Oral care products Flashcards
What is a caries
It is a cavity which is characterized as a progressive lesion on tooth
What are some symptoms of caries
see lesion
sensitive to stimuli
continuous pain with difficulty chewing if lesion invades dental pulp
can progress to abscess and toothloss
What are some causing factors of caries
carbohydrates in diet
oral bacteria
orthodontic appliances
xerostomia
medications
radiation therapy
tobacco product use
alcohol use
immune system dysregulation
when would you not self-treat a caries
symptoms of a toothache
visualized lesion
entire tooth discoloration
bleeding, swelling or reddened gums
persistent mouth odor despite regular use of fluoride toothpaste
What is the goal of caries prevention
prevent or control dental plaque
What is the difference between plaque and calculus
plaque is fresh/soft deposit on teeth that can be removed by brushing
calculus is a harder form of plaque and must be removed by professional cleaning
What are symptoms of gingivitis
inflamed gingiva
may progress to periodontal disease
What are some causes of gingivitis
accumulation of bacterial plaque
medications
reduced saliva flow
tobacco
pregnancy
When should you not self-treat gingivitis
swollen gums
gums that bleed with brushing or flossing
receding gums
gums that are darker red
What are goals of therapy when preventing gingivitis
prevent calculus formation
remove and control supragingival plaque
What non-pharmacologic options can be done to prevent caries and gingivitis
chewing sugarless gum for at least 20 minutes after a meal
brushing teeth
flossing at least once a day
T or F: waxed dental floss may help promote plaque build up between teeth
false
Do probiotics help with gingivitis
yes there is a possible benefit however there are so many formulations, strains and concentrations to consider when looking at probiotics
What does vitamin D help with
adequate vit D during pregnancy can reduce caries in children
What are some OTC treatment options for plaque management
fluoride
toothpastes
mouthrinses
How often should you go get a professional dental cleanings done
every 6 months
what was the first mouthrinse on the market
listerine
How should adults be using toothpaste
they should apply a pea sized amount
How often should adults brush their teeth
twice a day
what type of toothbrush should be used and how often should it be changed
soft bristle and changed every 3-4 months
what type of toothpaste should be used by both adults and children
flouride-containing
At what age should children start brushing their teeth
when teeth start erupting
How much toothpaste should children use
if younger than 3, size of a grain of rice
if older than 3, size of a pea
What can happen if too much fluoride is used
flecks/stripes or brown spots on teeth, enamel pits
if too much is ingested, can be toxic
What is the MOA of dentrifices
act directly on oral bacteria or disrupt plaque components to aid in mechanical removal
What are the 3 functions of dentrifices
help remove plaque and stain
reduce bacteria
enhance personal appearance
What are the categories of ingredients in dentrifices
abrasive
humectant
sweetener
surfactant
binder/thickener
flavor
anticaries activity agent
What is considered a low abrasive
silica abrasive
what is a mild abrasive
baking soda
what is a high abrasive
dicalcium phosphate
calcium carbonate
what can happen if a medium or high abrasive is used for too long
can wear away enamel
What are the 3 types of fluoride used
sodium fluoride
sodium monofluorophosphate
stannous fluoride
What do sodium fluoride and sodium monoflurophosphate work
it remineralizes and strengthen weakened enamel, reduce gingivitis, reduce sensitivity
What does stannous fluoride do
does same as other 2 fluorides and adds protective layer over teeth to prevent plaque
slight tooth staining if used continuously for 2-3 months(can be removed at professional cleaning)
What are the common ingredients you see in plaque control mouthrinses
aromatic oils
antimicrobials
phenol
What are cautions you should take with mouthrinses
mouth ulcers or irritation
alcohol content issues(poisoning or oral cancer)
Why should you keep mouthrinses out of reach of children
Only 5-10 ounces can kill children
What adverse effects can occur with the use of mouthrinses
occasional burning
irritation of oral mucosa
may cause sloughing of oral epithelium
How do you use mouthrinses
Swish 1-2 tablespoons for 30 seconds and then spit
When is mouthrinse most effective
Most effective before brushing except if the toothpaste contains fluoride, then use after
How long should you avoid eating or drinking after using a mouthrinse
for 30 minutes
How does gum remove plaque from teeth
Increases saliva flow
mechanical removal of plaque/debri
What is halitosis
bad breath caused by volatile sulfur compounds (VSC)
What are the causes of halitosis
Medications(TCAs, first-gen antihistamines, oxybutynin, meclizine, Parkinson’s meds)
Kidney/liver failure
Cancer
Ketosis(keto diet)
Poor oral hygiene
Xerostomia
Foods/beverages(garlic or onions especially)
tobacco
When should you not self-treat halitosis
medical conditions associated with halitosis
persistent halitosis despite good oral hygeine
What can you do to prevent halitosis
remove cause if possible
brushing and flossing and tongue brushing
Chemical mechanisms(zinc salts reduce receptor binding for VSCs; chlorine dioxide breaks disulfide bonds, oxidizes VSC precursores)
What are some causes of tooth hypersensitivity
- exposure of dentin
- injury to mouth or lips or with RAS or herpes simplex labialis
3.nerve pain of face, facial herpes zoster, cluster headaches
What are some symptoms of tooth hypersensitivity
short and stabbing/sharp pain
reactions to thermal, chemical or physical stimulus to exposed dentin or open tubule
When should you not self-treat hypersensitivity
toothache
mouth soreness associated with dentures
fever or swelling
loose teeth
bleeding gums
broken teeth
severe tooth pain started or worsened by hot, cold, or chewing
trauma to mouth
HAVE NOT previously been diagnosed with hypersensitivity
What are our goals of therapy when treating tooth hypersensitivity
repair damaged tooth surface via appropriate toothpaste
correct inappropriate brushing technique
What are complementary and non-pharmacologic options to help tooth hypersensitivity
-stop triggers(acidic foods, aggressive toothbrushing)
-avoid toothbrushing within 30-60 minutes of acidic foods/drinks
-correctly brushing teeth with fluoride toothpaste
What are some OTC treatment options of tooth hypersensitivity
standard toothpaste with fluoride
potassium nitrate 5% in fluoride-containing toothpaste
What is the mechanism of action of Potassium nitrate 5% and fluoride in toothpaste
depolarizes nerves in tubules and pulp to block perception of stimuli; seals exposed dentin
What is the mechanism of action of Arginine 8% and calcium carbonate toothpaste
Depolarizes the nerves in tubules and pulp to block perception of stimuli
What is a recurrent aphthous stomatitis
canker sore or aphthous ulcer
What causes RAS
unknown for most patients
some triggers such as stress, food allergy, gluten sensitivity, hormonal changes, genetic predisposition
systemic diseases
Where do canker sores develop
Only occur in the mouth on moveable mouth surfaces on nonkeratinized tissues
How long can canker sores last
between 5-14 days
When should you not self-treat a canker sore
if there is an underlying cause
lesions present 14 days or more
frequent recurrence
symptoms of systemic illness
self-care ineffective
What are the goals of therapy for RAS
- relieve pain and irritation
- heal lesions
- be able to eat/drink and do usual oral care
- prevent secondary infection
- prevent recurrence
What non-pharmacological things can be done to prevent/help with RAS
correct any undiagnosed nutritional deficiencies
avoid food allergy triggers
avoid spicy/acidic foods if active lesions
avoid textured foods that can irritate lesions
apply ice to lesions for 10 minutes(max of 20 minutes in an hour)
DIY salt water rinses
What is the follow up recommendation when using standard toothpaste with fluoride and a soft bristled brush
If hypersensitivity has resolved, then continue regimen
If not, switch to a desensitization toothpaste and use for 14 days
What is the follow up recommendation after using a desensitization toothpaste for 14 days
If hypersensitivity has resolved, switch to regular toothpaste
If not resolved, dental referral
What pharmacologic therapies are available to treat RAS
Topical
1. oral debriding and wound cleansing agents
2. topical oral anesthetics
3. topical oral protectants
oral rinses
Systemic
1. analgesics
What is the follow up recommendation when self-treating RAS
See provider if 7 days of treatment or 14 days since lesion/s first appeared
*could be indicative of underlying issue
What is the dosage and administration of carbamide peroxide 10-15% in anhydrous glycerin
Place drops of carbamide peroxide or hydrogen peroxide and apply for 1 minute
-OR-
Place drops on tongue and mix with saliva and swish for 1 minute
What is the dosage and administration of Hydrogen peroxide 3%
DIY
mix 50:50 hydrogen peroxide 3% and water
swish for 1 minute
What is the dosage and application of sodium perborate monohydrate
dissolve powder in 1 oz of water and use right away
What is the dosage and administration of sodium bicarbonate
DIY
make baking soda paste and apply
Expectorate
How often can you use the oral debriding and wound cleansing agents and for how long?
up to 4x a day for 7 days
What are some side effects that can occur
mouth tissue irritation
short-term tooth hypersensitivity
black hairy tongue
What are the 3 most common topical anesthetics used for RAS treatment
benzocaine 5-20%
butacaine sulfate 0.05-0.1%
dyclonine 0.05-0.1%
How do barrier protectants help with RAS
- protect
- decrease friction
- provide temporary relief
What are some rinses you can use to treat RAS
listerine
saline rinse
What is the etiology of minor oral mucosal injury/irritation
dental procedures
accidental injury: biting tongue/cheek, abrasion from shar foods
What are the goals of therapy when treating minor oral mucosal injury
- control discomfort
- aid healing
- prevent secondary bacterial infection
What are some non-pharmacologic therapy options for minor oral mucosal injury/irritation
sodium bicarb rinse
saline rinse
apply ice to area for 10 minutes(max 20 minutes in an hour
What are some pharmacotherapy options available for minor oral mucosal injury/irritation
- topical analgesics and anesthetics
- oral protectants
- oral debriding/wound cleansing
- astringents
When should you refer a patient who is experiencing minor oral mucosal injury/irritation
symptoms persist after 7 days of treatment or 10 days of initial injury
symptoms worsen during treatment
symptoms of infection develop(fever, redness, swelling)
What causes herpes simplex labialis(HSL)
herpes simplex viruses
CMV
Epstein-barr virus
What are some symptoms of HSL
-burning, itching, tingling, numbness in future lesion location
-small red papules of fluid-filled vesicles
-inflamed border
-crust on top of mature lesion
-spontaneous healing over 10 days
Who should not self-treat HSL
-the lesions have been present for 14 or more days
-increased outbreak frequency
-symptoms of infection
-no prior cold sore(may not be HSL)
What are we looking at when treating HSL? (goals of therapy)
- relieve pain and irritation
- prevent secondary infection
- prevent spread of lesions
What are some complementary options a person might consider when self-treating HSL
-keep lesions clean
-wash hands
-avoid sharing utensils and drinking vessels
-moisturize involved skin(petroleum jelly)
-avoid triggers that slow healing
-facial/lip sunscreen if sun is trigger
-tea tree oil, lysine and lemon balm
What OTC treatment options are available to treat HSL
topical skin protectants
external analgesics
docosanol 10%
What is the mechanism of action of docosanol 10%
inhibits fusion of the virus to cell membrane
prevents viral replication
**can reduce duration and severity of HSL symptoms
If you are using docosanol 10% to treat HSL, what should you avoid applying as well
placing aspirin tablet on lesion
hydrocortisone (inhibits natural healing)
astringents
zinc sulfate
What is the dosing of docosanol 10%
apply 5 times a day starting at first sign of symptoms and go until lesion is healed.
max of 10 days of use
What is xerostomia
dry mouth
What is the etiology of xerostomia
-health conditions(sjogrens, depression, etc…)
-radiation therapy
-medications(first-gen antihistamines, decongestants, diuretics, TCAs, antipsychotics, sedatives)
-excessive alcohol consumption
-tobacco use
-excessive caffeine use
-mouth-breathing
What are some presenting symptoms of xerostomia
-dry mouth
-difficulty talking, swallowing
-mouth sores
-halitosis
-altered taste, loss of appetite
-tooth hypersensitivity
-caries can happen over time
When should someone not self-treat xerostomia
-tooth erosion/decay
-candidiasis
-gingivitis
-decreased denture-wearing time
-mouth soreness due to dentures
-fever or swelling
-loose teeth
-broken teeth
-severe tooth pain worsened by hot, cold or chewing
-mouth trauma
-sjogren syndrome
What are our main goals of therapy when treating xerostomia?
-relieve discomfort and symptoms
-reduce risk of dental decay
-prevent and treat associated infections
What non-pharmacologic options are recommended for xerostomia
-avoid tobacco/caffeine/hot spicy foods/alcohol
-adjust or change causative meds if possible
-limit sugary food intake
-limit acidic food intake
-chew gum with sugar alcohol
-increase water consumption
-cool mist humidifier in home
-very soft bristled toothbrushes
What OTC treatment options are available to someone with xerostomia
artificial saliva products
** should reevaluate after 5-7 days of therapies
What is the mechanism of action of artificial saliva
mimics natural saliva
*acts as a replacement, not a cure
What is cheilitis
severe dry skin on or around lips
What is the etiology of cheilitis
- dry or cold weather
- excessive sun exposure
- frequent licking of lips
- food sensitivity
- personal car products(lip balm, lipstick, toothpaste, mouthwash, sunscreen)
- medications(retinoids)
- health conditions (eczema, crohn’s disease, nutritional deficiencies)
What are the 5 steps of prevention and treatment of cheilitis
- avoid licking/peeling/biting/exfoliating lips or surrounding skin
- protect lips with quality lip balm prior to lipstick/gloss
- hydrate: drink water, humidify air
- avoid irritants
- breathe through nose rather than mouth
What ingredients should you look for in quality lip balms
beeswax, petroleum jelly, dimethicone
How many coats of lip balm should be applied during the day
apply 6-8 coats through out the day and 1 coat at bedtime
