Chapter 25

Chemotherapeutic agents may be added to do the following:

-Mechanically block dentinal tubules -Chemically prevent the depolarization of nerve fibers in the tooth as potassium nitrate or potassium citrate does -Acting mechanically and chemically.

Disadvantages of high abrasive dentifrices:

-abrasion in clients with exposed root surfaces and dentinal hypersensitivity.

What percent of stains can hydrogen peroxide/carbamide peroxide remove?

0.5-1%

pH is measured on a scale from:

1-14

What dose of xylitol decreases S.mutans levels and plaque biofilm and its adhesion to the tooth?

1.55g (minimum of 5g used daily)

The threshold between ___&____ is equal to the hardness of cementum or dentin, often exposed because of gingival recession.

2 & 4

Dentifrices whose level of abrasiveness is ____ are recommended to avoid tooth structure loss on exposed roots.

2 or less.

What percent of water makes up the dentifrice?

20-30%

How long should a client using fluoride toothpaste wait before using a CHG containing product?

30 minutes. Some may suggest 1-2 hours.

Children can use a more abrasive dentifrice when their tooth enamel is mature. Hardness level of what?

4 to 5.

High concentrations are used as binders to stabilize the gel or liquid gel dentifrice formula and up to __% acts as a preservative.

40%

How much fluoride product is efficient in reducing dentinal hypersensitivity?

5,000 ppm

A Ph lower than _ in dentifrice or in saliva supports the incorporation of fluoride ions.

6.

Demineralization of dentin and cementum occurs at a pH of:

6.5

Decay caused by acids from the fermentation of sugars by S.mutans occurs at a pH of ___ on cementum,___ on enamel, and ___ on fluorapatite enamel.

6.5 5.5 4.5

How long should someone who experiences dietary acid or gastroesophageal reflux wait before brushing?

60 minutes.

For a medicinal ingredient to be therapeutic, it must improve oral health status in:

A safe and effective way.

What official bodies have no requirement in regard to natural or artificial origin on product and even less in terms of its labeling?

ADA and CDA

What are some toothpaste brands that are more abrasive than enamel?

AQUAFRESH KIDZMINT TRIPLE PROTECTION, COLGATE TOTAL WHITENING, AND NATURE'S GATECREME DE ANISE.

What % of dentifrices are very abrasive?

About 27%

What is used to clean and polish teeth to a smooth, lustrous surface; they establish the abrasive capacity of the dentifrice.

Abrasive agents.

What 3 things should be explained when choosing a dentifrice?

Abrasiveness, pH and insoluble materials.

What would a patient with root exposures need to be given advice on?

Abrasiveness, role of pH, and insoluble materials contained in dentifrices.

Level 1 pH is very:

Acidic

Peroxid is:

Acidic pH 4.9

Insoluble material with a very high abrasive potential whose hardness is greater than the tooth is?

Alumina

Toothpaste containing what should be avoided due to its abrasiveness being harder than enamel?

Alumina.

Xylitol has what kind of properties?

Anticaries and antiplaque.

What % of dentifrices fall below 2% on the abrasiveness scale?

Approx. 72%

What initiates caries?

Bacterial flora.

Sodium bicarbonate is:

Basic.

Level 14 pH is:

Basic/alkaline.

What are used as thickeners and prevent liquid and solid ingredients from separating in pastes and gels.

Binders

What occurs when the medicinal agent is stable during storage and biologically active when used in the mouth to achieve the desired therapeutic effect?

Bioavailability.

Neutral/basic pH levels promote the mineralization of biofilm which in turn supports the retention of:

Biofilm and extrinsic stains.

How does the acidity of a dentifrice promote the formation of fluorapatite?

By facilitating the incorporation of fluoride ions into the enamel crystals.

Fluoride neutralizes the antibacterial effect of:

CHG

What is available in different concentrations and is used to control dental plaque formation and gingivitis?

CHG

An efficacious ingredient for the treatment of gingivitis that cannot be found in over the counter dentifrices in North America but can be found in Europe. In North America, this type of mouthwash is available by prescription.

CHG (Chlorhexidine Gluconate)

Dentifrices containing what claim to enhance the bioavailability of calcium and phosphate ions for incorporation into the tooth surface are what kind?

Calcium and phosphate technologies.

what is used in toothpastes with MFP

Calcium carbonate (chalk)

What helps to clean and deodorize the mouth and make it smell fresh.

Carbonates.

What is added to dentifrices intended to remineralize teeth and add luster?

Casein phosphopeptide (milk protein)

A reverse reaction of Essential oils:

Cheilitis or circumoral dermatitis in sensitive individuals.

What is associated with stannous chloride and would provide better protection against erosion?

Chitosan (Europe)

What flavor can cause a burning sensation, tissue sloughing, contact stomatitis, intolerances, or allergic reactions?

Cinnamon

Some manufacturers use what instead of SLS to increase the bioabailability of fluoride ions?

Cocamidopropyl betaine.

What toothpaste is triclosan with PVM/MA found in that is available in antigingivitis/antiplaque ingredient?

Colgate Total

Toothpaste brands with high abrasive levels:

Colgate Total advanced health, and crest mulitcare whitening.

What are some medical agents that act directly on oral bacteria and volatile sulfur compounds?

Complex formulas triclosan-copolymer-sodium and stannous fluoride in combination with hexametaphosphate.

What kind of dentifrice is preferred for someone who has recurrent aphthous ulcers or irritation of oral mucosa?

Dentifrice containing cocamidopropyl betaine. (Ex: Sensodyne Pronamel, or Colgate Luminous).

Manufacturers develop dentifrices too;

Dentifrices for topical intraoral use and cleaning dentures.

What can cause allergic reactions, especially in someone with hypersensitivity to aspirin?

Dye yellow #5 (Tartazine)

A bleaching agent acts on the -----. A whitening agent action takes place in----.

Enamel, deeper layes as dentin.

Low pH contributes to __ of tooth structure.

Erosion.

A reverse reaction of tartar control:

Erythema, scaling, fissuring of the perioral area, chelitis, gingivitis, and circumoral dermatitis.

What kind of dentifrice is effective in caries prevention because it reaches the interproximal surfaces and deep grooves of teeth?

Fluoridated liquid gel.

A low pH is desirable in what kind of toothpaste?

Fluoride

SLS may interfere with:

Fluoride effectiveness.

The ingredient with the strongest evidence supporting its effectiveness in remineralization and caries prevention is:

Fluoride.

What plays a key role in keeping the remineralization-demineralization process in favor of remineralization?

Fluoride.

For a dentifrice to be considered therapeutic, the manufacturer must:

Follow strict pharmaceutic standards with regard to the quantity and bioavailability of the therapeutic agents used, their safety, and their efficacy.

The American dental association seal of acceptance and the canadian dental association seal of recongnition are designed to:

Help the consumer and hygienist make informed oral care product choices.

On the Relative Dentin Abrasivity (RDA) Scale, the ___ the score, the more abrasive the dentifrice.

Higher.

used to retain moisture, prevent air drying, and ensure a chemically and physically stable product, descries what product?

Humectant.

The addition of copolymer is for what?

Increase substantivity of triclosan, thus prolonging the antibacterial effect for 12 hours.

If abrasive capacity is too high, it may ___ abrasion of tooth structure and restored tooth surfaces.

Increase.

What can happen if the percentage of hydrogen peroxide is higher in toothpaste?

It can cause dental sensitivity.

An advantage of higher abrasive levels in a dentifrice (more than 2%) is:

It removes biofilm and acquires pellicle faster than a less abrasive agent. The acquired pellicle forms quickly and can protect enamel against erosion.

Fluorapatite crystals are charcteristically:

Larger, more stable, and less acid soluble.

If the percentage of hydrogen peroxide in a dentifrice is ___ the product is considered safe.

Less than 1%

If abrasive capacity is too low, the abrasive agent is ____ effective in removing the soft deposits and stains.

Less.

A client who brushes without a dentifrice must brush differently how?

Longer because there is no abrasive agent on the toothbrush to help remove soft deposits and stains adequately.

What kind of abrasive level is recommended for clients with esthetic restorations and or titanium implants?

Low abrasive.

____ can tarnish titanium implants.

Low pH

An additive that produces a therapeutic or beneficial effect on either the hard or soft tissues.

Medicinal ingredient.

Baking soda is what kind of abrasive?

Mild.

What % of dentifrices have a neutral or basic pH?

More than 87%

Level 7 pH is:

Neutral

Toothpaste whitening used every day should have a:

Neutral Ph.

The majority of dentifrices have a ___ pH, but few products have a pH between 3-10.

Neutral.

____ is less irritating for soft tissues and does not demineralize teeth.

Neutral/basic pH

An additive that is necessary to make the formulation thick, hold together, clean efficiently, or have a particular color or flavor for consumer appeal would be?

Nonmedicinal.

What is the most abrasive toothpaste and what is its abrasive level?

Nupro Fine prophylaxis paste, 7.9.

Dentifrices free of preservatives, sodium lauryl sulfate, fluoride, dyes, peroxide, and artificial flavors are for what?

Persons allergic or who desire a natural product.

Ingestible dentifrices are used who?

Persons with special needs.

The most common five common dentifrice abrasives are:

Phosphates, carbonates, silicas, aluminium compounds, and other substances.

This helps the dentifrice make the teeth look white and feel clean

Phosphates.

This includes: Dicalcium phosphate dihydrate (DCPD) and Calcium pyrophosphate (CalPyro)

Phosphates.

"Natural" dentifrice manufacturers tend to replace oil based products with what kind of products?

Plant based such as algae and agar agar.

What is added to Triclosan to increase the duration in the mouth and its antibacterial effect?

Polyvinylmethoxyethylene and maleic acid copolymer (PVM/MA)

What is added to dentifrices to inhibit mold and bacterial growth and prolong shelf life?

Preservatives.

The cosmetic effect of a dentifrice is:

Prevents or removes stains, inhibits supragingival calculus formation, whitens teeth, freshens breath, controls malodor.

what is the therapeutic effect of a dentifrice is:

Prevents or reverses dental caries; reduces gingivitis, oral biofilm, or dentinal hypersensitivity.

Calcium and phosphate are for what?

Reduce dentinal sensitivity and aids in enhancement or remineralization.

what is the hygienic effect of a dentifrice is:

Removes food particles and oral biofilm.

What can contribute to recurrent aphthous ulcers or irritation of oral mucosa in some people?

SLS

Dentifrices for those with recurrent aphthous ulcers would be free of what?

SLS free.

Calcium sodium phosphosilicate releases ions of calcium, phosphate, and sodium when exposed to:

Saliva.

Dentifrices formulated for those with xerostomia would contain:

Salivary enzymes, lubricants, and salivary enhancers.

Dentifrices may be compared only from the;

Same manufacturere or resort to an independent laboratory that conducts testing using the same protocol.

-Mechanically clean the teeth, and some thicken the dentifrice. -Chemically compatible with NaF and MFP. -These are nonreactive and are used frequently as abrasives in toothpaste.

Silicas

What is mixed with some dentifrices to make it more effective against caries?

SnF2

Used in toothpastes with NaF; bactericidal.

Sodium bicarbonate

Dentifrices for those with hypertention would be free of what?

Sodium bicarbonate free or sodium chloride free.

What is an example of a soluble material?

Sodium bicarbonate.

Mohs Hardness Scale described and rated the hardness of materials with 1 being the ___ and 10 being the ___.

Softest; hardest

What sweeteners contribute to a pleasant taste?

Sorbitol and xylitol.

Reverse reaction of antimicrobial agents:

Staining or soft tissue irritation.

____ cannot metabolize xylitol, therefore their acids that demineralize tooth structure are decreased.

Streptococcus mutans.

Popular in toothpastes to lower surface tension to loosen debris and stain.

Surfactants (foaming agents/detergents)

Low concentrations of ____ are used as a humectant

Synthetic cellulose

On a bottle of toothpaste, what can be a source of cross contamination?

The orifice of the tube.

Nonfoaming to low foaming dentifrices are used for what?

The use with a power toothbrush and children.

Ingredients added for specific preventive, treatment, or beneficial purposes are referred to as:

Therapeutic agents/medicinal ingredients.

A dentifrice can prevent or control an oral disease or condition when it provides what kind of function?

Therapeutic.

What is the purpose of adding flavor to toothpaste?

To provide a refreshing flavor and aftertaste and to mask the taste of unpleasant chemical compounds.

Complex formulas of medicinal and nonmedicinal that must be compatible to be effective.

Toothpaste

A bisphenol that is a broad spectrum antimicrobial agent that has antiplaque and antigingivitis properties.

Triclosan.

What has been shown to slow periodontal disease progression in periodontal pocket depths greater than or equal to 3.5mm?

Triclosan.

A dentifrice with a PH ___ demineralizes and weakens exposed root surfaces.

Under 6.5.

What is recommended to prevent or reduce hypersensitivity?

Using a Ph neutral and mildly abrasive product.

Chlorine dioxide has been shown to reduce:

VSC

In some countries, Triclosan as regarded as an active ingredient with restricted use because of detection of trace amounts in:

Water systems.

Products that have no abrasivness and no insoluble materials but differ in pH:

Water, hydrogen peroxide, and sodium bicarbonate.

What can be used as a buffer to create remineralization effects before toothbrushing?

Water, neutral sodium, fluoride containg mothwash, water and baking soda, magnesium hydroxide solution, milk, and cheese.

In doses greater than 10%, ___ is an effective antimicrobial agent to combat tooth decay.

Xylitol.

What is the most popular antimicrobial agent that is a sugar alcohol and sugar substitute derived from fruits, mushrooms, and birch bark.

Xylitol.

What prevents or breaks down calculus formation?

Zinc chloride and zinc citrate.

What % of dentifrices are not very abraisive?

about 29%

Mohs hardness scale is useful for understanding what?

abrasiveness of cleaning and polishing agents.

Fluoride levels in North America are ___, and most products contain about _____.

between 400 ppm and 5,000 ppm; 1,000 ppm

A reverse reaction of fluoride is:

dental fluorosis and soft tissue reactions.

A dentifrice can be a risk factor if it causes:

dentin hypersensitivity, erosion, or abrasion.

A reverse reaction to flavoring:

direct irritants or allergic reactions in the mouth or lips, contact cheilitis, rhinitis or asthma.

If baking soda is combined with fluoride is can:

have an anticaries effect.

A dentifrice containing alumina is efficient for stain removal but has higher risk for damaging tooth surfaces because its hardness level woul dbe?

higher than that of the tooth's enamel.

Ingredients that do not dissolve in water are:

insoluble

Dentifrices contain what kind of ingredients?

insoluble and water soluble.

Saliva plays roles in:

lubrication, predigestion, immunity, and buffering.

A reverse reaction of SLS:

mucosal desquamation or ulceration in sensitive individuals.

The origins of abrasive agents are either _________ or __________.

natural or synthetic.

Water is:

neutral

Seal of Acceptance contain a safe level of abrasives but do not mention:

pH

Dentifrices come in what kinds?

powders, liquid gels, gels, pastes, foam, and gel paste combinations.

Peroxide contatining toothpastes pose a risk to increase the:

roughness of implants.

Toothpaste containing the cocaprophyl betaine as a detergent has better bioavailabiltiy of F compared with a product containing:

sodium lauryl sulfate

Ingredients that dissolve in water are:

soluble

Chlorites, derivatives of sodium, phosphate, and stabilized SnF2 are accepted by the ADA as:

supragingival calculus inhibiting agents.

Dentifrices formulated for diabetics would be made with what?

sweeteners that have no effect on blood sugar.

Manufacturers choose the dentifrice ingredients based on:

their cost of production.