Gingival solutions

Medicines that are meant for the oral mucosa are often applied as a mouthwash, gingival solution or a semisolid mouthpaste. A mouthpaste will theoretically stay on the mucosa for the longest time and it is useful in formulating poorly water soluble ingredients. However viscous mouthwashes and suspensions in water are easier to apply to those parts of the oral cavity that are difficult to reach with a (stiffer) mouthpaste [1]. Especially in the case of a painful ailment prescribers and patients mostly prefer a mouthwash. An example of this is the local application of corticosteroids in oral lichen planus [2]. In such cases a (viscous) suspension could be preferred to a solution in water to obtain the intended effect [1]. 

Oromucosal and gingival solutions are applied to local ailments in the oral cavity. They are administered with a brush, a spatula or a cotton swab. 

Because of the risk of swallowing, mouthwashes and gargles should only be used by adults and children older than 6 years. Gingival solutions and oral gels or pastes can -with caution- be used in young children. These dosage forms can be apphed at specific locations. 

Liquid Preparations (Mouthwashes, Gingival Solutions and Gargles)... 

Gingival solutions with antiseptics or local anaesthetics may also be formulated in mixtures of water and glycerine. In this case glycerine serves the purpose of raising the viscosity of the vehicle and improving adherence to the mucosa. This is relevant because gingival solutions are used on local ailments in the oral cavity. 

For dental sodium fluoride solutions a plastic bottle is preferable as sodium fluoride reacts with glass, the solutions may therefore be stored longer in plastic. Gingival solutions are best supplied in a bottle with a brush or a spatula (see Sect. 24.4.19.1). 

Ghlorhexidine Gluconate. Chlorhexidine gluconate [18472-51 -0] (l,l -hexamethylene bis[5-(p-chlorophenyl) biguanide] di-D-gluconate) is used as an antimicrobial against both aerobic and anaerobic bacteria ia the oral cavity. It is used as a therapeutic supplement ia the treatment of gingivitis, periodontal disease, and dental caries. A mouth riase form is available as a 0.12 wt% aqueous solution (288). 

In vitro, chlorhexidine can adversely affect gingival fibroblast attachment to root surfaces. Furthermore, protein production in human gingival fibroblasts is reduced at chlorhexidine concentrations that would not affect cell proliferation. Such findings corroborate earlier studies showing delayed wound healing in standardized mucosal wounds after rinsing with 0.5% chlorhexidine solution. 

It is a caustic astringent, used as 5-10% solution in ulcerative gingivitis, pyorrhoeal pockets and apthous ulcers. 

Mouthwashes are aqueous concentrated solutions containing one or more active ingredients and excipients. They are used by swishing the liquid in the oral cavity. Approximately 15-30 ml. of mouthwash are used for single mouthful of rinse for about a minute. Mouthwashes can be used for therapeutic and cosmetic purpose. Therapeutic mouthwashes are used to reduce plaque, dental caries, gingivitis and stomatitis while cosmetic mouthwashes are used to reduce bad breath and it contains used antimicrobial and/or flavoring agent. Mouthwashes other than used for cosmetic purpose, should only be used under the direction of physician/dentist since it contains certain medicines. 

Buccal, sublingual, oral cavity Buccal mucosa gingival sulcus Bioadhesive patch biodegradable solution matrix, tablet... 

Chlorhexidine has been used as an adjuvant for plaque control and in the treatment of gingival inflammation. It is generally considered to be effective in the control of plaque and can be helpful in the treatment of gingivitis. It can be applied in the form of a solution, used as a mouth rinse or with a toothbrush, in dentifrice or as a gel. The concentrations used are 0.05-2%. 

Histological and histochemical examination of mucosal biopsies taken after 18 months of daily exposure to chlorhexidine did not show any adverse effect on the oral mucosa. There was increased keratinization of human gingival cells in vitro in cell cultures if the chlorhexidine concentration exceeded 25 p.g/ml, and the same acceleration of keratinization of human gingival cells in gingival swabs occurred after rinsing with 0.025, 0.05, and 0.1% chlorhexidine solutions (25). In one case there was excessive impairment of wound healing after daily rinses with a 0.1% chlorhexidine solution after oral surgery. 

Hexetidine is used as an antimicrobial preservative in cosmetics and nonparenteral pharmaceutical formulations. Therapeutically, hexetidine is mainly used as a 0.1% w/v solution in mouthwash formulations for the prevention and treatment of minor local infections, gingivitis, and mouth ulcers. 

The rinsing of one s mouth and the process of gargling is used both prophylactically to prevent the establishment of gingivitis and therapeutically to alleviate the symptoms of inflammation in the oral cavity. Many pharmacopoeias include Gargarisma as the Latin term for gargling solutions based on natural products such as essential oils, tannins and mucilages. 

The essential oil of Lippia sidoides (rich in thymol and carvacrol) was used in a double blind, randomized, parallel armed study against gingival in ammation and bacterial plaque. Fifty ve patients used a 1% essential oil solution as a mouth rinse twice daily for 7 days, and the results were compared to a positive control, 0.12% chlorhexidine. Clinical assessment demonstrated decreased plaque index and gingival bleeding scores as compared to the baseline, with no signi cant difference between test and control. The essential oil of L. sidoides was considered a safe and effective treatment. 

Fig. 15. Collagen gel plate. Three small bits of human gingival tissue have been inrubaled in Tyrodc s solution on the surface of a thin layer of collagen over the bottom of a petri dish. Collagenase produced by the tissues has resulted in lysis of the collagen gel in the vicinity of the tissues.

Fig. 16. Acrylamide gel patterns of collagen subjected to colli enase derived from human gingival tissues, gingival epithelium only, and ngival connective tissues only. The characteristic control pattern on the left depicts the two o-chains and the two /I-chains (dimers of a..chains) obtained after urea denaturation. In. addition to these two layers, collagen solutions digested by eollagenase from gingival tissues and sub. scquciitly denatured display two layers representing the approximate 3/4 pieces...

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