m 4 - Dentifrices, Mouthrinses, and Oral Irrigation

polishing (abrasive) re-accumulation

A ___________________ agent is used to produce a smooth tooth surface. This can prevent or delay the_________________ of stains and deposits and help fluoride work properly

very young children who have a tendency to swallow instead of expectorate. physically or mentally challenged patients who cannot follow rinsing instructions.

A mouthrinse is contraindicated in ________________________ A mouthrinse is also contraindicated in ________________

prolonged time frame

A mouthrinse that claims to control bad breath must substantiate the claim by showing that it works to reduce odors over a _________________________

statistically significant reduction

A mouthrinse that claims to control gingivitis must substantiate the claim by demonstrating a _____________________ in gingival inflammation

clinical studies formula

A mouthrinse that contains fluoride for reducing decay must either demonstrate effectiveness in _________________, or show that the _____________ is the same as a similar product that has been clinically proven

dentifrice, mouthrinse, and/or oral irrigation

Although not essential to biofilm removal, a _______________, ______________ and\or _______________ device can provide additional reduction and control of microorganisms.

oral cancer

Although there is no scientific evidence that mouthrinses containing alcohol contribute to ______________, some patients may feel more comfortable using a alcohol free mouthrinse

inactive ingredient

An ___________________ is an additive that is necessary to make the toothpaste thick, hold together, clean efficiently, or have a particular color or flavor for consumer appeal.

active ingredient

An ___________________ is an additive that produces a therapeutic effect on either the hard or soft tissues. The terms active and therapeutic are used interchangeably.

subgingival biofilm pathogenic microorganisms antimicrobial agents

Benefits from removing loosely connected biofilm with the use of an oral irrigator also include: Reduction or alteration of ____________________ Subgingival access to _______________________ Subgingival delivery of _______________________

impact zone flushing zone

Delivery Methods When a tip is directed perpendicularly to the long axis of the tooth (as it should be used), two zones of hydrokinetic activity (motion of fluid) are created. Zone 1: _______________, where the irrigant makes initial contact Zone 2: _______________, where the irrigant is deflected from the tooth surface subgingivally

A. Monojet (single stream) B. Fractionated microjet (multiple streams) Both types of tips can be purchased in a pulsating or nonpulsating version C. proper placement of the monojet tip

Delivery Tips are Categorized According to Stream A. _______________________ B. _______________________ C. Demonstration of the ______________________________

gingival blood flow mucosal irritations

Dental researchers have now linked SLS to increased ______________________ as well as ________________________

Relative Dentin Abrasitivity

Dentifrice abrasiveness is also determined by the _________________________ (RDA) index

inactive active

Dentifrices Formulations include ____________ and _____________ (or therapeutic) ingredients

physically or chemically

Dentifrices responsible for stain removal do so either ________________ or _______________

Inactivation of the nerve membrane (hyperpolarization) Occlusion of the open dentinal tubules

Dentinal hypersensitivity management Treatment options include self-applied desensitizing agents and professionally applied desensitizing procedures and surgeries. Desensitizing agents used in treatment are classified by mode of action. (2)

Cocamidopropyl betaine (from coconut oil) Sodium N-lauryl sarcosinate Sodium lauryl sulfate (the most common, probably because it is inexpensive) Sodium lauryl sulfate

Detergents used: _____________________ _____________________ _____________________ __________________ can be an irritant It is linked to recurrent aphthous ulcers in some patients bIf this occurs, recommend a dentifrice containing cocamidopropyl betaine such as Sensodyne Pronamel or Colgate Luminous

Thymol (oil of thyme) Eucalyptol (eucalyptus oil) Menthol (peppermint oil) Methylsalicylate (wintergreen oil Listerine

Essential oils include: (4) The most familiar essential oil mouthrinse is ________________

Gingival recession Loss of enamel Toothbrush abrasion Erosion Abfraction Acidic foods Periodontal surgery Occlusal hyperfunction Cusp grinding Instrumentation Cosmetic tooth whitening

Factors that contribute to dentinal hypersensitivity

Essential oils (peppermint, wintergreen, clove, or cinnamon) Cinnamon, can cause a burning sensation, tissue sloughing, contact stomatitis, or allergic reactions Artificial noncariogenic sweeteners -Glycerol -Sorbitol -Xylitol

Flavoring agents include:

scientific evidence ADA Council on Scientific Affairs Chemotherapeutic Products

How does a mouthrinse get the ADA Seal? A company must submit __________________ that the product is safe and effective The ___________________________ evaluates the evidence according to objective guidelines In the case of a mouthrinse, the Council may use any of the following guidelines, depending on the product's intended use: ____________________________ for the Control of Gingivitis Products Used in the Management of Oral Malodor

Oxygenating oxygen permeability antimicrobial

Hydrogen Peroxide is a __________________ Agents The mechanism of action of hydrogen peroxide is the release of _____________ that acts to debride the area It alters bacterial cell membrane by increasing ________________ It has a slight _________________ effect

less effective

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

therapeutic (active) ingredients

In addition to the basic ingredients (inactive ingredients), most dentifrices also include ______________________ which target the prevention of oral disease or target a specific condition

Staining supragingival calculus taste perception soft tissues, lips, and tongue Superficial desquamation CHX 30 mins

Issues to discuss with a patient when chlorhexidine is recommended; _______________ of teeth, soft tissues, tooth-colored restorations, margins of restorations, and pits and fissures Possible increase in ______________________ formation Possibility of an altered ___________________ Minor irritation to ____________, ________, and ___________ _____________________ of the oral mucosa ________ is inactivated by sodium lauryl sulfate and some fluorides (ingredients in some toothpastes) Advise patient to wait _____ minutes after brushing before rinsing with chlorhexidine

intradental nerves

It is believed that potassium ions diffuse along the dentinal tubules to inactivate ______________________

toothbrush and an interdental aid

Mechanical disruption of biofilm using a __________________ and an _______________________ are the most widely accepted methods for oral self-care.

Preprocedural rinse periodontal debridement or surgery high risk Immunocompromised adequate self-care

Mouthrinses Active Ingredients Recommended uses: _________________________ to reduce bacterial load prior to instrumentation that produces aerosols After _______________________ or ______________ Patients who are at a _________ for dental caries __________________________ individuals who are more susceptible to infection Temporary use for individuals who do not or can not perform __________________ with mechanical devices (e.g. patients that have oral lesions from cancer Tx

subgingival flora

Mouthrinses can have beneficial affects on oral tissues but rinsing is ineffective against the _____________ because it can deliver an agent less than 2 mm into the sulcus or pocket

Chlorhexidine Gluconate (Rx) Quaternary Ammonium (OTC) Essential oils (OTC) Triclosan (OTC)

Mouthrinses therapeutic agents (4)

antibiotic premedication

Patients who require ____________________________ for dental and dental hygiene treatment should be evaluated before introducing the use of an oral irrigator.

Sodium bicarbonate (mild abrasive) Dicalcium phosphate dehydrate (mild abrasive) Calcium carbonate (moderate abrasive) Aluminum silicate (very abrasive) Alumina (very abrasive)

Physical whitening (abrasive) dentifrices contain one or more of the following: (5)

prebrushing rinse. sodium benzoate mixture / Triclosan scientific benefit ADA approved.

Plax is sold as a _____________________ It contains a detergent-_______________________ (same ingredients that are in toothpastes) and it also contains _____________. There is no ____________________ from using a prebrushing rinse. Plax is not _____________________

appropriate areas lowest gingival margin flow of solution

Procedure to Irrigate with the Soft Rubber Tip Identify ____________________ for use (e.g. specific pocket, furca, or implant) Set unit pressure on _____________ setting Direct the tip at or below the ____________________ Activate ________________ for a few seconds into designated area; stop flow and move to next designated area

low substantivity Cell death Cetylpyridinium chloride (CPC)

Quaternary ammonium binds easily to oral tissues but has _________________________ It causes the cell membrane to leak, which eventually leads to ________________ __________________________ is the most commonly used quaternary ammonium

Chlorine dioxide, essential oils, and zinc chloride Triclosan/copolymer Stannous fluoride // sodium hextametaphosphate

Reduction of Oral Malodor (Halitosis) _______________, _______________ and _______________ reduce volatile sulfur compounds (VSCs). _____________\______________ reduces oral malodor by controlling bacteria. ____________________ combined with __________________________ can reduce VSC production.

enhancing permeability

SLS affects the barrier function of skin by ______________________

sweetness

SLS temporarily diminishes perception of ___________________

Sodium Bicarbonate (neutralizes acids)

Self-Prepared Mouthwash __________________________________ ½ to 1 tsp. baking soda dispensed in 4 to 6oz of warm water

Hypertonic sodium chloride (saline solution)

Self-Prepared Mouthwash _____________________________ Reduces swelling ½ to 1 tsp. salt dispensed in 4 to 6oz of warm water

staining altered taste bitter taste

Side effects of stannous fluoride include the potential for _______________ the teeth and tissues as well as ___________________ Stannous fluoride also has a ___________

Glycerol (absorbs water) Xylitol Sorbitol High

Substances used ________________ ________________ _______________ ________ concentrations are used as binders in gel dentifrices

Listerine (OTC, over-the-counter) Chlorhexidine Gluconate (Rx, prescription)

The American Dental Association (ADA) has approved only two mouthrinses for controlling and treating plaque biofilm and gingivitis

regulatory agency safety and efficacy FDA approval cosmetic, therapeutic, or a combination cosmetic and therapeutic.

The Food & Drug Administration (FDA) is the _______________________ for oral care products. The purpose of the FDA is to ensure the ___________ and ___________ of medical and dental drugs, equipment, and devices that affect living tissue. All drugs require _________________. Rinses and dentifrices are classified by the FDA as either ______________, ________________, or a ___________________

abrasive particles in toothpaste

The Mohs scale is 10-point scale classifies minerals from softest (1) to hardest (10) and can be used to classify the _______________________.

tin ion staining

The __________ in stannous fluoride has anti-caries, anti-plaque, and anti-gingivitis effects It also causes ________________

ADA Seal of Acceptance Program voluntary

The ____________________ Program for over-the-counter products is an internationally recognized program. The program is _______________ and products are included in the program after the Council on Scientific Affairs has approved them and a license agreement between the ADA and company has been signed.

reservoir container Antimicrobial

The ____________________ usually has measurement indicators. _________________ agents (e.g. Listerine, Chlorhexidine) can be used in most irrigators.

Water cleaning/polishing agent humectant Binders Flavoring/sweetening agents detergent

The basic inactive ingredients of toothpaste include: ____________ (the main ingredient) A _____________\____________ agent (abrasive) A ________________ (retains moisture) Preservatives ______________ (thickeners) _______________\____________ agents A ________________ (foaming action)

200 250

The higher the score, the more abrasive the dentifrice The Food & Drug Administration (FDA) recommended limit is _______ The American Dental Association (ADA) recommended limit is _____

sodium fluoride sodium monofluorophosphate

The most widely used dentifrices contain a combination of _____________________ (24%) and ________________________(76%)

Anti-caries Anti-biofilm/Anti-gingivitis Anti-calculus Anti-oral malodor (Halitosis) Anti-sensitivity

Therapeutic dentifrices offer benefits in the areas of:

The abrasive capacity is too high, it will increase abrasion of tooth structure.

What's occurring ?

Cosmetic mouthrinses Therapeutic mouthrinses

What's the difference between a cosmetic and a therapeutic mouthrinse? _____________________ temporarily reduce bad breath They don't deal with the causes of bad breath because they don't kill the bacteria that cause bad breath or chemically inactivate odor causing compounds _______________________, on the other hand, can help reduce plaque, gingivitis, cavities and bad breath

Foam

___________ assists in distributing the product in your mouth.

Zinc chloride and zinc citrate

_______________ and ________________ are used alone or in combination with other anti-calculus chemicals to prevent calculus accumulation or break down calculus formation

Xylitol Streptococcus mutans

_______________ is a naturally occurring sugar substitute that has anti-cariogenic properties It reduces the levels of ______________________

Binders (Thickeners)

________________ Stabilize the formulation Prevent separation of the solid and liquid ingredients during storage Gel formulas contain more binders than pastes.

Chlorhexidine

_________________ binds to oral hard and soft tissues It attaches to and breaks the bacterial cell membrane causing the death of the cell (lyses) It also binds to pellicle to prevent biofilm accumulation The substantivity of CHX is 8 to 12 hours.

Humectants

__________________ Retain moisture in the product Prevent hardening on exposure to air

Essential oils

__________________ of spices and herbs have antibacterial and antifungal properties

Detergents

___________________ Lower surface tension (allowing water to spread out) Penetrate and loosen surface deposits Emulsify/disperse the flavor oils Contribute to the foaming action

Dentifrice

___________________ is a term used to describe a powder, paste or gel that aids in the removal of biofilm, materia alba, and stain from teeth and soft tissues.

Oral irrigation

___________________ is defined as the targeted application of a pulsated or steady stream of water or other irrigant for preventive or therapeutic purposes.

Chemical whitening

______________________ dentifrices produce the effect by changing tooth color

Strontium Chloride (a salt)

______________________ occludes (forms a barrier) dentinal tubules They are both ADA-approved ingredients to treat tooth hypersensitivity

Stannous fluoride (0.4% or 0.454%)

______________________ produces the rapid formation of a protective smear layer and the precipitation of calcium fluoride crystals, which physically block exposed dentinal tubules.

Stannous fluoride

______________________ was the 1st fluoride added to a dentifrice formulation

Potassium Nitrate

_______________________ (also a salt and a preservative) works as a nerve calming agent rather than a barrier the most effective agent for reduction of dentin hypersensitivity

Physical whitening

_______________________ occurs through abrasives that remove stain

Crest Pro-Health

________________________ Can contribute to temporary, brown tooth discoloration has an alcohol-free formulation

Sodium lauryl sulfate (SLS)

________________________ is a synthetic detergent widely used in toothpastes, personal care products and household cleaners.

Hydrodynamic Theory

_________________________ Stimuli are transmitted to the pulp surface via movement of fluid or semifluid materials found within the dentinal tubules. Nerve endings transmit the pain impulse

Power-Driven Irrigator

_________________________ The irrigant (liquid) is delivered through a hand-held interchangeable tip that rotates 360° for application at or below the gingival margin. Has an adjustable dial for regulation of pressure and flow Depending on the system, it maintains a steady flow or pulsations of liquid from a reservoir.

Pyrophosphate

_________________________ is the next most effective ingredient in reducing calculus formation This as well as flavoring agents, have been implicated in tissue sloughing and a burning sensation

Flavoring Agents (Sweeteners)

__________________________ Provide a pleasant flavor and mask the taste of unpleasant chemical compounds

Chemical whitening

__________________________ dentifrices usually contain hydrogen peroxide or carbamide peroxide

Non-Power-Driven Device

__________________________ device Attaches to a household water supply: faucet or shower Delivers water through a hand-held interchangeable tip that can be turned for application at the gingival margin Cannot control water pressure Nonpulsating flow of irrigant Efficacy (effectiveness) has not been tested in clinical studies

Cochrane Reviews

___________________________ are reviews of research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care

Sodium bicarbonate (baking soda) neutralizes abrasitivity volatile sulfuric compounds

____________________________ has been used in dentifrices in the United States since the 1830s It ___________________ bacterial acids that initiate demineralization and dental caries It has very low ____________________, but can effectively remove extrinistric stains It also inhibits ________________________ (VSCs) to reduce oral malodors

Dentinal Hypersensitivity

________________________________ Short, sharp pain arising from exposed dentin that occurs in response to stimuli, typically thermal (both hot and cold), evaporative, tactile, osmotic, or chemical, and that cannot be ascribed to any other form of dental defect or pathology.

Mohs scale

a method of comparing the hardness of minerals and created a scale using 10 minerals.

Phosphates (Dicalcium phosphate dihydrate) Carbonates (Sodium bicarbonate (baking soda) Calcium carbonate (chalk)) Silicas (the main component of sand)

three most common abrasive agents