Dentifrices and Mouthrinses Flashcards
dentifrices (toothpaste) is used for
removal of biofilm, stain, and other soft deposits
application of therapeutic agents
superficial cosmetic effects
preventive and therapeutic benefits of dentifrices
prevent of dental caries
reduction in biofilm formation
reduction in dentin hypersensitivity
remineralization of early non-cavitated dental caries
reduction in gingivitis/inflammation
reduction in formation of supragingival calculus
first caries-preventive toothpaste contained
stannous fluoride
fluoride enhances
remineralization
agents used to reduce biofilm formation
triclosan
zinc citrate
stannous fluoride
what is the primary agent in reducing gingival inflammation
triclosan
reduction of dentin hypersensitivity
chemical occlusion of dentinal tubules and desensitization of the nerve
potassium nitrate and sodium fluoride
reduction in supragingival calculus formation tarter-control agents include
pyrophosphate salts
zinc salts (chloride and citrate)
sodium hexametaphosphate
cosmetic effects of dentifrices
removal of extrinsic stain
reduction of oral malodor (halitosis)
removal of extrinsic stain
mechanical removal of stained biofilm
delivery of bleaching agent
reduction of oral malodor
ingredients can temporarily reduce malodor by inhibiting production of volatile sulfur compounds
CHX
triclosan/copolymer
stannous fluoride and sodium hexametaphosphate
basic components of dentifrices: inactives
detergents
cleaning and polishing agents
binders
humectants
preservatives
flavouring agents
detergents
foaming agents or surfactants
lower surface tension
penetrate and loosen surface deposits
suspend debris for easy removal by toothbrush
emulsify/disperse the flavor oils
contribute to foaming action
cleaning and polishing agents
abrasives
cleans without damaging tooth surface
produces a smooth tooth surface
binders
thickeners
stabilizes the formulation
prevents the solid and liquid ingredients from separating during storage
humectants
retain moisture
prevent hardening on exposure to air
preservatives
prevent bacterial growth
prolong shelf life
flavouring agents
sweeteners
impart a pleasant flavor for patient acceptance
mask other ingredients that may have a less pleasant flavor
active components of dentifrices and what benefits in what areas
fluoride
provide benefits in areas of:
anticaries
antibiofilm/antigingivitis
anticalculus
malodor
antisensitivity
considerations for the pediatric patient
from birth to eruption of first tooth:
clean gingiva with soft infant toothbrush or with a wet cloth
eruption of first tooth:
brush 2x daily using fluoridated toothpaste and soft, age-appropriate toothbrush, use rice-sized amount until 3 years old
2-5 years old:
use a pea-size amount of toothpaste, perform or assist child, avoid swallowing excess toothpaste
patient-specific dentifrice recommendations
patient’s current oral condition
any patient complaint/concern
sensitivities or allergies to a specific ingredient
propensity of staining
patient’s nontherapeutic/cosmetic choices
expectation of compliance
purpose and use of mouth rinses
supplement mechanical aids
may have preventive, cosmetic, or therapeutic benefits
chemotherapeutic rinses may reduce inflammation
therapeutic rinses have healing properties
deliver an agent less than 2mm into the sulcus or pocket
functions of chemotherapeutic agents
remineralization
antimicrobial: biofilm control, gingivitis reduction
astringent: shrink tissues
anodyne: alleviate pain
buffering: reduce oral acidity
deodorizing: neutralize odor
oxygenating: cleansing
preventive and therapeutic agents of mouthrinses
fluoride
CHX
triclosan
phenolic related essential oils
quaternary ammonium compounds
oxygenating agents
oxidizing agents
stannous fluoride
deposits fluoride ions on enamel
tin ion from the stannous fluoride interferes with cell metabolism
has an antimicrobial effect
sodium fluoride
deposits fluoride ions on enamel
inhibits demineralization and enhances remineralization
fluoride availability and use
prevention of demineralization
reduction of hypersensitivity and of gingivitis
fluoride efficacy
reduction in biofilm and dental caries when used topically by patient
fluoride considerations
instruct patient not to swallow it
tooth staining
chlorhexidine mechanism of action
binds to oral hard and soft tissues
attaches to bacterial cell membrane and damages the cytoplasm
binds to pellicle and salivary mucins to stop biofilm from accumulating
depending on the concentration chlorhexidine can be either
bactericidal or bacteriostatic
chlorhexidine is an _______ and an ________ agents
antimicrobial
anti-gingivitis agents
chlorhexidine substantivity
8-12 hours
CHX availability and use
most effective antimicrobial and antigingivitis agent available
CHX recommended uses
preprocedural
before, during, after debridement
patients at high risk of dental caries
immunocompromised patients
post surgery
CHX efficacy
safe and effective in:
preventing formation and reducing viability of biofilm
preventing gingivitis
reducing mutans streptococci
CHX varnish reduces caries in these groups
children
xerostomia patients
patients undergoing ortho
root caries
triclosan mechanism of action
effective against both gram-negative and gram-positive bacteria
bisphenol and non-ionic antimicrobial agent
acts on microbial cytoplasmic membrane
CHX considerations
low level toxicity
staining of teeth
increase in supragingival calculus formation
altered taste perception
minor irritation
triclosan is an ______ and an _______ agent
antimicrobial and an antigingivitic agent
triclosan has low
toxicity
triclosan availability and uses
reduction of biofilm and gingivitis
reduced accumulation of biofilm
reduced formation of supragingival calculus
triclosan efficacy
reduces biofilm and bleeding on probing
triclosan considerations
easily released from the oral tissue-binding sites
when combined with PVM/MA there is an increase in substantivity and efficacy
phenolic-related essential oils mechanism of action
disrupts the cell walls and inhibits bacterial enzymes
decreases pathogenicity of biofilm
is an antimicrobial and antigingivitis agent
phenolic-related essential oils availability
a combination that includes thymol, eucalyptol, menthol, and methyl salicylate for clinical use
phenolic-related essential oils recommended use
patients who are unable to perform adequate brushing and flossing
use to help improve oral hygiene
can be used in adjunct for mechanical self-care routines
as a preprocedural rinse to reduce bacteria available to aerosols
phenolic-related essential oils efficacy
significant reduction in biofilm and gingivitis
phenolic-related essential oils considerations
burning sensation
bitter taste
poor substantivity
efficacy is based on patient following the manufacturer’s instructions
contraindicated for alcoholics
quaternary ammonium compounds mechanism of action
cationic agent that binds to oral tissues
ruptures cell wall –> alters cytoplasm
strong initial attachment then quickly releases
decrease ability of bacteria to attach to pellicle
low substantivity
quarternary ammonium compounds most common agent
CPC (0.05-0.07%)
quarternary ammonium compounds recommended use
reduction in accumulation of biofilm
use adjunct to mechanical self-oral care routine
quarternary ammonium compounds efficacy
weak evidence for reduction in biofilm and gingivitis
possible inhibition of formation of calculus
quarternary ammonium compounds considerations
staining of teeth and tongue
burning sensation and desquamation
oxygenating agents mechanism of action
alters bacterial cell membrane
poor substantivity
oxygenating agents most common agents
10% carbamide peroxide and 1.5% hydrogen peroxide
oxygenating agents recommended use
short-term use to reduce symptoms of periocoronitis and NUG
oxygenating agents efficacy
very small antimicrobial effect
debriding agent
oxygenating agents considerations
do not consistently prevent the accumulation of plaque biofilm short term
when used long term, some reduction in gingival redness has been recorded
some reports of erosive changes on oral mucosa
oxidizing agents mechanism of action
neutralization of volatile sulfur components
oxidizing agents common agents
chlorine dioxide and chlorine dioxide/zinc combination
oxidizing agents efficacy
management of halitosis
oxidizing agents consideration
diluted sodium hypochlorite used as a mouthrinse 2x/week showed reductions in BOP, biofilm, and inflammation
commercial mouthrinses active ingredients
usually contain more than one active ingredient, therefore may advertise multiple claims for use
factors that may influence how effective an agent is
dilution by the saliva
length of time the agent is in contact with the tissue or bacteria
evidence supporting the product
commercial mouthrinses inactive ingredients
water: largest %
alcohol: enchances flavour, increases solubility of active ingredients, 18-27%
flavouring: essential oils and derivatives, aromatic waters, artificial sweeteners
contraindications of mouthrinse
can enhance a patient’s oral self-care regime but is not intended to replace mechanical brushing or flossing
some cannot be given to children under 6 years old
patients with physical or cognitive challenges
check manufacturer’s instructions
oil pulling
swish with 10 mL of sesame oil
reduces biofilm
reduces bacteria
purpose of the FDA
regulate drugs, equipment and devices
some devices are exempt, including dental water syringe, power and manual toothbrushes and floss
dental products regulated include
infection control products
ultrasonic instruments
diagnostic test kits
prosthetic and restorative materials
surgical and periodontal materials
prescription drugs, controlled sustained release devices, chemotherapeutics
for dentifrices and mouthrinses, the FDA has
reviewed individual active ingredients and outlines permissible levels of those ingredients and statements that product labels must have
purposes of the ADA/CDA program
helps public and dental professionals make informed decisions regarding dental products
evaluate products for safety and efficacy when used as directed
inform dental teams and the public about the safety and efficacy of accepted products
maintain connections with regulatory agencies and professional research organizations
information required from the ADA company
a complete list of ingredients
data from clinical trials that support the product is safe and effective when used correctly
compliance with the specific product category
acceptance and use of the ADA Seal
any claims of product effectiveness on labeling in advertising must first be approved by the ADA Council
must be accompanied by an ADA-approved seal statement
statement tells consumer what claims have been reviewed and approved
documentation of dentifrice and mouthrinse
recommended dentifrice and mouthrinse
patient instructions: amount, frequency, usage
summary of current findings
factors to teach the patient
significance of ADA product acceptance seal
how to avoid impulse buying dental products
why chemotherapeutics are not a substitutes for daily biofilm removal
to ask about new dentifrices and mouthrinses
to understand the relationship between compliance and expected outcomes
to check ingredients of mouthrinses to prevent the purchase of high-alcohol content
