Mohd Masood

Lecture OutlineDentifrices

Ideal requirements for dentifricesDentifrices contentsRecent development in toothpaste

Mouthwash

Lecture OutcomesUpon completion of this course students

would be able toDiscuss different methods of chemical plaque

controlComponents of toothpaste and mouthwash

Methods of Plaque Control:Mechanical Plaque Control Methods.

Chemical Plaque Control Methods.

Chemical Plaque Control AgentsDentifrices/ Toothpastes

Mouth Rinses

TOOTHPASTE / DENTIFRICESToothpaste called as dentifrice, is an inclusive term used to

describepowder, paste or gel, used with a toothbrush to aid in the

removal of plaque, biofilm, materia alba, and stain from teeth and soft

tissue.

PURPOSE Cleaning Polishing Removal of stains Reduce incidence of tooth decay

Ideal requisitesShould decrease plaque & gingivitisPrevent pathogenic growthShould prevent development of resistant bacteriaShould be biocompatibleShould not stain teeth or alter tasteShould have good retentive propertiesShould be economic

Toothpaste ContentsAbrasives (20%-40%) Binders (2%)Humectants (20%-40%)Detergents (1%-2%)Flavoring agent (2%)Sweetening agents (2%)Colouring agent (2%)Preservatives (<1%)Water (20%-40%)

AbrasiveFunctions of Abrasive

Also called as polishing agentSolid, insoluble particlesRemoves debris and residual strain from teethMild abrasive actionRemoves stained pellicle, restores natural luster, enhances

enamel whitenessExamples of Abrasives:

Aluminium oxideCalcium pyrophosphateCarbonates like sodium bicarbonate, calcium carbonatesilicas

Binders Functions of Binder

To provide consistency and shape. Keep the solid phase properly suspended in the liquid phase . Prevent the toothpaste from drying out. Contribute to the creamy consistency of the toothpaste and hence, control the

viscosity. Provide body to the dentrifice, especially after extrusion from the tube onto

the toothbrush.Examples of Binders:

Water soluble agents• Alginates, Sodium carboxy methyl cellulose etc

Water insoluble agents• Colloidal silica, Magnesium aluminium salts etc

Humectants Functions of humectants

Used in toothpaste to prevent loss of water and subsequent hardening of the product upon exposure to air.

Reduces the loss of moisture from tooth pasteAffect taste perception

Examples: Glycerine Sorbitol Polyethylene glycol Mannitol Propylene glycol

Detergents/ surfactantsFunction

Produce foam and aid in the removal of debris.Emulsifies flavoring agents.Antimicrobial propertyHigh level may cause mucosal irritation.May react with other toothpaste components.

Examples:Sodium Lauryl SulfateSodium N-Lauryl SarcosinatePolyethylene glycol (PEG)

Sweeteners and FlavorsFunctions

Render the product pleasant to use & leaves a fresh taste in mouth after use

Sweeteners: sodium saccharin, sorbitol, mannitol, xylitol Flavors: improve taste of toothpaste

Examples peppermint, spearmint, wintergreen, menthol, cinnamon

Preservatives and Solvents

Function of Preservatives: prevent the growth of micro organisms such as mold and

bacteria in the toothpaste. Non-irritating Compatible with other ingredients

Examples: alcohols, sodium benzoate, dichlorinated phenols

Function of Solvents: dissolves the ingredients and allows them to be mixed. Water is the most common solvent used.

FluorideFunction:

Increases resistance to enamel solubility.Restricted usage level (for adults it must be within

1000 to 1450 ppm and for children not more than 1000ppm)

Examples:Sodium fluorideSodium monofluorophosphateStannous fluoride

Therapeutic AgentsAnti-caries agents:

sodium fluoride and sodium monofluorophosphateAnti-plaque:

Sodium Lauryl Sulphate, Triclosane, Zinc and Stannous ionsAnticalculus agents (crystal growth inhibitors)

Pyrophosphate, Zn citrate, Zn chlorideDesensitizing agents

Sodium fluoride, potassium nitrateAnti-dentin hypersensitivity:

Potassium saltsWhitening agents:

Papain, DimethiconeAnti bacterial agents

Triclosan, delmopinol, metallic ions & Zn-citrate trihydrate

Recent developments in dentifricesTooth paste for childrenNatural tooth paste (herbal)Whitening tooth pasteBreath freshening tooth pasteSodium bicarbonate tooth paste

TRICLOSAN Phenol derivative Is synthetic and ionic Used as a topical antimicrobial agent Broad spectrum of action including both gram positive and

gram negative bacteria It also includes mycobacterium spores and Candida

species

MECHANISM OF ACTION TRICLOSAN

ACT ON CYTOPLASMIC MEMBRANE

INDUCE LEAKAGE OF CELLULAR CONSTITUENTS

BACTERIOLYSIS

TriclosanTriclosan is included in tooth paste to reduce plaque

formationUsed along with Zinc citrate or co-polymer Gantrez to

enhance its retention within the oral cavityTriclosan delay plaque formationIt inhibits formation of prostaglandins & leukotrienes

there by reduces the chance of inflammation

METALLIC IONSeg: Zn & Cu ions

MECHANISM OF ACTIONIt reduces the glycolytic activity in bacteria &delays

bacterial growth

QUARTERNARY AMMONIUM COMPOUNDSCationic antiseptics & surface active agentsEffective against gram positive organisms

MECHANISM OF ACTIONPositively charged molecule reacts with negatively

charged cell membrane phosphates and thereby disrupts the bacterial cell wall structure

Eg: Benzanthonium chloride, Benzalleonium chloride and cetylpyredinium

SANGUINARINE

It is a benzophenanthredine alkaloidIt is most effective against gram –ve organisms

ANTIBIOTICS

Vancomycin, erythromycin, Natamycin and Kanamycin

Due to bacterial resistance problems the use of antibiotics has been reduced

CHLORHEXIDINE GLUCONATE(0.2%)

It is a cationic bisbiguanide Effective against gram +ve, gram –ve organisms,

fungi, yeasts and viruses Exhibit antiplaque & antibacterial properties

MECHANISM OF ACTION Antiplaque action of chlorhexidine

Prevents pellicle formation by blocking acidic groups on salivary glycoproteins thereby reducing glycoprotein adsorption on to the tooth surface

Prevents adsorption of bacterial cell wall on to the tooth surface

Prevents binding of mature plaques

Bacteriostatic at low concentrations

Bacterial cell wall(-ve charge)

Reacts with +ve charged chlorhexidine molecule

Integrity of cell membrane altered

CHX binds to inner membrane phospholipids & increase permeability

Vital elements leak out & this effect is reversible

Bacteriocidal action increased concentration of chlorhexidine

Progressive greater damage to membrane

Larger molecular weight compounds lost

Coagulation and precipitation of cytoplasm

Free CHX molecule enter the cell & coagulates proteins

Vital cell activity ceases

cell death

ADVERSE EFFECTS OF CHLORHEXIDINE Brownish staining of tooth or restorations Loss of taste sensation Rarely hypersensitivity to chlorhexidine has been

reported Stenosis of parotid duct has also been reported

EnzymesEnzymes has been used as active agents in

antiplaque preparationsIt is due to the fact that enzymes would be able to

breakdown already formed matrix some plaques and calculus

Some are proteolytic and have bactericidal actioneg:Mucinase, mutanase, dextranase etc

DELMOPINOLInhibits plaque growth and reduces gingivitis

Mechanism of action

Interfere with plaque matrix formation & also reduces bacterial adherence

It causes weak binding of plaque to tooth, thus aiding in easy removal of plaque by mechanical procedures

It is therefore indicated as a pre brushing mouth rinse

Adverse effect of delmopinol

Staining of tooth & tongue Taste disturbances Mucosal soreness & erosion

Essential Oil RinseReduces plaque 2o-35% and gingivitis reduction of 25-

35%

Essential Oil Preparation Contains:ThymolEucalyptolMentholMethyl SalicylateAlcohol (up to 24% depending on the preparation)

Questions