Drugs with topical administration in the oral cavity area

1. local anaesthetics in sprays, lozenges = trochs, collutoriums, mouth wash

(gargle) solutions, dental cones.
2. antibiotics in sprays, mouth wash (gargle) solutions, collutoriums, gels, dental
cones, lozenges = trochs. There are also fibers with antibiotics for the treatment of
gum diseases. Most commonly used: tetracyclines (tetracycline, doxicycline,
monocycline) and metronidazol.
3. haemostatics in sponges, gels etc, are usually used in order to stop or prevent
haemorrhage associated to diverse stomatology procedures. Examples fibrin,
thrombin, vitamin K.
4. flourids n tooth pastes, chewable tablets, films (used to prevent tooth decay);
5. sublingual tablets (nitroglycerin, isosorbid dinitrate, etc) for coronary heart
disease (avoidance of first pass metabolism, rapid absorption).
DRUGS with topical application in the oral cavity

A continuously growing number of drugs are applied topically in

the oral cavity, using various dosage forms.
The classification of drugs with topical application (local) in
the oral cavity includes
two main categories:
a. drugs for diseases of the oral mucosa, related tissues or dental
pathology;
b. drugs that are applied to the oral mucosa in order to treat diseases
corresponding to other areas of the body.

A. DRUGS FOR DISEASES OF THE ORAL MUCOSA, RELATED TISSUES

OR DENTAL PATHOLOGY

ANTISEPTICS

1. OXIDIZING AGENTS have antiseptic and haemostatic effects and

are used as oral-pharyngeal showers in stomatitis, angina and capillary
bleeding.
1.a. Hydrogen peroxide
-

Exhibits haemostatic effects

It is administrated as oral showers in stomatitis, gingivitis and

non-severe oral mucosa bleeding.
-

The concentration of the solutions is 1 to 3%.

1.b. Sodium and calcium perborates

- used to treat gingivitis and ulcerative necrotic periodontitis.
1.c. Potassium permanganate

2. HALOGENATED AGENTS
2.a. Halogens
2.a.a.Iodine:
- Tincture of iodine;
- Elemental iodine (Lugol solution);
- Iodoform;
- Betadine.
2.a.b.Chlorine:
- Dakin solution;
- Calcium hypochlorite;
- Sodium hypochlorite (concentration 3 to 5% for removing organic
debris), Dakin solution;
- Chloramines.

2.a.c.Fluoride:
- Sodium fluoride in the form of solutions, varnishes and gels.
2.b. Halogenated agents:
Chlorhexidine is active against Gram-positive and negative bacteria,
fungi, spores and viruses and disestablish the bacterial plaque.
Chlorhexidine has a plaque disclosing effect, it is not irritating, it can
affect taste and can produce the desquamation of mucosa. Daily use of
chlorhexidine 0.2% mouthwash significantly reduces dental plaque.
Chlorhexidine is available in many dosage forms such as: mouthwash
(Corsodyl), lozenges (Trachisan - chlorhexidine + lidocaine,
Hexoraletten - chlorhexidine + benzocaine), gel (Plak out),
pulverizer (Collustan), periodontal pellets (Periochip ). It is active
at a neutral or slightly alkaline pH and its activity is reduced by the
presence of organic matter. Its prolonged use does not alter local
ecosystems or microbial resistance to the pathogenic bacteria.
Chlorhexidine digluconate doesnt penetrate the gingival sulcus or
periodontal pockets by simply rinsing the mouth.

3. ACIDS:
3.1.Boric acid
- weak antiseptic
- is used in the treatment of mouth aphthae and ulcers;
3.2.Salicylic acid
- exhibits fungicidal, caustic and keratolytic effects.

4. PHENOL DERIVATIVES
4.1. Phenol
- is included in Walkhoff solution which is used in endodontics.
4.2. Cresol

4.3. Hexylresorcinol
4.4. Thymol
- is included in the composition of mouthwashes;
4.5. Eugenol
is
extracted
from
certain
essential
from clove oil, nutmeg, cinnamon, basil and bay leaf.

oils especially

- It has antiseptic, revulsive and local anesthetic effects.

4.6 Hexetidine is an antiseptic included in the composition of
toothpastes and mouthwashes (HEXORAL - topical solution: 1% or
spray: 2%).

5. DETERGENTS:
- Sodium lauryl sulphate (SLS) is a detergent found
personal care products such as toothpaste;

in

many

- Benzalkonium chloride is a detergent and quaternary ammonium

compound with a broad range of antimicrobial activity. Other
quaternary ammonium compound is dequalinium (Codecam - spray
used to treat an infection: stomatitis, ulcerative gingivitis, Vincent
angina, oralcandidiasis).

6. HEAVY METALS:
- contains inorganic silver salts and colloidal silver compounds
- inorganic silver salts: silver nitrate (solution 1 exhibits a strong
bactericidal effect and 10% solution is used to cauterize polyps or
necrosis of superficial tissue of the pus bags);
- colloidal silver compounds: colargol, protargol.

7. HYDROXIDES (ALKALIS)

- calcium hydroxide enters in the composition of pastes for root

canal treatment

8. COLORING AGENTS
- exhibit weak bacteriostatic effect
- are used in prevention, as dental plaque revealer revealed and in
cariology to identify the altered dentin.
- Gentian violet - dye which consists of a mixture of violet rosanilinis
with antibacterial and antifungal properties.
- Acridine dyes (acriflavine, proflavine, euflavine, rivanol);
- Azo-dyes and methylene blue.

ACTIVE PRINCIPLES OF PLANTS

Romasulan (from chamomile flowers), Aftolizol (extract of rose

petals);

volatile oils (Voseptol);

Ambazone (Faringosept) is used as an antiseptic especially in

infections with Gram-positive bacteria.

Sanguinarine and bloodroot extract is a vegetal product used in

dentistry as a 0.2% solution for the treatment of gingivitis and

as
anti-plaque
agent.
Sanguinarine is
a
mixture
of
benzophenanthride alkaloids
extracted
from
rhizomes
of Sanguinaria Canadensis. A related alkaloid is cheleritrine
acting through inhibition of protein phosphorylation.

NON STEROIDAL ANTI-INFLAMMATORY DRUGS

- it is used in gingivitis, stomatitis and some periodontitis.
Examples: indomethacin , naproxen, benzydamine.
Benzydamide is an anti-inflammatory, antiseptic, and local analgesic
agent with good penetration into oropharyngeal tissues. It is indicated
in inflammation of the oropharyngeal area: pharyngitis, tonsillitis,

gingivitis, stomatitis, periodontal disease, oral mucosal lesions of

various etiologies (prostheses, irradiation, and accidental wounds due
to dentistry treatments).

LOCAL ANESTHETICS
The most commonly used benzocaine (Dentocalm-gel), lidocaine
(Stomacaina-spray), bupivacaine and mepivacaine.
ANTIBIOTICS in sprays, mouth wash (gargle) solutions, collutoriums,
gels, dental cones, lozenges = trochs. There are also fibers with
antibiotics for the treatment of gum diseases. Most commonly used:
tetracyclines (tetracycline, doxicycline, monocycline) and
metronidazol.
HAEMOSTATICS in sponges, gels etc, are usually used in order to
stop or prevent haemorrhage associated to diverse stomatology
procedures. Examples fibrin, thrombin, vitamin K.
flourids n tooth pastes, chewable tablets, films (used to prevent
tooth decay);
SUBLINGUAL TABLETS (nitroglycerin, isosorbid dinitrate, etc) for
coronary heart disease (avoidance of first pass metabolism, rapid
absorption).