ANTISEPTIC
 Antiseptic:
an agent applied on a living tissue such as
dentist's hand to inhibit the bacterial growth.
 Disinfectant:
an agent used to inhibit or kill bacteria in
inanimate objects.
MECHANISM OF ACTION
1) Protein denaturation (usually bactericidal)
2) Cell osmolysis ( bactericidal)
3) Inhibiting microorganism metabolism

CLASSIFICATION:
 Physical agents :
A. Heat such as superheated steam
B. Irradiation such as ultraviolet rays , sunlight
C. Surface active agents: soaps and detergents
D. Substances exert osmotic pressure :
concentrated solution of sugar and salts
 Chemical agents : e.g. silver nitrate,
alcohols, formaldehyde
Uses of antiseptics
Antiseptics used in dentistry as :
1. components of mouthwashes
2. components of toothpastes
3. disinfectants
4. an aid to sterilization
5. For skin and mucosal cleansing prior to
surgery
Examples of antiseptics
in dental practice
Hydrogen peroxide
Potassium permanganate
Formaldehyde
Alcohol
Hydrogen peroxide
 Properties:
 Colorless, odorless liquid

 it forms thick froth in mouth
 it should preserved in cool
place to prevent its dissociation
into water and oxygen
Hydrogen peroxide
Pharmacological actions:
1) Antiseptic: in the body tissues it liberates
nascent oxygen which is more active than
atmospheric oxygen. It causes effervescence
(frothing action) which loosens adherent
deposits.
2) Bleaching agent: it changes pigments into
colorless materials by chemical reactions
3) Deodorant action: by oxidizing the odorless
gases which arise from the breakdown of
protein
4) Local anesthesia: in high concentrations (25-
30%)
Hydrogen peroxide
Uses:
1) Antiseptic especially anaerobic
bacteria to treat general acute
gingivitis, acute ulcerative
stomatitis.
2) Bleaching agent: remove
superficial stains of the teeth
3) Local anesthetic to control gingival
seepage during cavity preparation
Adverse effect:
Long term use may cause hypertrophy
of papillae of tongue
POTASSIUM PERMANGANATE
(CONDY'S CRYSTALS) KMNO₄
 Properties:
It is a dark purple crystal with a
metallic luster which is readily soluble
in water.
 Pharmacological actions:
Antiseptic & deodorant by liberation
of nascent oxygen and by metallic
action of manganese.
POTASSIUM PERMANGANATE
 Uses:
Mouth wash for stomatitis and Vincent's infection
(progressive painful infection with ulceration,
swelling and sloughing off of dead tissue from the
mouth and throat due to the spread of infection
from the gums)
but ,replaced now by peroxide mouth wash.
 Adverse effect:
Staining properties.
FORMALDEHYDE
 it has a bactericidal effect against bacteria,
fungi and viruses
 But with very slow action.
ALCOHOL
 They are used for disinfecting
the skin but infective when
applied to the oral mucosa.
 They do not kill bacterial

spores as well as many viruses
resist treatment with alcohol
 Its antiseptic effect is due to
denaturation and
precipitation of proteins
DENTAL CARIES
DENTAL CARIES
 Definition:
It is a degenerative condition which is
characterized by decay of the hard and soft
tissues of the teeth, caused mainly due to
infection or decaying food.
Pathophysiology of dental caries
 It is a biological interaction between bacteria, diet
and the tooth surface.
 Refined carbohydrates are broken down by acid
producing bacteria, producing further acid causing
demineralization of the enemal surface.
 The main bacteria responsible for dental caries is
streptococcal mutans which produce lactic acid from
dietary carbohydrates.
Treatment of dental caries:
Chlorophyll
Antibiotics
Silver nitrate
Fluorides
Treatment of dental caries:
1- Chlorophyll: it is a green color matter
of plant present in many tooth pastes
and tooth powders.
2- Antibiotics: They are present in

dentifrices to reduce bacterial count
of the mouth e.g. penicillin, bacitracin
and streptomycin.
3- Silver nitrate: it is applied on the

deciduous teeth after cleaning debris
and decaying material.
4- FLUORIDES
Mechanism of action of Fluorides:
 It is concentrated in bacterial plaque

(over 100 fold compared to saliva)-------
 inhibiting bacterial enzymes which
produce lactic acid. --------Thus
preventing acid decalcification of the
tooth structure.
 Mechanism of action of Fluorides:
 Enamel is composed mainly of crystals of
hydroxyapatite which dissolve easily in acid.
 In the presence of fluoride, hydroxyapatite loses
its hydroxyl group to form fluoroapatite which is
more resistant to lactic acid attack.
 Mechanism of action of Fluorides:
 Fluoride also has remineralization effect of enamel
after acid attack.
• Fluoride solution
Topical
• Fluoride toothpaste
• Fluoride mouth rinse
• Fluoridation water
Systemic
• Fluoride tablets
• Fluoridized milk
ADMINISTRATION OF FLUORIDE:
Systemic administration
of fluoride
a- Water fluoridation: if fluoride is

added to water supply, the incidence
of caries reduced (one part of
fluoride to million part of water).
b- Fluoride tablets:
available in Na and Ca salts.
c- Fluoridized milk
Topical administration of
fluoride
a- Fluoride solution: e.g.
Na fluoride: 2% solution applied for 3
min. (three to four times per day).
Stannous fluoride: it is more effective,
but it may cause staining of the teeth.
 Acidulated phosphate fluoride:
reduced PH in the solution, increase the
fluoride uptake by enamel.
b- Fluoride toothpastes: its regular use caused
30% reduction in the incidence of dental caries,
the commonest method of applying topical
fluoride.
C- Fluoride mouth rinse: usually recommended

once a week.
ADVERSE EFFECTS OF FLUORIDE
 Administration of Na Fluoride should be with care as
it is poisonous substance
Acute toxicity
 (Toxic dose 2.5-5 g fluoride found in 5-10 g Na
Fluoride)
 Manifestations: GI upset, hypotension, arrhythmia
ended with acidosis, respiratory failure.
 Treatment of toxcity:
1- Gastric lavage
2- intake full glass of milk
3- Alkalinization of urine
4- in severe cases :the patient requires IVI 10% Ca
gluconate solution to precipitate the excess fluoride
and restore blood Ca levels.
Chronic toxicity
long term use of high doses of fluoride can result
inDental fluorosis:
range from white flecks to extensive brown
staining.
Dental fluorosis
Crippling fluorosis:
 thickening of the cortex of

long bones
 exostosis especially in
vertebrae
 musculoskeletal changes
involving calcification of
ligaments, kyphosis and
limitation of mobility.
DENTAL ABRASIVES
 They are fine powder preparations Pumice
Uses:
1- Help in scouring action of tooth Bruch
mechinically
2- Cleaning, polishing and filling of
teeth Preparations:
a. Pumice: light porus stone of volcanic
origin
b. Precipitated calcium carbonate :
white fine ground chalk with mild
abrasive action
calcium carbonate

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LOCALLY

Seba Hassan Abdelhady

1) Protein denaturation (usually bactericidal)

2) Cell osmolysis ( bactericidal)

3) Inhibiting microorganism metabolism

 Colorless, odorless liquid

 They do not kill bacterial

2- Antibiotics: They are present in

3- Silver nitrate: it is applied on the

 It is concentrated in bacterial plaque

a- Water fluoridation: if fluoride is

C- Fluoride mouth rinse: usually recommended

 thickening of the cortex of

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