DENTAL OTC PRODUCTS

OUT LINES :



Dental anatomy.



Common dental problems and OTC Products

DENTAL ANATOMY :

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

C OMMON DENTAL PROBLEMS &OTC P RODUCTS

 1- Dental caries.  2- Plaque and calculus.

 3-Gingivitis.

 4-Periodontal disease.

 5-Acute Necrotizing Ulcerative Gingivitis (ANUG).

 6-Temporomandibular joint Syndrome.

 7-Teething Pain.

 8-Xerostomia.

1- DENTAL CARIES :

Def.

: formed by growth and implantation of cariogenic microorganisms.

Causes:

1-

Bacteria

: (

Ex.steptococcus mutans

) that produce acids (lactic acid) that demineralize enamel that will appear as white, chalky the bluish white then brown or yellow .

2-

Diet

: food with high concentration of sugar (sucrose)that destroy hydroxyapatite.

Fructose and lactose less cariogenic.

Xylitol , sorbitol and aspartame NONcariogenic

1- DENTAL CARIES :



OTC Products

: ONLY help to alleviate the pain until u can go to Dentist .. Ex:

Lidocain ,, benzocain

,, Or Oral analgesics : -

Acetaminophen -Aspirin

2- P

LAQUE AND CALCULUS

.



Causes :



Plaque

: sticky substance formed by the attachment of bacteria to the pellicle which is thin , a 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 ..

2- P

LAQUE AND CALCULUS

.

OTC Products :



1-Toothbrushes:

soft , rounded , nylon bristles .

If Hard can be irritant to gum and recede.

Some brushes reach deep between teeth ex

. Colgate whitening

.

Electric brushes can be used for orthodontic appliances.

Must change your toothbrushes every three months and after URI .

2- P

LAQUE AND CALCULUS

.

OTC Products :



2- irrigating devices :

 Direct high pressure steam of water to the hard to clean areas.

 Two types : *

Pulsating

(intermittent low and high pressure water steam) *

Steady

(constant and consistent water pressure )  -irrigation should be serve adjuncts.

 -ex.

Hydro-pik ,,,, waterpik oral irrigator

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3-Dental Floss :

**Available waxed , unwaxed , thick ,thin, flavored or unflavored..

**May be coated with additives such as baking soda and fluoride .

**Selection of dental floss depend on *tooth roughness or tightness of tooth contact.

 Ex.

Oral –B .. Johnson & Johnson

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4- Dentifrices

: products that enhance the removal of stains and dental plaque by toothbrushes.

 Include : 

(a) Toothpastes:

 *Decrease dental caries , reduce mouth odor . Enhance personal appearance ..



INGREDIENTS:



1-Abrasives

:responsible for removing plaque  Ex.

silicates , sodium bicarbonate. Dicalcium phosphate , calcium carbonate …ect

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OOTHPASTE INGREDIENTS 

2-surfactants

: foaming agent and removing debris  Ex.

SLS

… sensodyne doesn’t contain SLS.



3- humectants :

prevent preparation from drying ex. sorbitol and glycerin.



4-suspending agents

: add thickness to product ex.

MC &tragacanth 

5-falvoring agent:

sorbitol or saccharin 

6-pyrophosphates:

retard tartar formation ..rash around mouth may occur ex.(

Colgate

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OOTHPASTE INGREDIENTS 

7-fluoride

: is an anticariogenic coz it form fluorapatite on the enamel which become harder and more acid resistance also have antibacterial activity..

** MOST beneficial if used from birth through age 12 or 13 **toothpaste include 0.24%sodium F and 0.76% or 0.80% sodium monofluorophosphate (

crest , Aqua fresh

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

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(b) antiplaque

: potential for inclusion in dentrifrices includes : *plant extracts (

sanguinarine

) *metal salts (

zinc)

*phenolic compounds

( triclosan

) :antimicrobial agent that prevent gingivitis , plaque and tartar.

*essential oils (

thymol and eucalyptol

)

C ON .



(c) Anticalculous include

: zinc chloride , zinc citrate and 33% pyrophosphate to prevent calculus formation 

(d) 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 of other agents.

 - antiseptics have been used as whiteners e.g(

Gly-oxide

)

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(e) Desensitizing agents:

reduce the pain in sensitive teeth caused by cold , heat , acids.sweets or touch .should be nonabrasive  Eg

: 5%

apotassium

nitrate compounds ( Colgate sensitive , senso dyne , aquafresh sensitive.



(f) Disclosing agents:

aid in visualizing where dental plaque has formed.

Should not be swallowed -FDA approved product is a vegetable dye , food , Drug

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(g) Mouthwashes

: contain astringents , demulcents ,detergents , flavors, germicidal and fluoride.

FOR : 

1- cosmetics purposes

: freshen the breath , nontherapeutic & not – antiseptic agents.

 *most popular that contain medicinal phenol & mint ..

 * more alcohol higher effect of flavor within mouth.



2-antiplaque:

contain the same active ingredients as Anticalculous dentifrices.

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 Ingredient : 

(i) cetylpyridinium chloride (CPC) :

for class 1 plaque and gingivitis. Eg. Cepacol , oral – B 

(ii) chlorhexidine

Eg. Colgate PerioGard.

 Staining is a result for long use of (i) & (ii)

**Fluortidated Mouthwash:

 Expectorated for cleaning the teeth .

 Dnt put any thing in your mouth for 30 min  Eg .

ACT(Anti –Cavity Dental Rinse

) 

(Oral-B Rinse Therapy )

C ON .



(h) Dental Gums:

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 demineralize the teeth & prevent cavities.

 Also Contain Xylitol.

 Not a substitute for brushing and flossing

3- G

INGIVITIS 

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 fresh the breath ***acetaminophen ****seek the advice of dentist.

4-

PERIODONTAL

D

ISEASE

.

 Result of chronic gingivitis left untreated.



Risk Factors:

**Gender( man more than women) **Age (> 35 Y.O) **Smoking **Lack of oral care and regular dentist visits **Diabetes , HTN ,RA 

TMT:

 RX Products as 

(1) Periostat (doxycycline hyclate 20mg cap)



(2)Atridox(doxycycline hyclate 10%)

 Provide antibacterial effects  Low dose (-) collagenase that lead to tooth loss

5-A CUTE NECROTIZING ( ANUG ) U LCERATIVE GINGIVITIS  Necrosis and ulceration of gingival surface  Seen in teen &young adults 

Sign :

severe pain, halitosis , bleeding,foul taste &inc salivation.



Cause

:unknown 

Risk factors :

anxiety , stress , smoking , malnutrition ,poor oral hygiene.



TMT:

local debridement, pen VK, Metronidazole.



OTC:

acetaminophen & benzocaine , rinsing with warm normal saline  NO. eugenol NO salicylates

6-T

EMPOROMANDIBULAR JOINT SYNDROME  Caused by improper working relationship btwn the chewing muscles and TMJ, 

Signs:

dull , aching pain around ear , headache , neck aches ,limited opening of the mouth 

Risk factors

: bruxism (grinding the teeth ), occlusal (bite) , abnormalities..



TMT:

moist heat applied to jaw , muscle relaxants , diet of soft foods . Correcting the occlusion or surgery.



OTC:

acetaminophen & ibuprofen.

7-

TEETHING PAIN

&

XEROSTOMIA 

TMT :

frozen teething ring & local anesthetic (benzocaine) (orajel Baby) 

Dry mouth. Caused by dysfunction of salivary glands



TMT :

Artificial saliva as an OTC  Eg .

Moi-stir .. Salivart .. Xero-lube & OralBalance Gel.

1-C

ANKER SORES

&

LESIONS 

Cause

: is unknown but may caused by hypersensitivity to bacteria or dysfunction of immune system 

TMT:

prednisone or topical steroid to reduce allergic rxn.

Tetracycline susp. Peridex & Listerine that dec. bacteria in mouth.

C ON .

 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 & debriding & wound – cleansing agents.

to control the pain & shorten duration of current lesions and prevent new lesions

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(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 Rx product : (1) Amlexanox

.. Approved for tmt of canker sores.

Applied qid after meals and at bedtimes.

(2)Gelclair

to relief pain Patient should use one packet at least 3 times a day as needed. And mix 1 packet with 3

2-

COLD SORES

\

FEVER BLISTERS  Caused by (HSV-1) , outbreak may be provoked by stress , minor infection , fever , sunlight ..occure in lips and are recurrent..

 Preceded by burning , itching, numbness ..red papules of fluid – containing vesicles .. **Self limited and heal in 10-14 days

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OTC :

1- softening compounds (eg emollient creams , petrolatum ) 2- local anesthetics in nondrying bases (eg orabase with benzocaine) **NO astringent bases No caustic agents (phenol) **Docosanol 10% cream : tmt of cold sores applied 5 times a day until is healed.

**Viractin gel (2%tetracain) relief pain and itching.

*bacitracin or neosporin antibiotic ointment used if 2 nd infection developed .

C ON .



Rx products :

(1) Valacyclovir (valtrex) for tmt of herpes labialis.

(2)Acyclovir cream 5% (zovirax) Adults and adolescents>12 yo..applied 5 times a day for 4 days.

(3)penciclovir cream 1% (denavir) antiviral medication .. Used in adults and children >12 Y.O Apply every 2 hr for 4 days .

C OMMON ORAL INFECTION AND OTC PRODUCTS :  (1) Candidiasis: (thrush).. caused by fungus Candida albicans ..

 Thrush has a milky curd appearance ..

 (2)Oral cancer : *The Most common oral cancer is squamous cell carcinoma ..

*appear as red or white lesions , ulceration or tumor ..

*Signs : color change in tongue , sore throat that doesn’t heal , unexplained bleeding *Risk factors: smoked &smokless tobacco. & alcohol.

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Tmt : elimination use of alcohol and tobacco.

(1)

Wide local excision

for small lesions &

en bloc excision

for large one .

(2) Radiation alone or combined with surgery.

(3)Chemotherapy **OTC Products shouldn’t be administered until checking with Dr.

S\ E that don’t require medical attention : nausea , vomiting . Appetite loss or hair .. And trouble sleeping ..

Ondansetron or metoclopramide can be useful for this cases.

P ROPHYLAXIS AND PREVENTION OF ENDOCARDITIS ; *** Amoxicillin : 2 g orally I hr before the procedure for adults and 50 mg \kg for children ..

Recommended prophylactic for all dental, oral and URT procedure.

*** if patients is

allergic to penicillin ..

Use A-

clindamycin

(children) 600 mg (adults) 20 mg\kg B-

cephalexin

2 g(adults) 50mg\kg (children) C-

azethromycin

or 500 mg (adults) 15 mg\kg (children) 1 hr before procedure.

O TC DENTURE PRODUCTS : (1) Dental cleansers: A-chemical 1-alkaline peroxide (tab &powders) release O2 which create cleansing effect.

2-Alkaline hypochlorite: (its bactericidal & fungicidal).. Dissolve matrix of plaque but no effect on calculus ..

Disadvantage.

. Corrodes metal denture components ..

**

not used more than once a week ..

B-

abrasive: ( gel , paste or powder)

Eg. ( silicates , sodium bicarbonate, Dicalcium phosphate ).

O

TC DENTURE PRODUCTS

:

(2) 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 lead to soft tissue deteriorates .. And provide medium for bacteria and fungal growth ..

** Daily use not recommended ..

Eg Fixodent .. ORAfix .. Sea-Bond and Effergrip.

P HARMACIST ’ S RESPONSIBILITIES TO PATIENT USING OTC ORAL PRODUCTION :  (1) Refer the patient to a dentist ..

 (2) Remind patients that cold and canker sores with appropriate tmt are usually a self limiting problem .

 (3) patients should informed about

how to use recommended products ..

The duration of use , the expectation of using the product ..

 (4) if a nonprescription product doesn’t improve a condition or if worsens u should