Dentifrices

Dentifrices

Learning Objectives

• Explain the purpose of a dentifrice and the types of effects it produces.

• Discuss the process of selecting the right dentifrice, including its role in demineralization and remineralization.

• Describe the roles of medicinal and nonmedicinal components in dentifrices.

• Explain the concept of bioavailability.

• Debate the possible adverse oral health effects of dentifrices.

• Explain the impact of the pH level of dentifrices.

• Recommend dentifrices appropriate for unique patient needs and risk factors.

• Delineate the legal and ethical responsibilities of dental hygienists regarding dentifrices.

Purpose of a Dentifrice

• Dentifrice or toothpaste: A substance used with a toothbrush or other oral hygiene device to clean the teeth, tongue, and gingiva.

• Delivers cosmetic and therapeutic agents to the teeth and oral environment.

• Effects:

  • Cosmetic

  • Hygienic

  • Therapeutic

Choosing a Dentifrice

• Many types exist for different purposes:

  • Nonfoaming to low-foaming: For use with power toothbrushes or children.

  • Ingestible: For persons with special needs.

  • Free of preservatives, sodium lauryl sulfate, dyes: For persons who are allergic.

  • Fluoride: To prevent caries and remineralize teeth.

  • Amorphous calcium phosphate: To remineralize teeth and add luster.

  • Antibacterial: For controlling plaque and gingivitis.

  • Antisensitivity: To control dentinal hypersensitivity.

  • Salivary enzymes and lubricants: For dry mouth.

Potential for Toothpaste Tube Cross-Contamination

• The opening of the tube can be a source of cross-contamination.

• Permits the transmission of infectious diseases such as:

  • Hepatitis B

  • Gastroenteritis

  • The common cold

  • The flu

• Each family member should have his or her own tube of toothpaste.

Forms of Dentifrices

• Powder

• Liquid gel

• Gel

• Foaming gel

• Gel/paste

• Tablets

Components of Dentifrices

• Toothpastes are complex formulas of medicinal and nonmedicinal ingredients that must be compatible to be effective.

• Medicinal ingredient:

  • Produces a therapeutic or beneficial effect on either the hard or soft tissues.

  • May be beneficial but not necessarily therapeutic.

• Nonmedicinal:

  • Necessary to make the toothpaste thick, hold together, clean efficiently, or have a particular color or flavor.

Abrasives

• Five common dentifrice abrasives:

  • Phosphates

  • Carbonates

  • Silicas

  • Aluminum compounds

  • Other substances

• Example structure:

  • NH

  • HO-P-O

  • O

  • OH OH

More Components of Dentifrices

• Humectants: Used to retain moisture and ensure stability of product.

• Water: 5% to 30% of dentifrice.

• Preservatives: Inhibit mold and bacterial growth and prolong shelf life.

• Binders: Thickeners prevent separation of ingredients.

• Detergents: Foaming agents to loosen debris and stains.

• Flavoring and sweetening agents: Provide refreshing flavors and aftertastes.

• Coloring agents: Dyes.

• Therapeutic agents (medicinal agents): Have preventive, treatment, or beneficial purposes.

Therapeutic Effects, Therapeutic Agents, and Medicinal Ingredients

• Anticaries remineralizing agents:

  • Fluoride

  • Nonfluoride components

  • Antimicrobial components that target caries pathogens

• Desensitizing agents

• Antigingivitis agents:

  • Triclosan

  • Chlorhexidine gluconate (CHG)

• Anticalculus agents

• Antistain agents:

  • Hydrogen peroxide

  • Sodium bicarbonate

• Antihalitosis agents

Bioavailability

• Occurs when the medicinal agent is stable during storage and biologically active when used in the mouth to achieve the desired therapeutic effect.

• Cocamidopropyl betaine increases the bioavailability of fluoride ions.

• Factors that affect bioavailability include:

  • Type of fluoride

  • A pH of less than 6

  • The presence of sodium lauryl sulfate (SLS)

Dentifrice: Adverse Health Effects?

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

• Fluoride: fluorosis when ingested during tooth development

• Soft-tissue reactions:

  • Tartar control and herbal: erythema, scaling and fissuring of the perioral area, cheilitis, gingivitis and circumoral dermatitis

  • Sodium lauryl sulfate: mucosal desquamation or ulceration

  • Essential oils: cheilitis or circumoral dermatitis

  • Antimicrobial: staining or soft-tissue irritation

  • Flavoring: allergic reactions

Ingredients of Dentifrices

• 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, cause hypersensitivity

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

• The Relative Dentin Abrasivity (RDA) Scale measures the abrasiveness of most dentifrices

Dentifrice pH

• The pH of a dentifrice can be beneficial or detrimental to dental structures by interfering with or supporting the remineralization process.

• The majority of dentifrices have a neutral pH

• Advantages of low pH include the formation of fluorapatite crystals

• Disadvantages of a pH of less than 6.5 include the erosion of dentin and cementum on exposed root surfaces; these dentifrices can also tarnish titanium implants and affect sealants and composite restorations

Recommending Dentifrices to Patients

• Comparing dentifrices is important so that available products can be recommended with confidence

• A patient who uses peroxide- containing toothpaste daily increases his or her risk of tooth surface erosion over time

Loss of Tooth Structure

• Results from diverse causes such as:

  • Type of dentifrice used

  • Frequency of brushing

  • Toothbrush filament hardness

  • Pressure during brushing

  • Direction of brush strokes

  • Manual or powered toothbrush

  • Surface substrate being brushed

  • Insufficient amount of salivary flow or constituents

Related Legal and Ethical Responsibilities

• Assess the patient’s health, dental, and pharmacologic histories before making a particular dentifrice recommendation

• Consider the patient’s assessed needs and expectations as well as product evidence

• Recommend products approved by the ADA or the CDA and that contain ingredients that have been approved by the U.S. Food and Drug Administration

• Document recommendations in the patient’s record

• Many types exist for different purposes:- Nonfoaming to low-foaming: For use with power toothbrushes or children. - Ingestible: For persons with special needs. - Free of preservatives, sodium lauryl sulfate, dyes: For persons who are allergic. - Fluoride: To prevent caries and remineralize teeth. - Amorphous calcium phosphate: To remineralize teeth and add luster. - Antibacterial: For controlling plaque and gingivitis. - Antisensitivity: To control dentinal hypersensitivity. - Salivary enzymes and lubricants: For dry mouth.