DH119A Dentifrices and oral rinses

intrinsic sources of halitosis

10% systemic, 90% from oral cavity, oral based malodor caused by volatile sulfur compounds which are primarily hydrogen sulfide and methyl mercaptan, by products of bacterial metabolism for g- anaerobes

Informs the public and professional regarding the safety and effectiveness of a product, awarded for a 3 year period, manufacturers must reapply, voluntary, yet desired by companies

ADA seal of acceptance

indications for chlorhexidine gluconate

Adjunct therapy for surgical procedures, patients with NUG or NUP, Patients who have short term oral self care limits, patients who have limited manual dexterity, patient with fixed or removable prosthetics

brands of monofluorophosphate

Colgate Gel, Tom's of Maine

brands of sodium fluoride

Colgate, Crest, Aqua Fresh, Aim, Arm & Hammer Dental Care, Prevident 5000 Plus (Rx)

brands of stannous fluoride

Crest Pro-Health, Sensodyne Products

brands of recaldent

MI paste

essential oils in listerine, the only OTC essential oil product with ADA Seal of Acceptance for therapeutic use in the treatment of gingivitis

Menthol .042%, Thymol .064%, Methyl Salicylate .06%, Eucalyptol .092%

brands of stannous fluoride as a desensitizer

Pro-Health, Sensodyne (Rapid Relief, Repair & Protect) Colgate Total

who should rinses containing alcohol NOT be recommended for?

Recovering alcoholics, patients with a history of alcohol abuse, individuals taking certain antibiotics (e.g., metronidazole) with which gastrointestinal upset may occur as an interaction effect, small children, patients being treated with head and neck radiation and clients with mucositis

brands of potassium nitrate

Sensodyne, Sensodyne True, Crest Sensitive

what does bioavailability depend on?

Specific fluoride: SnF2 has a lesser bioavailability capacity than NaF The pH: a pH lower than 6 in dentifrice or in saliva supports the incorporation of fluoride ions Other ingredients: Sodium Laurel Sulfate may interfere with fluoride effectiveness

what is the job of the ADA council on scientific affairs

Studies, evaluates, and disseminates information with regard to dental therapeutic agents that are offered to the public or professional

ideal properties of oral rinses

Substantial efficacy, Acceptable to the patient, Cost effective, Highly soluble and stable in storage, Broad spectrum, Adequate bioavailability and retention, Minimal side effects

20-40% of the dentifrice, solid, insoluble particles used to remove stains and debris; serves as a polishing agent by causing abrasion, may have one agent or a combo of 2 or more

abrasive system

basic ingredients of a dentifrice

abrasive system, detergent, soap, surfactant, sweetener, flavoring, binder/thickener, humectant, preservative, water, coloring

An additive with the specific purpose of providing a benefit to the dentition or by targeting a specific oral health condition, may be cosmetic or therapeutic, often added to dentifrices may be designed to prevent calculus formation, remove/prevent stain formation, and/or whiten tooth surfaces

active ingredient

dentifrices may have this to enhance the product, may be cosmetic or therapeutic, additionally some may have both cosmetic or therapeutic

additives

Typically 10-30% of the product • Acts as a solvent and increases solubility • Preservative • Mild astringent-shrinking tissue • Evidence exists there may be an association between oral cancer and the use of alcohol based rinses

alcohol of rinses

• Anti-inflammatory • Antibacterial • Antiplaque • Antioxidant

aloe vera

phenolic compounds, bacteriostatic, nonselective and rapid bacterial cell wall disruption, inhibits cell enzyme activity, protein denaturation, alleviates pain, soothing, essential oils may have their own antimicrobial properties and effects

anodynes essential oils

Buffering ability-capable of reducing oral acidity, Fluoride: Sodium Fluoride, Stannous Fluoride

anti-caries and caries prevention

antimicrobial effects; prevents or reduces gingivitis, alteration of cellular aggregation and metabolism, examples; Stannous Fluoride (SnF 2 ), Essential oils (combination), Eucalyptol, Menthol, Thymol, Methyl salicylate

anti-gingivitis agents

Formulation that is able to provide bacteriostatic or bactericidal activity; CPC, Alcohol, Essential Oils, Aloe Vera, CHX, Stannous Fluoride

antibacterial/antimicrobial

delmonpinol 0.2%, 1.5% alcohol, perioshield, sodium benzoate

antiplaque agents

1-2% of the dentifrice, hold solid and liquid agents together, prevents separation, contribute to the smooth soft texture, composed of organic hydrophillic colloids, alginates, gums and carboxyl methyl cellulose

binders

Property of a therapeutic agent , agent is stable during storage and biologically active when used in the mouth to achieve the desired therapeutic effect

bioavailability

"tartar control"-supra calculus inhibitors, may increase dentinal sensitivity, Tetrasodium phosphate, disodium dihydrogen pyrophosphate, zinc citrate

calculus inhibitors

potential problems with sodium lauryl sulfate

can be irritating to tissue, may cause increased incidence of aphthous ulcers, mucosal desquamation, may interfere with the effects of chlorhexidine, found in shampoo and other degreasing products

disadvantages of chlorhexidine gluconate

can stain teeth, tongue and restorations, bitter taste, mucosal burning sensation, slight increase in supragingival calculus

purposes of a dentifrice

caries inhibition, reduction of gingival disease, desensitization, calculus prevention, cosmetic, bioavailability

quaternary ammonium compounds, bactericidal, ruptures bacterial membrane, rapid leakage of cell contents and cell death, alters bacterial metabolism and inhibits cell growth, decreases bacterial ability to attach to tooth

cetylpyrindium chloride

• Bis-biguanides, bacteriocidal and bacteriostatic, broad spectrum effect against g-/g+, supresses s. mutans, interferes with bacterial colonization and attachment, binds to oral tissues and releases for 6+ hours, most effective of all rinses for gingivitis, alcohol free is available, ADA seal of acceptance, prescription only

chlorhexidine gluconate

common therapeutic agents for oral malodor

chlorhexidine, CPC, chlorine dioxide, zinc citrate, essential oils, triclosan, or combinations in pastes or rinses

1-2% of the dentifrice, attractiveness of the product, must not stain dentition or tissue, vegetable dyes

coloring

Contain ingredients that address a cosmetic need, removal of debris from the oral cavity, tartar control, freshen breath, whitening, treatment of Halitosis (Oral Malodor)

cosmetic

A substance used with a toothbrush to remove dental biofilm, may provide a means of delivering an agent to the dentition or oral cavity

dentifrices

Thermal sensitivity caused by external stimulus of exposed dentinal tubules, seen areas of gingival recession or in areas where the enamel has been worn away and exposed the dentin

dentinal hypersensitivity

• Minimizes or reduces dentinal hypersensitivity by occluding or mechanically blocking exposed dentinal tubules or chemically by preventing depolarization of the nerve fiber within the dentinal tubule

desensitizers

1-2% of the dentifrice, foaming action, lowers surface tension, emulsifies debris

detergents/soaps/surfactants

1-1.5% of the dentifrice, used to cover the taste of other ingredients, must be pleasant and have consumer appeal, non-cariogenic, essential oils, menthol, etc, some may be a contact allergen for some patients

flavoring agents

0.1-0.4% of the product • Essential Oils or aromatic waters • Non-cariogenic-sorbitol, xylitol, glycerin • Mint, cinnamon, cloves (eugenol) • May also double as a antimicrobial agent (methyl salicylate) • Coloring additive-should be discolor the tissue or teeth

flavoring and sweetener of rinses

caries prevention and remineralization effects, may be OTC or prescription

fluoride

types of therapeutic agents

fluoride, antigingivitis agents, plaque inhibitors, desensitizers

extrinsic sources of halitosis

food, meds, alcohol, tobacco

natural ingredients that have antibacterial benefits, in addition to other medicinal effects, may be plants or plant oils, in an aqueous solution or additives to pastes, may be considered cosmetic, as research into the therapeutic effects is limited or not widely accepted

homepathic/natural

20-40% of the dentifrice, moisture reatiner, glycerol, sorbitol, glycol, water may serve as this

humectant

5-20% • Adds "body" to the rinse • Glycerin, sorbitol, xylitol, polyethylene glycol

humectant of rinses

1 t. salt per 8 oz warm water, solution contains more salt than the cells-draws fluid out of the cells

hypertonic solution

½ t. salt per 8 oz warm water, same osmotic pressure as cellular fluid; not useful in shrinking tissue-palliative

isotonic solution

tooth polishers, usually contains 2 abrasive agents

liquids

delivery of dentifrices

most are in paste form, but powders and liquids are also available

not often the main active ingredient, may have some therapeutic effects, witch hazel, aloe vera juice, xylitol, tea tree oil, neem, eucalyptus oil, peppermint oil, propolis, myrrh

natural or herbal

May inhibit S. Mutans • May inhibit gingivitis

neem

may be paste or gel, additive: Pyrophosphate, Zinc Citrate, Citric Acid, Sodium Hexametaphosphate, Tetrasodium pyrophosphate, Baking Soda, Crest Pro-Health, Aquafresh, Gleem, Ultrabrite

non-peroxide

chlorine dioxide, used in treatment of halitosis

oxidizing rinse

hydrogen peroxide, antimicrobial if o2 is being released, continued use of hydrogen peroxide rinses may cause; sponginess of gingiva, black hairy tongue, dentinal hypersensitivity, demineralization

oxygenating rinse

easy to dispense, best patient acceptance, several ingredients

pastes

may be paste or gel, additive: hydrogen or carbamide peroxide, PeroxiCare, Colgate, Mentadent

peroxide

inhibit plaque formation and adherence, types; zync citrate

plaque inhibitors

1st type of dentifrice, easy to manufacture, ingredients separate, generally more abrasive

powders

<1% of the dentifrice, prevents bacterial growth, alcohol, benzoate, formaldehyde, dichlorinated phenols, chlorophyll

preservative

brands of sodium citrate

protect

used to restore oral moisture, dry mouth associated w/ gland damage, radiotherapy, prescription drugs, or conditions such as sjorgens syndrome, ADA accepted: salivart and biotene

rinses that treat xerostomia

examples of sweeteners

saccharin, sorbitol, glycerin, xylitol

brands of strontium chloride

sensodyne

home prepared, 1/2 tsp of baking soda/1 cups warm water

sodium bicarbonate

examples of types of abrasive system

sodium bicarbonate, calcium carbonate, calcium pyrophosphate, aluminum oxide and silica

Additive to prevent staining, particularly stain associated with stannous fluoride use, Research shows it may "help" fluoride in the remineralization process; however, more research is needed to support this claim, Crest Pro-Health toothpaste is the most common product using this agent

sodium hexametaphosphate

most common ingredient in commercially prepared toothpastes, creates foaming action in toothpaste

sodium lauryl sulfate

common ingredients of surfactants

sodium lauryl sulfate, sodium laureth sulfate, sodium lauryl sarconsinate, ammonium lauryl sulfate, cocoamidoprophyl betaine

bacteriostatic, reduces plaque biofilm, alters bacterial cell metabolism, inhibits cell adhesion, products: Gel-Kam, Crest Pro-Health- ADA acceptance (due to fluoride addition)

stannous fluoride

<1% of the product • Lowers surface tension

surfactant of rinses

1-1.5% of the dentifrice, nonfermentable, non-cariogenic substance, must be appealing to customer, may also serve as a component of the humectant and flavoring agent

sweetener

• In addition to antibacterial effects, may have antifungal properties • May be effective in the treatment of oral herpes • May be effective against halitosis • Should NEVER be swallowed

tea tree oil

functions of oral rinses

therapeutic, antibacterial/antimicrobial, anticaries/caries prevention, xerostomia, cosmetic, preprocedural rinse

directions for paste use

use only pea sized amount of paste on toothbrush as needed, evenly distribute the paste over entire dentition to maximize benefits

20-40% of the dentifrice, distilled, deionized

water

Typically 70% of the product • Rinse Medium

water in rinses

agents used to whiten tooth surface and enamel, stain preventers can also whiten tooth surface indirectly, may be peroxide or non peroxide based, activated charcoal is a natural alternative

whitening agents

treatment of oral malodor or halitosis

zinc chloride