Ch 28 Dentifrices and Mouthrinses Flashcards
Chemotherapeutics
What can inflammation cause
Who can administer chemotherapy
=reduction of inflammation in oral cavity
-Increased inflammation associated with diabetes can make patient more susceptible to periodontal disease, also linked to heart diseases and several others
-Oral pathogens can travel to lungs can cause healthcare associated pneumonia
-Chemotherapeutics can be administered by clinician or patient
Dentifrices
Benefits may be preventative, therapeutic or cosmetic (superficial for cosmetics)
Preventive and Therapeutic Benefits of Dentifrices (6)
- Prevention of dental Carie’s
- Remineralization of Early Noncaviated Dental Caries
- Reduction of Biofilm Formation
- Reduction of Gingivitis/Inflammation
- Reduction of Hypersensitivity
- Reduction of Supra gingival Calc Formation
Prevention of Dental Carie’s
Stannous fluoride was problematic bc of lack of compatibility with abrasive agents (1st 1995)
Xylitol anticaries benefits
Remineralization of Early Noncaviated Lesions
Fluoride enhances Remineralization
Reduction of Biofilm Formation
**Agents used
-Triclosan
-Zinc Citrate
-Stannous Fluoride
Reduction of Dental Hypersensitivity
Chemical occlusion (**potassium nitrate and sodium fluoride) of the dentinal tubules and nerve desensitization are most effective
Reduction of Supra-gingival Calc Formation
“Tartar control”
Contain:
Pyrophosphate Salt
Zinc Salts (chloride and citrate)
Sodium Hexametaphosphate
Cosmetic Effects of Dentifrices
- Removal of Extrinsic Stain
-food, tobacco, chemicals imbed in acquired pellicle and biofilm
Based on mechanical removal and bleaching agent - Reduction of Oral Malodor (Halitosis)
-reduce on temp basis by inhibiting production of Volatile Sulfate Compounds (VSC)
-Chlorhexidine (CHX), cetlypyridinium chloride (CPC) and zinc formulations beneficial via reduction of VSCs
-Stannous fluoride + sodium Hexametaphosphate reduce VSCs
Basic Components: Detergents (Foaming Agents)
Lower surface tension (make surface slick)
Substances used: sodium lauryl sulfate USP, sodium N-lauryl sarcosinate
Basic Component: Cleaning and Polishing Agents (Abrasives)
Abrasives Used
Silica, silicates, hydrated silica gels
Calcium carbonate
Dicalcium phosphate
Sodium Bicarbonate
Basic Components: Binders (Thickeners)
Stabilize formation and prevent separation
Used:
Mineral colloids
Natural gums
Seaweed colloids
Synthetic cellulose
Basic. Components: Humectants (Moisture Stabilizers)
Prevent hardening
Used
Xylitol
Glycerol
Sorbitol
Basic Components: Preservatives
Prevent bacterial growth and prolong shelf life
Used
Alcohol
Benzoates
Dichlorinated Phenols
Basic Components: Flavoring Agents
Pt acceptance, mask other ingredients
Used
Essential oils
Artificial noncariogenic sweeteners (xylitol glycerol and sorbitol)
Active Components of Dentifrice
First active ingredient was fluoride
Anitbiolfilm=Stannous fluoride and zinc citrate
Anti calc=tetrapotassium pyrophosphate, tertasodium pyrophosphate, sodium Hexametaphosphate and zinc compounds
Desensitizer=potassium nitrate, potassium citrate, potassium chloride, Stannous fluoride and strontium chloride
Oral malodor=essential oils, chlorine dioxide, Stannous fluoride/Hexametaphosphate
Selection of Dentifrices
-To prevent
-Considerations for pediatric patient?
What type of Recommendations?
Prevention or Reduction of oral disease
Ped Pt -
eruption of first tooth, “smear sized” or rice
2-5 years: pea sized
Patient Specific Recommendations
-current oral condition
-complaint or concern
Sensitivies
Compliance
Etc
Mouthrinses
How far into the pocket?
Used as what?
Chemotherapeutics reduce what?
**deliver the agent less than 2mm into the pocket/sulcus
Should only be a supplement
Chemotherapeutics reduce inflammation
Functions of Chemotherapeutic Agents (7)
Remineralization
Antimicrobial (biofilm control, gingival health)
Astringent (shrinks tissues)
Anodyne (alleviate pain)
Buffer (reduce acidity)
Deodorize
Oxygenate (cleanse)
Purposed and Uses of Mouthrinse (2)
Before Professional Tx
-lower bacterial load and reduce aerosols
Self Care
-biofilm control
-prevent cavities
-contribute to malodor control
-post tx therapy
Fluoride
Mechanisms of action ?
Stannous-tin oxide which interfere with cell metabolism
Sodium-cariostatic inhibits demineralization/enhances Remineralization
Chlorhexidine
- Mechanism of action
- Availability and recd uses
- Reduces ______ ______
- Considerations (side affects)
- Some research suggests it interacts and inactivated by ___. Rinse should be performed immediately ____ brushing.
- Broad antibacterial activity, binds to oral hard & soft tissue, cell lysis or interferences, substantivity=8-12hrs
- Available by prescription in 0.12% or higher in US. For typical uses plus immunocompromised and susceptible to infection
- Mutants streptococci
- Stains teeth, increase in Supra Calc formation, altered taste
- Sodium lauryl sulfate (in toothpaste). After brushing
Triclosan
No substantivity-easily released from tissue
Reduced Supra gingival calc
Phenolic Related Essential Oils
Specific example
Disrupt what
Considerations
Listerine
Disrupt cell wall
Burning sensation, not for current or recovering alcoholics due to alcohol content
Quaternary Ammonium Compounds
Action
Uses
Considerations
Low substantivity
Rupture cell walls and alter cytoplasm
Agent in CPC , reduce biofilm, adjunct for self care
Weak evidence of gingival, biolfim reduction
Stains , burns, sloughing (desquam)
Oxygenating Agents
Actions
Common agents in commercial rinses
Short or long term to reduce periocoronitis and NUG
Considerations ( issues with product )
Alters bacterial cell membrane INCREASES permeability
Poor substantivity
10% carbamide peroxide and 1.5% hydrogen peroxide
Only short term use
Doesn’t consistently prevent biofilm and can be erosive mucosa
Oxidizing Agents
Action
Agents are
Neutralizes VSCs that contribute to oral malodor
Chlorine dioxide and chlorine dioxide and zinc combo
Dilute 0.25 to 0.5 sodium hypochlorite used as mouth rinse reduces BOP, biofilm and gingival inflammation
Commercial Mouth rinse Ingredients :
Active-influence how affective an agent can be
Inactive
Pt Specific Recs
Diluting saliva, length of time in contact with tissue/ bacteria
Water makes up largest volume
Alcohol-increase solubility of actives, preserve, ENHACE FLAVOR
Flavoring-oils, aromatic water, sweetener
Uses as substitute? Contraindications, xerostomia could be worsened
FDA:
Rinses and dentifrices are classified as
Dental product regulation
Cosmetic, therapeutic or combo
Infection control, ultrasonic instruments, diagnostic kits, prosthetic and restoratives, surgical/periodontal, prescriptions, chemo
Clinical trial
Larger sample who have disease condition
Large with disease do test efficacy, side effects
20-80
100-200
1k to 3k
ADA is for ___ products
Its _^___
Acceptance for __ years
OTC
Voluntary
5
