Asian Journal of Pharmaceutical and Health Sciences

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Astringents in dentistry: a review

*Gaurav Gupta1, Sunil Kumar M.V2, Harikesh Rao3, Pooja Garg4, Rajesh Kumar5, Alok Sharma5, Harleen Sachdeva6
[1,2,3,4,5] Department Of Prosthodontics, Jaipur Dental College, Jaipur
[6], Department of Prosthodontics, Bhabha College of Dental Sciences, Bhopal

ARTICLE HISTORY ABSTRACT

Received: 07.04.2012 Astringents are any group of substances that cause the
contraction or shrinkage of tissues & that dry up secretions.
Accepted: 05.05.2012 Although Astringents were being used from age-old in one form
or the other but their role & efficacy in dentistry & in mucosal
Available online: 10.08.2012 health is now well explained & now it has emerged from salt
water to various newer drugs. This article provides professionals
with a broad overview of various categories of drugs as
Keywords: astringents and their implications for dental patients and
Astringent, gingival retraction, gum paint, treatment.
retraction cord, ayurvedic astringent

*Corresponding author:
Email : [email protected]
Tel : +91-9414057158

INTRODUCTION medical use.

R apid progress in dental pharmacotherapeutics requires

that clinicians constantly update their knowledge of
new drugs, drug interactions and useful therapeutic
trends. Astringents play a useful role in prosthodontics in the
management of bleeding during gingival retraction. They also
Astringents cause contraction of tissues. They accomplish this
by constricting small blood vessels, extracting water from tissue
or precipitating protein. Astringents are widely used in medicines
especially in dental care to cleanse, tighten the gums and detoxify
them and remove plaque from teeth. Dentist can also apply
help in increasing the gingival resistance against infections. astringents to gingival tissues before taking impressions, placing
Class V or root surface restorations.
Astringents are the substances that precipitate proteins, but do
not penetrate cells, thus affecting the superficial layer of mucosa Astringents for Gingival Retraction :
only. They toughen the surface by making it mechanically
The entire impression process for fixed prosthodontics
stronger and decrease exudation. The word "astringent" derives
requires careful management of the soft tissue. The inability of
from the Latin word adstringere, meaning "to bind fast". They
impression material to adequately displace soft tissue, fluids, or
have relatively low cell permeability, and they act generally as
debris to record finish line, mandates adequate isolation.
irritants in moderate concentrations and caustics in high
Chemicomechanical method has been described in the literature
concentrations[1].
to achieve exposure of the finish line and create an acceptable
The common sources of astringent foods are legumes such as environment for the impression materials [2,3].
beans and lentils. Raw fruits and vegetables like lemon,
Several displacement cords preimpregnated with epinephrine
pomegranate, cranberry, gooseberry, pears, cauliflower,
are available commercially. (Fig. 1 to 5) Epinephrine used in
asparagus, turnip are also good sources. These items when eaten
concentrations of 0.1% and 8% to saturate the retraction cord
create a puckering sensation in the mouth making it feel dry and
creates local vasoconstriction of the gingival tissues [4,5,6].
this property is called Astringency. This is also found in green tea
Controversy has developed over the use of epinephrine, because it
and wine and is attributed to the presence of tannins in them.
has been shown that 1inch of cord saturated with 8% solution
Astringent are also used to improve blood circulation and contains 2 to 15 times the safe dose of epinephrine recommended
tighten the skin besides improving the pH level of the skin. for outpatients [7,8]. There is evidence of increased heart rate and
Astringents due to its remarkable shrinking and water absorption elevated blood pressure when epinephrine is applied to lacerated
qualities are majorly used in skin care as toners to remove excess gingiva. Contraindications include a positive history of
oil and makeup from the skin. One of the popular tannin, Oak cardiovascular disease, hyperthyroidism, patients receiving
Bark, is used to prepare commercial astringents for cosmetic and monoamine oxidase inhibitors for treatment of depression [9].

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chloride and Ferrous sulfate are preferred astringents amongst

prosthodontists because they cause minimum tissue damage.
Aluminum sulfate compounds (aluminum potassium sulfate
[Alum] and aluminum sulfate) : Alum (potassium aluminum
sulfate) in a 100% concentration has been shown to be only
slightly less effective in shrinking the gingival tissues than
epinephrine, and it shows good tissue recovery. Only slight tissue
injury was noted in a 10-minute application, and that completely
Figure 1. Finished tooth preparation healed in 10 days [5,10]. 0.1 mm permanent loss of crestal
gingiva usually occurs. Fischer indicated that although alum is
kind to the tissue, the tissue retraction and hemostatic ability is
limited. Alum has been recommended for use in place of
epinephrine because it is safer and has fewer systemic effects
[8,11]8. The cord should be wet when placed to avoid tearing the
tissue on removal. Cord saturated with 100% alum can be safely
left in the sulcus for as long as 20 minutes without adverse effect
[5].
Aluminum sulfate, which differs from alum, has been
suggested as a gingival retraction material. The available data
Figure 2. Placement of primary compression cord indicated that the material is effective and biologically acceptable.
A practical concern is that, like most sulfates, aluminum sulfate
compounds can inhibit/retard the setting reaction of additional
reaction impression materials [8].
Aluminum chloride: Aluminum chloride is one of the most
commonly used astringents [7,12]. The actions of aluminum
chloride result from its ability to precipitate protein, constrict
blood vessels, and extract fluid from tissues. It is used in the
concentration of 5% to 25%. A permanent crestal gingiva loss of
0.1 mm can be expected. There are no known contraindications
Figure 3. Insertion of second retraction cord and has minimal systemic effects [8]. Studies have shown that
solutions stronger than 10% can cause local tissue destruction. A
10-minute application is usually sufficient. Aluminum chloride is
the least irritating of the medicaments used for impregnating
retraction cords, but it is shown to disturb the setting of Polyvinyl
siloxane impression materials. The inhibitory effect can be
greatly reduced by thoroughly rinsing the preparation with water
after the treated cord is removed.
Ferric subsulfate : also known as Monsel's solution, has been
advocated for use in gingival displacement[7,13,14] . It is slightly
more effective than epinephrine in gingival displacement. Tissue
Figure 4. Removal of second retraction cord
recovery is good, but the solution is messy to use [13]. The
Before taking impression
recommended time of use is 3 minutes. The literature infers that
ferric or ferrous salts should not be used because they are
corrosive and injurious to the soft tissues and enamel and because
they stain the teeth. These properties are attributed to the high
acidity (72%) of the solution[7].
Ferric sulfate: Ferric sulfate (13.3%) used for tissue
displacement has recently been reported. It does not traumatize
the tissue as noticeably, and healing is more rapid than with
aluminum chloride. Solutions of ferric sulfate above 15% are very
acidic and can cause significant tissue irritation and postoperative
Figure 5. Finished tooth preparation root sensitivity. Ferric sulfate is compatible with aluminum
chloride but not with epinephrine. When used with epinephrine, a
Equally effective astringent gingival deflection agents exert no massive blue precipitate develops. Ferric sulfate coagulates blood
systemic effects [2]. so quickly that it must be placed directly against the cut tissue. If it
Astringents may be administered by retraction cords already is not, the ferric sulfate becomes tied up with the extravasated
impregnated with the agent or by applying them to cotton pellets. blood and floats away, leaving a bleeding surface. The
Some of the examples are alum, aluminum chloride, zinc chloride recommended use time is 1 to 3 minutes, but can be used for 10 to
(8-20%) and tannic acid. Styptics are the concentrated form of 20 minutes. The resulting tissue displacement is maintained for at
astringents. They cause superficial and local coagulation. Some least 30 minutes, so that repacking is seldom necessary for
of the examples are ferric chloride and ferric sulfate. Aluminum multiple impressions [1]. The tissue is temporarily discolored to a

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black or bluish color but will appear pink again after 1 or 2 days. classified as a chemical cautery agent and is not recommended for
In vitro tests failed to show the corrosive or staining effects on the gingival displacement [4].
enamel that had previously been reported with ferric compounds.
Various combinations of chemicals have also been described
However, ferric sulfate can modify the accuracy of surface detail
as tissue displacement agents. Zinc chloride with 8% epinephrine
reproduction during impressions because it disturbs the setting
gave better retraction than epinephrine alone but only fair tissue
reaction of polyvinyl siloxanes. Therefore, all traces of
recovery. If applied for an excessive time, the tissue may be
medicament should be carefully removed from the tissues before
cauterized [13]. Alum and aluminum chloride is reported as an
the impressions are recorded [7]. Due to its iron content, ferric
acceptable combination that attempts to gain the advantages of
sulfate stains gingival tissues a yellow-brown to black color for
both chemicals. Rather than mixing the two chemicals together, it
several days after being used as a retraction agent.
is recommended that the cord be saturated with one solution
Zinc chloride (bitartrate): has been used in 8% and 40% before insertion and the other applied after the cord has been
solutions. Gingival displacement effectiveness of the 8% solution placed in the sulcus. The epinephrine with alum combination
is about equal to that of epinephrine, while the 40% solution is a showed a slightly better gingival retraction effectiveness than
little more effective. The 8% solution caused severe necrosis of epinephrine alone and fair tissue recovery.
the tissue that did not heal for 60 days. The 40% solution is so
The acidity of the commonly used gingival displacement
caustic that it has been classified as a chemical cautery agent.
medicaments are high, with pH ranging from 1 to 3 [17,18]. This
Because both of these concentrations are escharotic and cause
could result in the removal of the smear layer and can negatively
permanent injury to the soft tissue and sometimes to the bone,
affect the bonding mechanism of the self-etch dentin bonding
their use is not recommended [7,15].
systems [18] . The removal of smear layer could also cause the
Tannic acid (20% and 100%): is less effective than opening up of the dentinal tubules cervically and cause dentinal
epinephrine but shows very good tissue recovery. The hypersensitivity.
recommended use is for 10 minutes [16]. The hemostatic
Advantages and disadvantages of the various agents used for
effectiveness of tannic acid is minimal.
gingival retraction
Negatol solution: is a 45% condensation product of
Astringents for completely edentulous patients :
metacresol sulfonic acid and formaldehyde. It provides better
retraction than epinephrine. Tissue recovery is poor. It is highly Butcher and Mitchell observed that continued covering of the
acidic and decalcifies teeth in both 10% and 100% so1utions. It is palatal surface results in progressive regression of the palatal

The astringents used in gingival displacement are as follows:

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glands. Rinsing the mouth with an astringent reflexly stimulates It also decreases sensitivity and increases gingival resistance
palatal glandular activity. This activity and dilation of the ducts against infections.
cause turgidity within the adjacent tissues [19]. Frequent
Stolin gum paint 15ml contains cetrimide 0.1 % w/v, tannic
removal of any restoration and rinsing will keep the mucous
acid 2 % w/v, zinc chloride 1 % w/v. Sensorok gum astringent
membrane in a better physiologic state.
with zinc sulfate is used for gum massage 2-3 times daily.
Astringents are also used as an aid in obtaining accurate
S. G. PAINT contains Tannic acid- 27% , Potassium Iodide -
maxillary arch impressions. Astringent mouthwash helps in
0.05% , Iodine - 0.03% , Thymol-0.033% , Menthol- 0.05%,
removal of excess mucus secretions from the oral cavity and thus
Glycerine -72%. Tannic acid in S. G. PAINT has been used as an
minimizing effectively the defects due to mucus secretions [20].
astringent for the mucus membranes of the mouth and throat.
Gum astringent Ingredient rationale of S. G. PAINT gum paint, provides cooling,
soothing, astringent effect. Similarly, ingredients like iodine,
Gum paints are the combination of antiseptics and tanning
potassium iodide have germicidal, fungicidal, anaesthetic and
agents which precipitate proteins but do not penetrate cells
healing properties. Menthol provides the cooling effect and also it
thereby affecting only the superficial layer making it
possesses local anesthetic action. Glycerine helps the healing of
mechanically stronger and decreases exudation. They have
the ulcer as well as it has anti- inflammatory property. Gum paint
germicidal, fungicidal, anesthetic and healing properties. When
is indicated for treatment of Stomatitis, Glossitis and Aphthous
applied, they provide a soothing, cooling and an astringent effect.
Ulcers.
All these preparations contain Choline salicylate, Tannic acid,
Cetrimide, Thymol, Camphor, Cinnamon oil, Iodine and Alum Arofil gum paint contains Iodine 1.0%, Potassium Iodide
(hydrated potassium aluminium sulfate). They are applied on 2.0%, Thymol 0.25%, Menthol 0. 25%, Camphor 0.2%, Tannic
flabby edentulous ridges for gum massage to improve the Acid 1.55%.
edentulous foundation.
Astradent contains Tannic Acid 5% w/v, Choline Salicylate
Zingisol containing 2% Zinc Sulfate is used to control 8% w/v, Cetrimide 0.01% w/v, Lignocaine 2%, Glycerine base.
bleeding gums. The patient is advised to apply 3-4 drops on finger
Ayurvedic medicines with astringent properties:
and massage 3-4 times a day. Sensoform gum paint (Warren)
contains tannic acid, glycerine and potassium iodide and is  Myrrh (Commiphora molmol) has antimicrobial and
applied on affected area several times with the cotton applicator astringent properties that help to tighten the gums. It is considered
for the treatment of stomatitis, inflammation and bleeding gums. one of the best herbs for healing bleeding gums and mouth ulcers,

List of Astringents used in Dentistry

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problems. restorative treatment. Quintessence Int 1981:2: 141.
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tissues. In a British Dental Journal Study published in 2003, it was Soelberg KB. Human blood pressure and pulse rate response
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11. Wilson CA, Toy WM. Alum solution as an adjunct to
 Citric acid present in fruits has astringent properties and is gingival retraction. Br Dent J 1977:142:155.
used for dermatology treatment. It is used for demineralization of
root surfaces to enhance gingival reattachment after flap surgery 12. Shaw D, Krejci RF, Cohen DM. Retractive cords with
and detoxifying and cleaning implants during reentry of tissue to aluminum chloride: Effect on the gingiva. Oper Dent
repair defect. It increases astringency of phenolic compounds like 1980:138.
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