DENTAL AND ORAL PRODUCTS

DENTAL ANATOMY :

Enamel : crystalline calcium salts (hydroxyapatite) cover the crown

to protect the tooth. Dentin : largest part

of the tooth beneath the enamel and protect pulp.

Cementum : bone-like structure, cover the root and provide the attachment

of the tooth with periodontal ligaments.

Pulp : consists of free nerve endings.

1- DENTAL CARIES :

Def. : formed by growth and implantation of cariogenic microorganisms.

Causes:1-Bacteria : produce acids (lactic

acid) that demineralize enamel.2-Diet: food with high concentration

of sugar.

Common dental problems & OTC Products

OTC Products :- ONLY help to alleviate the pain until visiting the Dentist !Ex: Lidocain ,, benzocain ,, Or Oral analgesics : -Acetaminophen -Aspirin

2- Plaque and calculus: Causes :- Plaque: sticky substance formed by the attachment of

bacteria to the pellicle which is thin , cellular glycoprotein.

- Calculus: substance formed when plaque is not removed within 24 hr. (calcium salts ppt from saliva ).

And only can be removed by professional dental cleaning!

OTC Products :1-Toothbrushes:- Soft , rounded , nylon bristles..if Hard

can be irritant to gum.- Must get changed every three months.

2-Irrigating devices :Types: (a) Pulsating (low and high pressure

water steam)(b) Steady (constant water pressure )- Ex. Hydro-pik oral irrigator

3-Dental Floss :- Available waxed , non-waxed , thick ,thin,

flavored or unflavored..- May be coated with additives such as baking

soda and fluoride .- Selection of dental floss depend on tightness of

tooth contact.- Ex. Oral –B .. Johnson & Johnson

4- Dentifrices : products that enhance the removal of stains and dental plaque by toothbrushes…Include :

(a) Toothpastes: - Decrease dental caries, mouth odor &

enhance personal appearance. INGREDIENTS:1-Abrasives : responsible for removing

plaque - Ex. silicates , sodium bicarbonate,

Dicalcium phosphate , calcium carbonate …ect

2-surfactants : foaming agent and removing debris

Ex. SLS … Sensodyne doesn’t contain SLS.

3- humectants : prevent preparation from drying ex. glycerin.

4-falvoring agent: saccharin.

5-suspending agents: add thickness to product

Ex. Gum tragacanth 6-fluoride : is an anticariogenic..form

fluorapatite on the enamel which is harder, less soluble and more acid resistant.

- MOST beneficial if used from birth through age 12 or 13

- fluoride is toxic in 5-10mg\kg…Acute fluoride toxicity causes nausea vomiting and diarrhea.

- Max concentration approved in toothpaste is 260 mg per container.

(b) Cosmetic whitening agents :- MOST IMPORTANT ingredient : 10 %

carbamide peroxide (ex. Gly-oxide).. And hydrogen peroxide (ex.

Crest whitestrips)- Possible risks: alteration of normal flora , tissue damage , tooth sensitivity , gingivitis and potentiation of carcinogenic effects. (c) Desensitizing agents: reduce the

pain in sensitive teeth caused by cold , heat , acids, sweets ..should be non-abrasive

- Eg : 5% potassium nitrate compounds

(d) Mouthwashes : contain astringents , demulcents ,detergents , flavors, germicidal agents and fluoride. FOR :

1- cosmetics purposes : freshen the breath , non-therapeutic.

- Most popular that contain medicinal phenol & mint .

2-antiplaque: contain the same active ingredients

as Anticalculous dentifrices.- Ingredient :(i) cetylpyridinium chloride (CPC) : for plaque and gingivitis. Eg. Cepacol , oral – B (ii) chlorhexidine : Eg. Colgate PerioGard.- Staining is a result for long use.

(e) Dental Gums: Uses: - Reduce plaque , whiten teeth , reduce the

risk of tooth decay . Freshen breath - Inc. salivary flow so produce beneficial

buffering effect against acids- May contain baking soda as mild abrasive

cleaner & neutralize acid.- Calcium help to prevent cavities in the teeth.- Also Contain Xylitol.- Not a substitute for brushing and flossing.

3- Gingivitis:

Def. : Inflammation of gingiva that may appear larger in size

Causes : microorganisims that damage cellular and internal tissue

**chronic may be localized or generalized which bleed when brushed.

OTC products:- anesthetics (eugenol or

benzocaine) (eg Orajel)- Mouthwashes and Gargles- Acetaminophen (oral analgesic)- Seek the advice of dentist!

4- Lesions: Lesions can occur on any

nonkeratinized mucosal surface in mouth , appear gray to yellow with erythematous halo of inflamed tissue.. Persist 7-14 days and heal without scarring.

OTC.. Protectants , local anesthetics & wound-cleansing agents.- To control the pain & shorten duration of current lesions and prevent new

lesions.

(1)Protectants : Orabase , dental adhesives & benzo tincture .

(2)Local anesthetics : benzocaine (5%-20%) or butacaine or Benzyl alcohol (0.05%-0.1%) or Menthol (0.04%-2%)

Eg. Orajel ,Benzodent , Zilactin-B

5- Dental Adherents: - Contain ( karaya gum , pectin , Mc) that swell

gel and become viscous to promote adhesion so increase denture attachment to underlying soft tissue ..

Disadvantages: long use leads to soft tissue deterioration .. And provide medium for bacteria and fungal growth ..

** Daily use not recommended ..Eg Fixodent .. ORAfix .. Sea-Bond and Effergrip.

Pharmacist’s responsibilities to patient using these products :(1) Refer the patient to a dentist in

serious cases.(2) patients should be informed about

how to use recommended products .. The duration of use , the expectation of using the product.

(3) if a nonprescription product doesn’t improve a condition or if worsens you should disconnect the use of product and dentist should be contacted.