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