prevention dentifrices, mouth rinses, and chewing gums quiz

preventative/ therapeutic benefits of dentifrices

• prevention of dental caries (fluoride)

• remineralization of early noncavitated dental caries

• reduction of biofilm formation

  • zinc citrate

  • stannous fluoride

• reduction of gingivitis/inflammation

• reduction of dentin hypersensitivity

• reduction of supragingival calculus formation

pyrophosphate

• leads to increased sensitivity

• common anti-tartar (reduction of supragingival calculus formation) ingredient

cosmetic effects of dentifrices

• removal of extrinsic stain

  • mechanical removal

  • delivery of bleaching agent

• look for hydrogen peroxide and carbamide peroxide as active ingredients

halitosis

• reduction of oral malodor

• certain ingredients can reduce production of volatile sulfur compounds (VSCs)

  • chlorhexidine (chx), cetylpyridinium chloride (cpc), and zinc

• stannous fluoride combines with hexametaphosphate

primary cause of halitosis

• volatile sulfur compounds that are in the environment of the mouth

• also has a direct relationship to periodontal disease

ingredients that can reduce production of volatile sulfur compounds

• chlorhexidine (chx)

• cetylpyridinium chloride (cpc)

• and zinc

• stannous fluoride combines with hexametaphosphate

evaluation of dentifrices by the FDA

• ensures safety (safe for daily use, non toxic, protects oral tissues)

• verifies effectiveness (supports therapeutic claims, proper fluoride levels)

• standardizes ingredients (approved actives, consistent formulations)

• protects consumers (accurate labeling, directions, warnings)

• prevents misleading claims (evidence-based, trustworthy products)

• safe, effective, and reliable for patient use and professional recommendation

anticaries remineralizing agents

• fluoride

• non-fluoride components: antimicrobial components that target caries pathogens

antigingivitis agent

• triclosan

• chlorhexidine gluconate (CHG)

antistain agent

• hydrogen peroxide

• sodium bicarbonate

therapeutic effects, therapeutic agents, and medicinal ingredients

• anticaries remineralizing agents

• desensitizing agents

• antiginigvitis agents

• anticalculus agents

• antistain agents

• antihalitosis agents

dentifrice adverse health effects

• some ingredients in toothpaste can affect the overall health of those who suffer from allergies or intolerances

  • for example, fluorosis when ingested during tooth development

tartar control and herbal soft tissue reactions

• erythema

• scaling and fissuring of the perioral area

• cheilitis ( long standing c. albicans infection)

• gingivitis

• circumoral dermatitis

sodium lauryl sulfate adverse effects

• most common detergent, but most common to cause mucosal desequamation or ulceration

essential oils adverse effects

• cheilitis or circumoral dermatitis

• Listerine!

antimicrobial adverse effects

• staining or soft tissue irritation

flavoring adverse effects

• allergic reactions

insoluble materials and soluble materials

• insoluble materials affect abrasiveness of dentifrice

• higher levels of abrasives >2%: remove more biofilm and acquire pellicle faster

  • disadvantage: can increase abrasion and cause hypersensitivity

relative dentin abrasivity scale

• measures the abrasiveness of most dentifrices

abrasiveness scale

• 80% of dentifrices fall below 2% on the abrasiveness scale, which means they do not risk damaging dentin or exposing cementum

• RDA scale

dentifrices

• 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 teeth

carbamide peroxide

• breaks down to form urea and hydrogen peroxide

• active ingredient in whitening toothpaste

hydrogen peroxide

• which forms a free radical that contains oxygen, which is the active bleaching molecule

• whitening toothpaste active ingredient

potassium nitrate

• is a commonly used, FDA-approved OTC

• desensitization agent

• reduces the reaction of the nerves in the teeth to stimuli such as cold and hear

• 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

stannous fluoride

• specifically the stannous ion

• has reported activity against caries, plaque, and gingivitis

triclosan

• is a broad-spectrum antibacterial agent and is no longer added to toothpastes

sugar-free chewing gum products

• contain polyol 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

rationale for adjunctive antimicrobial biofilm control

• periodontal health requires a combination of supportive periodontal therapy and daily oral hygiene efforts

• oral antimicrobial agents have a definitive adjunctive benefit for reducing plaque biofilm and gingival inflammation beyond what is accomplished mechanically

chlorhexidine gluconate

• FDA approved prescription plaque-control rinses containing 0.12% chlorhexidine

• call for 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

• in US, available ONLY by prescription

purposes and uses of mouthrinses

• self care

  • as part of personal oral self-care for specific needs

  • biofilm control

  • dental caries prevention through remineralization of noncavitated early dental caries

  • prevention of gingivitis

  • contribute to malodor control

  • posttreatment therapy following nonsurgical periodontal therapy

self-applied modes of delivery

• Chlorhexidine gluconate (CHX) (long viewed as gold standard of therapeutic mouth rinses)

• essential oils

• cetylpyridium chloride (CPC)

essential oils

• components of plants that contain phenolic compounds that destroy microorganisms by compromising cell membrane and inhibiting enzyme activity

• effective in controlling plaque and gingivitis because the oil alters the bacterial cell wall

cetylpyridium chloride

• mouth rinses that have antimicrobial properties

Quaternary ammonium compounds (CPC)

• use: OTC rinses for plaque and gingivitis

• action: disrupts cell membranes; decreased adhesion

• adverse: mild staining, increase in calculus, taste changes

povidone-iodine

• use: antiseptic, preprocedural rinse

• action: release iodine→ broad-spectrum antimicrobial

• adverse: allergy risk, thyroid concerns, irritation

sanguinarine (Sane-gwen-a-rine)

• plant-derived (bloodroot plant)

• use: rinse/toothpastes for plaque and gingivitis

• action: antimicrobial; disrupts cell membranes

• adverse: burning, irritation, leukoplakia risk