Dentifrices and Mouthrinses

The prevention and control of oral disease depends on:

controlling bacterial plaque and biofilm

Although the total elimination of bacterial plaque biofilm is unrealistic

a reasonable approach is to prevent disease through methods that reduce bacterial plaque to a level below the individual’s threshold for disease

Mechanical Therapy:

• Involves the physical removal of plaque, calculus, and bacteria

• Includes techniques such as toothbrushing, interdental care, and professional dental hygiene treatment

• Limitations: requires patient compliance and may not reach all areas of the mouth, particularly deep periodontal pockets.

Chemotherapy:

• Chemotherapy in dentistry refers to the use of chemical agents to prevent or treat oral diseases

• It includes the use of antimicrobial agents such as mouth rinses, gels, or local drug delivery systems containing antibiotics or antiseptics.

• Chemotherapy aims to reduce the bacterial load in the oral cavity, especially in areas where mechanical cleaning is difficult.

• Benefits: It can complement mechanical therapy by targeting bacteria that are not easily reached by mechanical means, potentially improving the overall effectiveness of treatment.

• Limitations: Overuse of antimicrobial agents can lead to bacterial resistance, and they may not be as effective as mechanical therapy in removing plaque and calculus.

Mechanical therapy focuses on….. while chemotherapy uses …..

physically removing plaque and calculus / chemical agents to target bacteria

Both mechanical therapy and chemotherapy approaches play important roles in….

preventing oral diseases, and a combination of both may be recommended for optimal oral health

Two major organizations in the United States—the U.S. Food and Drug Administration (FDA) and the American Dental Association (ADA) Council on Scientific Affairs contribute to

ensuring the safety and efficacy of oral chemotherapeutics

FDA:

The FDA checks that prescription drugs and OTC products claiming to treat illnesses are safe and effective

ADA Seal of Acceptance:

• Products approved by the FDA may apply to receive the ADA Seal of Acceptance, which is granted to those products that demonstrate therapeutic efficacy in accordance with published criteria:

1. “Supply data from independent laboratory and clinical studies that supports the product’s safety and effectiveness”

2. “Submit ingredient lists and pertinent product information”

3. “Provide evidence that manufacturing facilities meet FDA standards”

• The ADA’s Council on Scientific Affairs then review and evaluate these products. ADA charges manufacturers $14,500 to evaluate their products. If a product is approved, the ADA will charge a yearly $3,500 fee (must re-apply every 5 years)

• The absence of a seal does not mean that the product is not safe and effective; it implies the company did not obtain, or possibly apply for, approval.

• ❗Toothpaste cannot be approved unless it contains fluoride

Local delivery methods:

are those in which the agent is applied directly to the oral cavity

Systemic delivery methods:

are those that are ingested and delivered via the bloodstream

The active ingredient:

refers to the agent, chemical, or drug component within a particular delivery system that is responsible for the therapeutic improvement

Toothpaste: The active ingredient represents approximately _%- _% the dentifrice’s formulation

1.5-2

Toothpaste exhibits either _____ _____, which means that they kill microbes directly, or ______ ______, which means that the metabolism or reproduction of the microbe is affected

bactericidal activity, bacteriostatic action

Pediatric Considerations with Toothpaste:

• Parents can brush twice daily using fluoridated toothpaste once first tooth erupted

• Use a very small “smear” or rice-sized amount of toothpaste to brush the teeth of a child less than 3 years of age

• A “pea-sized” amount of toothpaste for children over 3 years of age

• Children should be supervised until they are able to adequate removal plaque biofilm, spit out toothpaste, and not swallow excess toothpaste during brushing

Mouthwash:

• Rinsing can deliver an agent less than 2 mm into the sulcus or pocket and is not a delivery of choice for patients with moderate or deep pockets

• Effectiveness is also impacted by (1) dilution by saliva and (2) length of time the agent is in contact with the bacteria/tissue

• Substantivity—ability to be released over a period of time

Alcohol and Mouth rinse:

• According to the FDA, the ADA, and the National Cancer Institute, there is no evidence of a causal relationship between alcohol-containing rinses and oropharyngeal cancer.

• The risk of oropharyngeal cancer related to alcoholic beverages appears to be associated with urethane

• Ethanol, which is found in oral rinses, has not been demonstrated to be carcinogenic

• Alcohol is not significantly associated with either the perception of oral dryness or actual salivary flow. Xerostomic individuals do not appear to have an increased sensitivity to alcohol-containing rinses.

• ⚠Alcohol-containing oral rinses may be contraindicated for some individuals with other conditions (e.g., recovering alcoholics) and for individuals taking certain antibiotics, in whom gastrointestinal upset may occur.

Inactive Ingredients-Detergents:

suspend debris; contribute to foaming

Inactive Ingredients-Abrasives:

remove plaque and stains and produce smooth tooth surface

Inactive Ingredients-Binders:

stabilize formulation; prevent separation

Inactive Ingredients-Humectants:

retain moisture, prevents hardening on exposure to air

Inactive Ingredients-Preservatives:

prevent microbial growth, prolong shelf life

Active Ingredients-Stannous Fluoride

Antibacterial, anti-gingivitis, anti-sensitivity, may cause staining

Active Ingredients-Sodium Fluoride and Potassium Nitrate:

Reduce dentinal hypersensitivity

Active Ingredients-Zinc Salts:

Help reduce calculus formation

Substantivity:

Ability of an agent to bind and release over time (e.g., chlorhexidine).

Active Ingredients-Chlorhexidine

High substantivity 8-12 hours; bactericidal and bacteriostatic; reduces gingivitis; may stain, increase calculus formation, taste altered, may irritate soft tissues

Active Ingredients-Cetylpyridinium chloride:

Helps manage halitosis (bad breath)