DENTAL PRODUCTSCourse Title : Inorganic Pharmacy-IICourse No.: PHR 107

Course Teacher : Shahana Sharmin

Dental Products

• Dental products are the pharmaceutical preparations widely used in dentistry for the following aspects – • To prevent dental carries as anticarries

agent• To clean & polish teeth.• Bringing freshness to the mouth• Reducing the sensitivity of the teeth to

hot & cold.• To prevent various periodontal disease.

Structure of teeth

• A teeth is composed of four distinct structural components. They are –

a.Enamel

b.Cementum

c.Dentin

d.Pulp & pulp cavity

Structure of teeth

Structure of teeth

• Enamel : • It is a hard, glistening substances

that covers the crown of the teeth.• It consists of 96-98% mineral, with

water and organic material composing the rest.

• Enamel's primary mineral is hydroxyapatite, which is a crystalline calcium phosphate.

• The normal color of enamel varies from light yellow to grayish white.

Structure of teeth

• Cementum : • Cementum is a specialized bony

substance covering the root of a tooth.It is approximately 45% inorganic material (mainly hydroxyapatite), 33% organic material (mainly collagen) and 22% water.

• Cementum is excreted by cementoblasts within the root of the tooth and is thickest at the root apex.

• Its coloration is yellowish and it is softer than either dentin or enamel.

Structure of teeth

• Dentin :• Dentin is the substance between enamel

or cementum and the pulp chamber. • It is secreted by the odontoblasts of the

dental pulp. The formation of dentin is known as dentinogenesis.

• The porous, yellow-hued material is made up of 70% inorganic materials, 20% organic materials, and 10% water by weight.

• Dentin is a mineralized connective tissue with an organic matrix of collagenous proteins.

Structure of teeth

• Pulp & pulp cavity :• The dental pulp is the central part of the tooth

filled with soft connective tissue.• This tissue contains blood vessels and nerves

that enter the tooth from a hole at the apex of the root.

• Along the border between the dentin and the pulp are odontoblasts, which initiate the formation of dentin.

• Other cells in the pulp include fibroblasts, preodontoblasts, macrophages and T - lymphocytes.

• The pulp is commonly called "the nerve" of the tooth.

Role of oral hygiene

• Practice of oral hygiene plays two major roles :• Maintenance of personal confidence in

appearance & social contacts.• Prevention of dental carries &

periodontal diseases.• The primary purposes of oral

hygiene is to reduce or counteract the effects of bacterial population which causes malodor, staining & periodontal diseases.

Dental diseases

• There are several types of dental diseases, they are • Dental pellicle• Dental plaque• Dental calculus (tartar)• Periodontal disease (gingivitis)• Dental stain• Dental hypersensitivity• Oral malodor

Dental disease

• Dental pellicle :

• After a teeth has been thoroughly cleaned within a minute to hours, a dental pellicle, a film that deposits selectively from saliva, covers the tooth. Bacterial mass adheres to this film & stain, when exposed to chromogenic materials.

• Dental pellicle consists of glycoproteins selectively absorbed from saliva. Pellicle may hinder penetration of substances from plaque to enamel.

• Treatment : Tooth brushing alone is inadequate to remove pellicle, it may be removed through abrasion. A thorough polishing or using a dental burr can remove the pellicle

• Dental Plaque :• Dental plaque is a whitish soft accumulation of bacteria & their

substrate which deposits on the teeth while not cleaned adequately.

• Plaque Formation : • A pellicle derived from the saliva or gingival fluid first forms on

the teeth. This pellicle is a thin, clear cuticle & is composed mainly of glycoproteins.

• Very soon after its formation, bacteria of the coccus type (streptococci largely) are attached to the pellicle which has a sticky surface, i.e. one which enables colonies of organisms to be anchored. These organisms divide & form colonies.

• Attachments of micro organisms is further enhanced by the production of dextrans by the bacteria as by-products of metabolic activity. Later other types of organisms are attached to the mass & a dense mixed flora of filamentous forms. i.e. plaque results.

• Plaque may attach to the teeth supragingivally, or subgingivally in the gingival crevice, or in periodontal pockets.

Dental disease

Dental disease• Types of Dental Plaque :• There are two types of dental plaque –

• Supragingival plaque : Grow above the gum line or gingiva.

• Subgingival plaque : Grow below the gum line or gingiva.• Reasons for plaque formation :

• Saliva composition• Nature of bacterial flora• Dietary habit• Oral hygiene habit• Genetic characteristics• The existence of specific diseases state & the use of

medicines.• Compositions of plaque :

• The microorganisms that form the biofilm are mainly Streptococcus mutans and anaerobes, Examples of such anaerobes include fusobacterium and actinobacteria.

• The extracellular matrix contains proteins, long chain polysaccharides and lipids.

• Dental Calculus (Tartar) :• Calculus has been defined as an adherent calcifying or

calcified mass that forms on the tooth surface. If the plaque is not removed, the cover becomes hard & ultimately calculus is developed. The formation is explained as a hard mineralized dental plaque with crystal of calcium phosphate, covered with a layer of vital non-mineralized plaque. Actually, plaque undergoes maturation to form calculus. In terms of its location it can be classified as –

• Supragingival calculus • Subgingival calculus• Supragingival calculus : If the calculus grow above the

gum line or gingiva, it is known as supragingival calculus. It is explained as a hard mineralized with crystals of various calcium phosphates covered with a layer of vital non-mineralized plaque. Supragingival calculus arises from the nucleation of calcium phosphate, particularly in areas where the large salivary gland ducts secret their saliva.

Dental disease

• Subgingival calculus : It grows below the gingiva & is defined as an organic structure of microorganisms & intermicrobial matrix, containing major amounts of crystalline calcium phosphate, different in amount & distribution from those of supragingival calculus. Subgingival calculus of octacalcium phosphate, brushite, whitlokite & hydroxyapatite. It has a major amount of whitlokite & a reducing amount of brushite compare to supragingival calculus.

• Composition of Calculus :• It consists of organic matrix (20%) & Inorganic portion

mainly containing – • Calcium Phosphate• CaCO3 (less amount)• Mg3(PO4)2 • Trace minerals

• Ca3(PO4)2 crystals in both type of calculus consists of • Octacalcium phosphate (OCP)• Brushite• Whitlokite• Hydroxyapatite.

Dental disease

• Periodontal disease :• It is characterized as a family of chronic

inflammatory infections affecting the supporting tissue of dentition.

• Modern periodontal therapy is based on the fact that supragingival plaque causes gingivitis which is the precursor of the more advanced periodontal breakdown arising from subgingival and apical extensions of bacterial plaque.

Dental disease

Dental disease• Stages in periodontitis :• Bacterial plaque forms at the gingival margin

if not removed , it spreads The bacteria generate toxin that inflame the soft gum tissue resulting

soft, puffy & red followed by bleeding

Inflammatory process is A periodontal pocket form aggravated

Pocket is enlarged & forms the receptacles for subgingival plaque bacteria, debris & exudates.

Surrounding connective tissue degenerates pocket continue to deeper & teeth starts to loosen

Microbial plaque toxins & others The gums recede from the tooth materials in the pocket intensify the crownsinflammatory process, supporting bonetissue is destroyed & the teeth loosen & eventually fall out or extracted.

Stages of periodontitis

• Dental Stain :• The tooth stains accumulated by a significant number of

individuals are extrinsic in nature & results from discoloration of pellicle & or plaque. It is the formation of color on teeth surface.

• Cause of dental stain formation :• Usually tea, wine, tobacco, smoke, other pellicle reactive

color materials, oral use of anti microbial agents are responsible for dental stain formation.

• Mechanism of dental stain formation :1. Extrinsic staining may involve at least three mechanism – 2. The production of colored substances in plaque by

chromogenic bacteria.3. The retention of colored substance either by dietary factors

passing through the oral cavity from smoking.4. The formation of colored products from the chemical

transformation of pellicle components.

Dental disease

• Dental Hypersensitivity :

• Dental or cervical hypersensitivity is experienced by some individuals after their roots are exposed by gingival recession or surgical or other periodontal treatment. The condition called dentinalgia, which is characterised by pain when the exposed dentin is subjected to – • Thermal• Osmotic• Electrical or • Dehydrating stimuli

• Treatment :• Desensitizing agents (SnCl2, KNO3, di-basic Na-

citrate) have succesfully been incorporated into dentifrices for the treatment of dental hypersensitivity.

Dental disease

• Oral malodor :• Oral malodor is mainly caused by the putrefaction of

sulfur containing protein substances, predominantly by gram –ve bacteria.

• The fermentation process release H2S gas & methyl mercaptan, di-methyl sulfide & di-methyl disulfide. The mouth air also contains aliphatic & aromatic alcohols & indole.

• Mouth air & putrefying saliva from persons with periodontal disease show higher than normal levels of S-compound.

• Control of oral malodor : • Oral malodor can be controlled by various oral

hygiene practice. Most of the H2S & methyl mercaptan in periodontal dentitis free individuals derive from the dorso – posterior surface of the tongue & can be considerably reduced by tongue brushing, tooth brushing & use of a oral rinse that reduces oral bacterial populations.

Dental disease

Dental Products

• Products used for dental disease are of three types –

• Antiplaque agents• Dentifrice

• Anticaries

Antiplaque agents

• Antiplaque agents are the agents or drugs that are used to prevent or inhibit plaque formation in the mouth, e.g. Chlorhexidine, Povidone iodine etc.

• Ideal properties of an Antiplaque agents :• It should be non-toxic, non-allergic and non-

irritating.• It should have a broad spectrum of antimicrobial

activity.• It should specifically affect only the pathogenic

flora.• It should not have any induced drug resistance.• It should have an acceptable taste.• It should possess sufficient chemical stability.• It should be of low price and available.

Antiplaque agents - Chlorhexidine

• Properties :

1. It is a chlorophenyl bisbiguanide that has been used as the acetate and more commonly the gluconate salt in mouth rinses, gels and dentrifices for control of plaque and gingivitis.

2. It is highly cationic antiseptic.

3. It has fungicidal activity and bactericidal action against both gram +ve and gram -ve microorganism.

Antiplaque agents - Chlorhexidine

Antiplaque agents - Chlorhexidine• Mechanism of Actions :• Due to its high cationic nature chlorhexidine binds the anionic

groups on the bacterial surface, i.e. Phosphate group of teichoic acid in gram +ve bacteria and phosphate group of lipopolysaccharides in gram –ve bacteria.

• When the bisbiguanide binds to the organism, the cell membrane becomes permeable allowing the cytoplasmic contents to leak out of the cell. At higher concentration chlorhexidine causes precipitation of cytoplasmic proteins.

• By virtue of their cationic properties the bisbiguanide also bind electrostatically to the hydroxy-apatite of teeth and forms a pellicle (film or surface) against plaque and to buccal mucosa. This is how it acts as an anti-plaque agent.

Antiplaque agents - Chlorhexidine

Use of Clorhexidine :1. Mouth rinse

• 0.12% chlorhexidine gluconate solution is used as a mouthwash for oral hygiene and oropharyngeal infections, especially apthous ulcers.

• 0.2% chlorhexidine gluconate solution prevents the accumulation of plaque. It is absorbed onto tooth enamel, where it exerts a persisting action to decrease the growth of dental plaque.

2. Irrigator • 400 ml of a 0.02% solution of chlorhexidine (80mg

totally) applied once daily in an oral irrigator will give complete plaque inhibition.

3. Gels• 1% gel of chlorhexidine gluconate applied for a

period of five minutes, once or twice a day is effective in the inhibition of bacterial plaque specially in the treatment of denture stomatitis.

Antiplaque agents - Chlorhexidine

Use of Chlorhexidine (cont..) :4. Antiseptics

• 4% aqueous solution of chlorhexidine is effectively used as a surgical scrub, it decreases the cutanous bacterial population more than either hexachlorophene or povidone iodine.

Precaution before use :1. Chlorhexidine rinses should be performed

after meals to minimize taste alteration.

2. Patients should not rinse with water following a chlorhexidine rinse.

Antiplaque agents - Chlorhexidine

Side effects or adverse reaction :

1. The most common side effects of chlorhexidine is the formation of staining or an extrinsic yellowish or brownish discoloration of the tooth surface and gum. Stain may appear on the natural teeth, artificial teeth & composite filling.

2. It has an unpleasant bitter taste & may cause irritation to the oral mucosa & disturbance in the taste buds.

3. Regular use of it may sometimes block the salivary duct of the parotid gland & lead to painful condition.

4. Local tissue damage may occur if the drug is applied to absorbed epthelium.

5. Hypersensitivity reaction may occur in some individuals.

Antiplaque agents – Povidone Iodine

• Properties :1. Povidone-iodine is a stable chemical complex of

Polyvinylpyrrolidone (PVP) & elemental iodine. It shows broad spectrum germicidal action & acts as bactericide. It is effective in dilute solution & does not develop resistance in microorganisms.

2. It is safer & easier to use than classic iodine preparations & has low systemic toxicity.

3. Unlike iodine solutions, it does not cause pain when applied to wounds or mucous membranes.

4. It is less irritating to the skin than conventional iodine preparations.

5. It will not permanently stain skin or hard surfaces.

Antiplaque agents – Povidone Iodine

• Use :1. Povidone-iodine containing mouth wash &

gargle is used for the treatment of acute mucosal infections of the mouth & pharynx.

2. It is also used for oral hygiene prior to, during & after oral surgery.

Dentifrices

• Dentifrices are the agents used with a toothbrush for the removal of bacterial plaque, food debris, stain & calculus only from the accessible surface of the tooth.

• Ideal properties of a dentifrices :

1. It should not be harmful to the oral tissue & fluid.

2. It should not stain teeth.

3. It should not be scratching to the enamel surface of tooth.

4. If it is ingested it should not be harmful to the G.I.T.

5. It should have pleasant odor & taste.

• Types of Dentifrices : Commercially dentifrices are generally available in two forms-• Powder• Paste or gel• Liquid (mouth wash)

• Ingredients of powder dentifrices :• Abrasives• Foaming agent • Flavoring agent

• Ingredients of paste dentifrices :• Abrasives• Foaming agent• Flavoring agent• Humectants• Binders or thickening agent• Preservatives• Therapeutic agents• Sweetening agent• Coloring agent• water

Dentifrices

Ingredients of Dentifrices

• Abrasives :• Abrasives are the solid cleansing materials.• It gives mechanical aids to the dentifrice & helps

to remove debris & stains from the tooth surface.• These agent must be non-toxic & should provide

a maximum cleansing action with a minimum of abrasion to the dental hard tissues.

• In general dentifrice abrasives are inorganic salts that are relatively insoluble.

• CaCO3 is widely used abrasives, others are insoluble Sodium metaphosphate (NaPO3), Anhydrous & Hydrous Calcium monohydrogen phospahte (CaHPO4 & CaHPO4.2H2O), Calcium pyrophosphate (Ca2P2O7), Magnesium carbonate, Hydrated aluminium oxides, silicates & dehydrated silica gels.

Ingredients of Dentifrices

• Foaming Agents :Foaming agents flushes & cleans the cavity. Consumers prefer to use foaming dentifrices.

E.g. : Sodium Lauryl sulfate is the most commonly used foaming agent. Others are shown to be useful include Sodium N-Lauryl sarcosinate & Sodium coconut monoglyceride sulfonate.

• Humectants :Humectants are incorporated into tooth paste formulations to prevent loss of water & subsequent hardening of the preparation upon exposure to air. The most frequently employed agents include sorbitol, glycerol & propylene glycol.

Ingredients of Dentifrices

• Binders :• Binders or thickening agents are used to stabilize

dentifrice formulations to prevent separation of the liquid & solid phases, especially upon storage.

• Binders increase the viscosity of the preparation & help to keep it on the brush.

• The most widely used thickening agent are the natural gums such as gum tragacanth & gum karaya, sodium alginate, synthetic cellulose such as sodium carboxymethyl cellulose & methylcellulose.

• Preservatives :• Preservatives are used to inhibit bacterial

proliferation in the preparation. Aqueous solutions of humectants support the growth of bacteria & molds & therefore a preservatives such as benzoic acid or esters of p-hydroxy benzoic acid is commonly added to dentifrices.

Ingredients of Dentifrices• Therapeutic agent : The majority of dentifrices contain

therapeutic agents such as fluoride salts. Fluoride salts inhibit caries. Common fluoride salt, which are used in the paste are – • Sodium monofluoride phosphate (SMFP)• Monofluoro phosphate (MFP)• Stanous fluoride.• Triclosan

Flavoring agent :Flavor is an extremely important factor in choosing dentifrice. The flavoring agents used in dentifrices must be compatible with other dentifrice constituents & yet provide a smooth pleasant flavor both during brushing & as aftertaste. Principle flavor ingredients, usually spearmint, peppermint, wintergreen or cinnamon-mint are blended with other essential oils to produce a distinctive flavor.

• Sweetening agent : Sweeteners are added to almost all flavors. The most frequently used synthetic sweetener is saccharin.

• Coloring agent :Red, green, chocolate or blue coloring agent are used.

Composition of tooth paste

• “Crest” toothpaste :• Stanous fluoride 0.4%• Stanous pyrophosphate 1.0%• Calcium pyrophosphate 39 %• Glycerin 10 %• Sorbitol (70% solution) 20 %• Water 29.6%• Miscellaneous formulating agent

• “Colgate” toothpaste :• Sodium monofluorophosphate 0.76 %• Insoluble sodium metaphosphate 41.85%• Anhydrous dicalcium phosphate 5 %• Sorbitol 11.9 %• Glycerin 9.9 %• Sodium N-Lauryl sarcosinate 2 %• Water 24.4 %• Miscellaneous formulating agent

Mouthwash• Mouthwash is a medicated solution to cleanse or treat the

oral mucosa, reduce halitosis (Bad breath), or add fluoride to the teeth for control or prevention of dental caries.

• In dental practice mouthwashes may also be employed as a part of postoperative treatment, & during the course of certain operative procedures when such use adds to comfort or oral hygiene of the patient.

• Some mouthwashes have a topical anesthetic effect on oral mucosa & are useful for relieving pain associated with denture sore spots, herpetic infections & aphthous ulcers. In patients with painful lesions, these mouthwashes should be used prior to eating improve comfort.

• Materials used for mouthwash :• Chlorhexidine • NaCl• Povidone iodine• Sodium fluoride• Na borate• Hydrogen peroxide• Cetylpyridinium chloride

Halitosis (bad breath)• Halitosis is a condition in which the breath smells

unpleasant.• Causes :• The most common cause of halitosis is accumulation

of plaque & food debris on oral hard or soft tissues. Bacteria in these plaque accumulations produce odoriferous sulfate substances which contribute significantly to bad breath. Halitosis may also be caused by a number of other local & systemic factors.

• Until the causative factors are removed, a commercial mouth wash may be recommended to mask bad breath. Mouthwashes flush loose debris from the mouth, provide a pleasant taste & mask bad breath for 15 to 30 minutes.

• The most commonly studied mouthwashes associated with a reduction in badb breath are Listerine (Thymol & essential oil), Cepacol (Cetylpyridinium chloride ) & Scope (Cetylpyridinium chloride &domiphen bromide)

Dental Caries• Dental caries is a progressive, largely irreversible bacterial

damage with consequent decalcification of the enamel & dentin of a tooth.

• Causes of dental caries :• Dietary aspects :

• A diet rich in fermentable CHO• Sucrose is the most important food stuff serving as

bacterial substances because it is• Metabolized by streptococcus mutans to glucons, lead

to form plaque.• Readily metabolized by the Lactobacillus acidophilus to

form lactic acid.• Inadequate intake of fluoride (less than 0.3 ppm) during

calcification of teeth.• Excessive intake of milk products & chocolates, which

contains lactobacillus.• Salivary aspects :

• To assist clearance of small sticky CHO• As a buffer against acid production in the more superficial

part of plaque formation.• As a vehicle for immune globulins.

Dental Caries• Microbial aspects :

• Dental caries is a bacterial disease & the organisms mainly responsible appears to be specific stains of Streptococcus mutans & Lactobacillus acidophilus.

• Initiation of plaque formation depends on bacterial mechanism of adhesion to tooth surface.

• Formation of carries :• The formation of carries is attributed to the action of acids mostly

lactic acid obtained from oral bacteria metabolism of dietary CHO as follows :

• CHO binds with Lactobacillus bacteria Lactic acid

Forms a layer named plaque which causes dental carries

This caries become deep day by day & produce pain & inflammation

• The build up of plaque on the tooth surface usually aids the decay process by forming pockets or caries on the tooth surface in which food particles can lodge & can be degraded by the bacteria of the mouth.

Dental Caries

• Factors involved in initiation of dental caries :

• Susceptible tooth surface to acid attack : Generally caries is initiated in the enamel but it may also begin in dentin or cementum.

• Plaque attached to the tooth surface : Plaque is a tenaciously adherent deposit that forms on tooth surface.

• The bacterial activity in the plaque : Plaque contains bacteria that are acid producing. Mutans streptococci are believed to be the most important bacteria in the initiation & progress of dental caries.

• Substrates : Bacteria utilize fermentable carbohydrates for energy & the end-points of the glycolytic pathway in bacterial metabolism are acids. Sucrose is the fermentable carbohydrate most frequently implicated but bacteria can use all fermentable carbohydrates, including cooked starches.

Dental Caries

• Prevention of dental caries :• Increasing the resistance of the tooth surface enamel

against acid products : The resistance of the tooth surface enamel to acid attach can be very greatly enhanced by the incorporation of minute amounts of fluoride ion so that the hydroxyapatite crystals become fluoroapatite. The principle mode of action of all fluorides (tooth pastes, rinses, gels & community water fluoridation) is its topical effect on enamel.

• Diet modification : Minimizing intake of dietary refined carbohydrates & good dental hygiene prevent growth of bacteria that contribute to the development of caries. Sweet etc. should be limited to mealtimes.Frequency of intake is more important than overall quantity. “Grazing” or “snacking” between meals should be avoided. The frequent consumption of soft drinks is a major problem, these being not only cariogenic but extremely erosive.

Dental Caries

• Plaque removal :Proper brushing of the teeth is effective in preventing & removing dental plaque in all areas except those between the teeth & deep fissures. Ideally, tooth brushing should be carried out twice a day & emphasis should be placed on brushing just before bed.Use of dental floss or tape removes plaque from adjacent tooth surfaces, deep pits & fissures may be sealed by the application of resins. The sealant may need to be replaced periodically.Parents should be advised to begin cleaning their children’s teeth from when they first erupt. Gauze or a cloth on a finger, or a small very soft toothbrush may be used to remove plaque.

• Early detection & dental restorations offer the best form of control once caries has formed.

Anticaries agents

• Anticaries are the agents used to treat dental caries. Dental caries is gradual decay & disintegration of tooth tissues, i.e. progressive decalcification of the enamel & dentin of the tooth.

• Types of caries according to location :• Pits & fissure caries• Smooth surface caries• Root caries• Deep dentinal caries

• Fluoride containing products are basically used to treat dental caries.

Anticaries agent

• Mechanism of action of Fluorides :• The principal mode of action of all fluorides

(tooth pastes, rinses, gels & community water fluoridation) is its effect on enamel. The resistance of the tooth surface enamel to acid attack can be very greatly enhanced by the incorporation of minute amounts of fluoride ion so that the hydroxyapatite crystals become fluoroapatite.

• The formation of this solubility resistant form explains the mode of action of fluorides as preventive agents.

Anticaries agent

• Fluoride Therapy :

• In the child, the developing tooth will receive its necessary building materials from the blood plasma & thus the enamel fluorine content will at this point be completely dependent on systemically absorbed fluorine. After tooth eruption, maturation of the enamel takes place & a great deal of fluoride uptake is a topical one. Hence it may be assumed that fluoride acts in two complementary ways – by systemic action & by its topical action.

• Fluoride therapy for the prevention of dental caries is considered under the two main headings :• Systemic fluoridation• Topical fluoridation

Anticaries agent

• Systemic fluoridation :A. Fluoridation of public water supplies :

An optimal level of fluoride in the water supply provides significant protection against caries. The optimal concentration depends on the annual average temperature of the community as temperature influences the amount of daily water intake.

• Temperature ranging between 14.70C to 17.70C, the optimal level of fluoride is 1 part per million (ppm). The adjustment of the fluoride concentration of public water supplies to 1 ppm is necessary in low fluoride areas. Most commonly, fluoride is added in the form of hexafluorosilicate acid or sodium hexafuorosilicate, but sodium silicofluoride & sodium fluoride have also been used.

• In a warmer climate slightly less than 1 ppm is sufficient. The effect of fluoridein drinking water persists in between 8 to 18 years of age, i.e. during tooth formation & mineralization.

Anticaries agent

B. Fluoride supplement : Fluoride supplements like tablet, drops, lozenges, tablet salt etc. offer an alternative source of systemic fluoridation where water fluoridation is not feasible. These supplements are usually administered continuously on a daily basis from birth to the pre-eruptive maturation of permanent teeth.

• If Fluoride tablets are prescribed they should be chewed rather than swallowed whole. This will increase the topical benefit of fluoride.

Anticaries agent

• Topical fluoridation :A lifetime protection against dental caries results from the continuous use of low concentrated fluoride. In addition to their use in caries prevention, topical fluorides may be used to control established caries lesions. This is effective for both adults & children.

A. Fluoride toothpaste : The use of fluoride toothpaste has led to a 25% reduction in the prevalence of caries in industrialized countries.Conventional toothpastes 1. Contain approximately 1mg F / g paste (1000-1100

ppm of fluoride)2. Added as Sodium Fluoride such as Sodium

monofluorophosphate (MFP) or Stanous fluoride.B. Fluoride mouth rinses : Studies showed that supervised

fluoride-rinse programs reduces caries by 20-50%. Weekly 0.2% NaF & daily 0.05% NaF rinses were considered to be ideal public health measures.

Anticaries agent

C.Fluoride varnishes : Fluoride varnishes were developed to prolong contact times between fluoride & enamel with a view to increasing the formation of fluoroapatite. E.g. Duraphat – an alcoholic solution of natural varnishes containing 50 mg NaF/ml. This varnish remains on the teeth for up to 12 hours & there is still fixation of fluoride evident up to 48 hours after application.

D. Concentrated fluoride gels & solutions :• APF gels : Acidulated phosphate fluoride (APF) gels,

containing 1.23% fluoride are used for professional applications & consists of a mixture of NaF, HF & orthophosphoric acid. The incorporation of a water-soluble polymer (i.e.Sodium carboxymethyl cellulose ) into aqueous APF produces a viscous solutino that improves the ease of application.

• APF gels are mainly used for the prevention of caries development.

Anticaries agent

• Sodium Fluoride (NaF) :• Preparation - By interaction of 40% HF with an

equivalent quantity of NaOH or Na2CO3 .• Stannous Fluoride (SnF2) :• Preparation – Stannous oxide is dissolved in 40% HF &

the solution is evaporated out of contact with air.• Use of NaF / SnF2 :

• NaF or SnF2 is used as a dental caries prophylactic. Ingested fluoride is effective only while teeth are being formed.

• The fluoride is incorporated into tooth salts as fluoroapatite.

• Topical application results in changes only in the outer layers of enamel or exposed dentin. It alters composition & crystalline structure of the hydroxyapatite-like salts that make up the bulk of enamel & dentin, so that the tooth material is more resistant to acidic erosion & dental caries (decay).

Dental surgery

Reference text book

• Remington’s Pharmaceutical Sciences.• Inorganic Medicinal & pharmaceutical

chemistry- Jhon H. Block• Dental Pharmacology – Dr. A.N.M Nazmul

Hossain