dentirifices, mouth rinses and hard tissue examination POHC

dentifrice components

•Surfactant/Detergents

•Cleaning/polishing agents (abrasive)

•Binder

•Humectant

•Flavoring

•Preservative

•Water

•Therapeutic agent

detergents prupose

to lower surface tension and penetrate and loosen surface deposits

•Emulsifies debris for easy removal -Eg.sodium lauryl sulfate USP. MOST COMMON DETERGENT FOUND. MAKES FOAM. Some pts sensitive to it so some dentrifices don't have it.

-Sodium N-lauryl sarcosinate

Sodium lauryl sulfate (SLS) is the most widely used detergent

-Stable -Possesses some antibacterial properties - Has a low surface tension, which facilitates the flow of the dentifrice over the teeth May cause tissue sensitivity or reaction

abrasives clean and polishing agents smoothe the tooth surface

The degree of dentifrice abrasiveness depends on the inherent hardness of the abrasive, size of the abrasive particle, and the shape of the particle

The ADA evaluates US commercial toothpaste formulas and assigns them an abrasiveness rating or relative dentin abrasivity.

The higher the number the more abrasive. • The ADA certifies any toothpaste the has a RDA of 250 or less while the FDA prefers 200 or less.

• The most common types of abrasives used are

carbonates, phosphates, aluminum oxide and silicas • Examples: in the toothpaste ingredients these are the abrasives: - Calcium carbonate - Calcium pyrophosphate - Dicalcium phosphate - Silica - Silicates - Silica gels

Binders (thickeners). You want tp to be homogenous! Binder helps that

• Prevents separation of solid and liquids during storage

• Binders need to be stable, nontoxic - Examples:

▪ mineral colloids

▪ Seaweed colloids - (organic colloids require preservatives to prevent microbial growth)

▪ Synthetic celluloid

▪ Natural gum

Humectants ( to study think humidity) •Purpose to retain moisture and prevent hardening on exposure to air

•Stabilizes the preparation

-Examples: ▪ Glycerin ▪ Sorbitol ▪ Propylene glycol

Humectants can cause mold growth, and thus, preservatives such as sodium benzoate are added to prevent their growth

• Prevents bacterial growth

• Prolongs shelf life

• Examples: - Alcohols - Benzoates - Formaldehyde - Dicholorinated phenols

Flavoring/Sweetening Agents • To give product a pleasant flavor

Essential oils (peppermint, cinnamon, wintergreen, clove) - Artificial sweeteners

▪ aspartame, saccharin

▪ Xylitol

▪ Glycerol

▪ sorbital

therapeutic dentifrices: Chemical plaque control compounds are used to supplement the usual brushing, flossing, and use of auxiliary aids employed in mechanical plaque control

Stannous fluoride, specifically the stannous ion, has reported activity against caries, plaque, and gingivitis

▪ Deposits fluoride ion on enamel or in carious lesion

▪ Tin interferes with cell metabolism (antimicrobial)

▪ It causes a staining but they added an ingredient to combat this in stannous flouride containing toothepastes, and generally not for kids

Chemical plaque control compounds are used to supplement the usual brushing, flossing, and use of auxiliary aids employed in mechanical plaque control (continued, this is another chemical plaque control compound)

Triclosan is a broad-spectrum antibacterial agent, trade name Irgacare. Banned from soap now so idk if still in tp. Its essentially an antibacterial

▪ Recommended as an antigingivitis dentifrice

▪ Reduction in supragingival biofilm formation

▪ Reduction in gingival inflammation

Potassium nitrate is a commonly used, FDA-approved OTC desensitization agent,

it reduces the reaction of nerves in the teeth to stimuli such as heat and cold.

•Known to desensitize the nerve by penetrating through the length of the dentinal tubules and to depolarize sensory nerve endings located at the dentin- pulpal interface

Whitening toothpastes generally use either

- Carbamide peroxide, which breaks down to form urea and hydrogen peroxide

-Hydrogen peroxide, which forms a free radical that contains oxygen, which is the active bleaching molecule. More often seen in whitening tps.

mouth wash

traditional method for stabilizing and delivering many pharmaceutically active agents

Zinc chloride found in some mouth rinses has gained momentum in its efficacy claims for

reducing malodor in patients with good oral health. zinc chloride is effective in neutralizing volatile sulfur compounds (VSC) and killing the gram-negative bacteria responsible for VSC formation for greater than 3 hours

The FDA has approved prescription plaque-control rinses containing 0.12% chlorhexidine but its ONLY AVAILABLE BY PERSCRIPTION IN THE USA

•Directions call for a twice-daily, 60-second rinse with one-half ounce of such solutions

•Chlorhexidine has proved to be one of the most effective anti-plaque agents to date

•Substantivity - 8-12 hours

•Antimicrobial and antigingivitis agent

•Chlorhexidine is a cationic compound that...

binds to the hydroxyapatite of tooth enamel, the pellicle, plaque bacteria, the extracellular polysaccharide of the plaque, and especially to the mucous membrane.

chlorhexidine absorbed to the hydroxyapatite is believed to inhibit ...

bacterial colonization and prevent pellicle formation. chlorhxidine is also •Bactericidal and bacteriostatic

•High substantivity

•Its downside is it causes staining

•CHX is inactivited by SLS.....wait 30 minutes after brushing before rinsing

CHX side effects

-Staining of the teeth, tongue, and tooth-colored restorations are the most common effects

- Increase in supragingival calculus, unsure why

-Altered taste sensation, irritation of the oral mucosa, and burning sensation are reported

•It is reported that essential oil mouth rinses are effective in controlling plaque and gingivitis because the...

oil alters the bacterial cell wall (antigingivitis/antimicrobial). Poor substantivity aka it doesn't last really long

(CPC) The most common quaternary ammonium compound used in mouth rinses is

cetylpyridinium chloride found in Scope, Cepacol, Crest Pro Health.

• This compound is a clinically studied bactericidal agent that interacts with the bacterial cell membrane and, through cellular pressure, weakens and disrupts the membrane to effectively kill bacteria

• some issues are Staining, burning and supra calculus (most pt shouldnt have these issues but some will uncommonly)

flouride mouth rinses

•They are intended for daily or weekly use, depending on their categorization as lowconcentration/high-frequency or highconcentration/low-frequency rinses

flouride mouth rinses

are highly indicated for patients who have a history of moderate-to-rampant caries, who are undergoing orthodontia or who wear prosthetic appliances

Oxygenating Mouth Rinses

•Alters cell membrane

•Oxygen acts to debride area

•Poor substantivity doesn't last long it oxygenates then its done

•Rx short term use

sugar free products

•Contain sweeteners such as sorbitol or xylitol. These sweeteners are not broken down by plaque or oral microorganisms to produce acid

•Xylitol is considered non-acidogenic and not fermentable by bacteria responsible for caries production

•Dentifrices, mouth rinses, and chewing gums are categorized ...

•Use of therapeutic fluoride dentifrices and mouth rinses is ...

•FDA has developed rigid ...

1. as either cosmetic or therapeutic

2. credited with helping to reduce the prevalence of dental decay

3. guidelines for testing the safety and efficacy of products

demineralization is

Dissolution of calcium and phosphate ions from the hydroxyapatite crystals of the tooth by bacteria (acid producing bacteria)

Bacteria uses carbs as energy source, ...

produces acid that dissolves minerals (calcium and phosphate) in the tooth.

remineralization• Healing process in which minerals are redeposited in the demineralized tooth structure.

• Accomplished by protective factors in saliva (and fluoride) - Saliva buffers acids (pH rises) - Supplies minerals to replace minerals - Source of fluoride transport

actions of flouride:

• Inhibits demineralization -

• Enhances remineralization -

• Fluoride interferes with the enzymatic ...

1. Fluoride passes into enamel - Increased fluoride in subsurface prevents continuation of demineralization.

2. Minerals in saliva go back into tooth for remineralization

3. requirements of bacteria accomplished by action of fluoride.

4 steps of multifactorial disease process

1. There must be a susceptible tooth and host

2. Cariogenic microorganisms must be present in a sufficient quantity

3. There must be frequent excessive consumption of refined carbohydrates, causes acidic environment. Meals > snacking because lower ph. Gives us hours to remineralize

4. This process must occur over a sufficiently long period of time

criteria for carries development

Susceptible tooth surface

• Mineral content of tooth (Fl)

• Morphologic characteristics (depth of pits/grooves)

• Malpositioning (more plaque retention)

• Any tooth surface constantly covered by plaque

Cariogenic Bacteria, specifically referring to strep mutans and lactobacilli

• Acidogenic (acid producing)

- Strep. Mutans -produces high amounts of acid, adheres well to tooth surface

- Lactobacilli

• Plays a role in the spread of caries. More active during progression of caries.

• Does not cause drop in pH to start process

• Found in greater number in more advanced smooth lesions.

• Acid producing and acid tolerant.

• Mutans streptococci and caries

- Considered to be the major pathogenic bacterial species involved in the caries process

- Usually found in relatively large numbers in the plaque that forms immediately over developing smooth-surface lesions (i.e. most active during initial stages of demineralization and cavity formation)

- Transmitted after birth from mother

carcinogenic foods

• Carbohydrates-

• Glucose

• Fructose

• Sucrose

• Cooked starch

Acidogenic bacteria in plaque ferment simple sugars into lactic acid

- Sucrose, dextrose > lactic acid

- Pass rapidly through channels in enamel and exposed root

- Acid is held in contact with tooth, pH drops, critical acidic level is 5.5 and below

contributing factors and salivary factors

• Quantity ingested

• Frequency of ingestion***

• Time of ingestion try to confine to mealtime; oral pH is 6.2- 7; takes 1-2 hours to return to normal

• Salivary Factors

- Amount of saliva

- Viscosity/thickness of saliva (thick, ropy saliva associated with higher caries activity)

- Buffering capacity

- Antibacterial properties & mineral content (facilitates remineralization process and strengthen tooth surface)

enamel caries formation Phase One - incipient lesion (enamel, early, white spot lesions)

- Earliest stage of caries development

- Subsurface lesion

- This stage can be arrested and reversed.

enamel carries formation Subsurface demineralization

•Cariogenic bacteria (s. mutans)

•Acid production

•Pass thru enamel rods (pores)

•Acid dissolves thru pellicle

•Appears as a white or yellow to tan spot

•Surface is relatively intact

Enamel Caries Formation Phase Two - untreated lesion

- Enamel continues to breakdown

- Spreads to DEJ, along dentinal tubules

- Can feel irregularity with explorer

classification of carries

Number of affected surfaces

• Simple (1 surface)

• Compound (2 surface)

• Complex (3 + surfaces)

TQ! GV BLACKS I-VI

Class I -occlusal

• Class II -proximal posteriors

• Class III -proximal anteriors

• Class IV -proximal anterior plus incisal

• Class V -cervical 1/3

• Class VI -incisal/ occlusal edge

TQ! 5 types of carries not classes

• Simple enamel caries

• Rampant caries (acute) - Rapidly progressive decay; numerous large lesions; requires immediate attention

• Early Childhood Caries(baby bottle) - Bottle Mouth; Baby Bottle Syndrome

• Recurrent Decay (secondary) - Decay that reoccurs

• Arrested Decay - Areas of beginning decay but recalcified/remineralized

TQ! developmental defects: enamel hypoplasia

Enamel Hypoplasia - Defect occurs as a result of a disturbance in the formation of the organic enamel matrix.

- Amelogenesis imperfecta-enamel hypoplasia which is inherited. Having no associated systemic defect. Varies according to clinical appearance.

tooth damage: attrition

- Excessive wear of incisal/occlusal surfaces due to tooth to tooth contact. can cause a Wear facet

Tooth Damage • Abrasion

- Mechanical wearing away of tooth structure by forces other than mastication

Tooth Damage • Erosion

- Chemical wearing away of tooth structure. Does not involve known bacterial action. - Max ant lingual teeth effected by bulimia

Fractures and Dislocations of Teeth

• Usually caused by trauma; sports, auto, bike accidents, fights

• Universal classification system to identify fracture.

TQ! class I-V of tooth fractures

• Class I-Enamel fracture only

• Class II-Crown involved

• Class III-Crown and Pulp

• Class IV-Crown and root at neck of tooth

• Class V-Root Fracture

Dislocations of Teeth • Avulsion

-Complete displacement of tooth

Dislocations of Teeth due to trauma: intrusion and extrusion

• IntrusionTooth forced down into the socket.

• ExtrusionTooth partially displaced out of socket.

TQ! 6 detection methods for caries

• Visual exam - transillumination

• Radiographic exam

• Instrumentation for occlusal grooves

• Caries indicating dye

• Fluorescence

• Sopro camera