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Chapter VII Dental Products

Anticaries Agents

Caries
Tooth decay
Attributed to the action of acids mostly lactic, obtained from oral bacterial
metabolism of dietary carbohydrates
Buildup of plaque on the tooth surface aids in the decay process by forming pockets
or crevices on the teeth surface where food can enter
Brushing
Remove materials from the tooth surface before it hardens into calculus, since a
smooth surface make it difficult for the adherence of food particles and bacteria
Fluoride
Contain in floss and brush that can prevent caries
Topically or internally(orally) administered
Internally: in solution or rapid soluble salts are deposited in the bone or developing
teeth with the remainder excreted by the kidney
Has higher concentration on the surface layer of the enamel in both erupted or
unerupted teeth
Dental fluorosis
Too much fluoride in the tissue fluids
Mottled enamel: chalky and soft indicating a loosely bound structure
Food pigments adsorbed to the enamel making a mottled appearance
Occurs in area where the fluoride concentration of drinking water exceeds 2 pp.
Only occurs during excessive ingestion of fluoride
Lethal adult dose for NaCl: 2 to 5 g
2.2 mg NaF in 1 ppm fluoride
Two hypothesis of for fluoride:
That fluoride decreases the solubility of the enamel in acid
Bacterial inhibition hypothesis which is based on the enzyme inhibitory properties of
fluoride
Orally administered: places fluoride into systemic circulation allowing the fluoride to lay
down unerupted teeth as they are formed
Fluoridation of the public water supply
Most convenient dosage form
Done by adding sodium fluoride or a fluorosilicate, yielding a fluorine concentration of
0.7 to 1 ppm = average daily intake of 2.2 mg NaF based on six glasses of water
Sodium fluoride
NaF
White odorless powder
Soluble in water; insoluble in alcohol

Dental prophylactic agent


Topically: 2% solution of NaF; procedure is series of 4 treatments given several days
apart beginning at the age of 3 for the deciduous teeth
Other applications: given at ages 7,11 and 13 as the permanent teeth erupt
Stannous Fluoride
SnF2
Tin Difluoride
White crystalline powder
Bitter salty taste
Melts at 213C
Topical fluoride application
Used is freshly prepared 8% solution at 6 to 12 month intervals
One application per treatment
Applied to clean dry teeth
Dentrifices used to clean teeth
Pumice
o Pumice stone
o Piedra pomez
o Volcanic origin consisting chiefly of complex silicates of Al, K and Na
o Very light
o Hard rough porous grayish mass
o Gritty gray powder
o Fineness: pumice flour or superfine pumice, fine pumice and coarse pumice
o Odorless and tasteless
o Is not attacked by acids
o Dental abrasive

Chapter VIII Miscellaneous Inorganic Pharmaceutical Agents


INHALANTS

Oxygen USP 31
Dephlogisticated air, Aire Vital, Fire air, Aire Puro
Commercial Production:
o Fractional Distillation of Liquid Aire ( Linde Process) :Air is liquefied by a
combination of low temperature and high pressure; gives 86% pure oxygen; also
produces commercial nitrogen
o Electrolysis of water: electric current is passed through water containing 15%
NaOH or KOH , water breaks down into its component elements, H2(liberated at
the cathode) and O2( liberated at the anode); iron electrode separated by an
asbestos cloth diaphragm
o In laboratory, O2 can be obtained by either thermolysis of ClO3 with MnO2 as
catalyst or by the action of water on Na2O2
Supports combustion more energetically than does air
1 vol : 32 vol H2O; 1 vol: 7 vol of alcohol at 20C ; 1 vol : pressure of 760mm of Hg
Responsible for oxidative changes in paint , fats and oils
Antioxidants are used to lessen the effects of oxidation
Stored in cylinders which is usually green colored or carry a green label
Kept away from fire
Standard purity 99% and limits CO2, halogens, acids or alkalis and oxidizing substances
As inhalant for cyanosis and dyspnea ( difficulty in breathing)
Pure oxygen inhalation uninterrupted for 1 2 days can cause edema of the lungs if not
regulated
Given when poisoned by carbon monoxide, coal gas, nitrous oxide and chloroform
Carbon Dioxide
Carbonic acid gas, Carbonic Anhydride
Aqueous soln is acid to litmus
1 liter at 0C and at pressure of 760mm of Hg weighs 1.977g
1 vol: 1 vol H20
Stored in gray metallic colored cylinders
Administered in concentrations up to 7% in O2 stored in grayish green cylinders
20C it is liquefied at pressure of 59 atm
Dry ice: CO2 cools at 79C to form a solid CO2, used as refrigerant, destroy tissue by
freezing it
Used as respiratory stimulant ( when mixed with O2 and air) for persons suffering from
impairment of the respiratory organs in diseases such as pneumonia and asphyxiation
Dry ice used for treatment of acne, angiomas ( tumor made up of blood and lymph
nodes), corn and calluses, eczema, moles, psoriasis and warts
Used to make carbonated drinks

Most effervescent preparations NaHCO3 and an acid usually citric acid


Used to displaced air in parenteral and topical preparations that are easily oxidized but
must be stated in the label
Helium
Not combustible and does not support combustion
Slightly soluble in water
stored in brown cylinders
stored in brownish green cylinders when mixed with 20% or 40% O2
has relatively low density and high diffusibility
80 part He and 20 parts O2 is used as a respiratory inhalant, it has one third the density
of air
The mixture penetrates the restricted respiratory passages than does air
Used in high pressure underwater diving (reduces the risks of bend: formation of
bubbles in the blood and the time of decompression when bringing the diver up.
Causes pitch of sounds uttered by the vocal cords to be increased producing a
unintelligible speech with a DONALD DUCK sound

Nitrous Oxide
Laughing Gas, Nitrogen Monoxide, Dinitrogen Monoxide
N2O
Store in blue containers
Coercible ( condensable) gas
Sweetish taste, agreeable odor
Soluble at low water temp
Revives combustions
Can be distinguished from oxygen by the test of adding NITRIC OXIDE: O2 form reddish
brown vapors of NO2 and N2O3 while nitrous oxide will NOT REACT.
When inhaled in small doses it can cause INEBRIATION
Large doses or mixed with 1 vol of O2 used as an anesthetic
Used in dentistry as anesthesia when extracting the teeth etc.

Nitrogen
N2
Azote
Non flammable, does not support combustion
Sold in Black cylinders
Has little therapeutic use
Used as pharmaceutical air for displacing air to increase shelf life
Used in parenteral and topical preparation must be indicate in the label

RESPIRATORY STIMULANT

Aromatic Ammonia Spirit is composed of two active ingredients


Ammonium Carbonate NF XV
Strong Ammonia Solution NF XV
Both causes a reflex action of the patient taking a sudden deep breath
Used to revive an unconscious person who may have fainted

Ammonium Carbonate NF 26
Preston salt, Sal Volatile, Bakers Ammonia, Ammonium Sesquicarbonate
Consists of varying proportions of Ammonium bi carbonate ( NH4HCO3) and ammonium
carbamate ( NH2CO2NH4) such that it yields between 34 to 40 % ammonia without
EMPYREUMA ( odor of animal and vegetable matter when charred in a closed vessel)
Alkaline to litmus
Loses ammonia and carbon dioxide when exposed to air becoming opaque the
converted to friable porous lumps or white powder of ammonium bicarbonate
Decomposed by hot water
Hard translucent state to white powder is caused from total loss of NH3 and CO2 from
ammonium carbamate leaving ammonium bicarbonate
The basis of smelling salts
Valuable in hysterical syncope
Used as leavening agent
Source of Ammonia

Aromatic Ammonia Spirit USP XX


Contains in each 100 ml 1.7 to 2.1 g of total ammonia and ammonium carbonate
corresponding to 3.5 to 4.5 of ammonium carbonate
As solvent ethyl alcohol and volatile oils
Respiratory stimulant by inhaling the vapors

EXPECTORANT ( low dose) AND EMETICS( high dose)

Expectorants
Used orally to stimulate the flow of the respiratory tract secretions
Allows ciliary motion and coughing to move the loosened material toward the pharynx
more easily
Used in the treatment of respiratory disorders in which secretions are purulent , viscid
or excessive.
Terpinhydrate: agent used, may have a direct effect on the bronchial secretory cells

Ammonium chloride, glyceryl guaiacolate, syrup of ipecac, potassium iodide and


hydroiodic acid syrup: believed to act with a reflex action by irritating the gastric
mucosa and thereby stimulating respiratory tract secretion
Emetics in low doses have sometimes been use in cough preparations ; mild emetic
response stimulates flow of respiratory tract secretions

Ammonium chloride
Sal ammoniac, salmiac, ammonium muriate
Hygroscopic
Ammonium ion marked increases the secretions, especially saliva, mucous and sweat.
As expectorant ; it renders the secretions less viscous and less tenacious
Crude form used in solution as an electrolyte for voltaic batteries
Systemic acidifier and chloride replenisher

Potassium Iodide
KI
Kalium Jodatum
Saturated solution prepared by dissolving 1000g of KI salt in 680 ml of Hot water the
cooled then diluted to exactly 1 liter
Cubicle crystals either transparent and colorless or opaque or as white granular powder
Slightly hygroscopic 1 g : 0.7 ml of H2O
Expectorant
Employed in the treatment of bronchitis, asthma, emphysema and sinusitis
Antifungal agent
Antitussive agent
Treatment of goiter
Iodide salt: when small amount of KI is added to table salt

ANTIDOTES

An agent that counteracts a poison


Mechanism of antidotal action usually occurs in one of three ways:
Physiological Antidote : counteracting the effects of a poison by producing other effects.
Ex. Sodium nitrite which converts hemoglobin into methemoglobin in order to bind
crystals
Chemical antidote: changing the chemical nature of the poison Ex. Sodium thiosulfate
which causes the conversion of the systematically toxic cyanide to non toxic
thiocyanate
Mechanical antidote: preventing the adsorption of the poison into the body Ex.
Activated charcoal and kaolin which adsorb the poison prior to absorption across the
intestinal wall and magnesium sulfate and cupric sulfate which inactive and precipitate
the toxic materials as insoluble salts

Sodium Nitrite USP 31


Natrium, Nitrosum
NaNO2
White to slightly yellow granular powder or white opaque, fused masses or sticks
Mild saline taste
Deliquescent in air
Freely soluble in water and sparingly soluble in alcohol
Antidote to cyanide poisoning given in the form of 2 % solution administered
intravenously
Sodium Thiosulfate USP 31
Antichlor hypo, incorrectly called Sodium hyposulfate which is really Na2S2O4
Na2S2O3 . 5H2O
Deliquescent in moist air
Effloresce in dry air
Antidote for cyanide poisoning
Antidote for iodine poisoning
Term HYPO is still used in photography ; as a fixer in photographic films because of its
solubilizing action on silver halides
Antichlor in bleaching paper pulps
Activated charcoal
Carbon ligni
Residue from the destructive distillation of various organic materials treated to increase
its absorptive power
Charcoal is obtained by incomplete combustion of wood out of contact of air, the
residue left being composed of almost pure carbon
It is inactivated by heating 500C to 900C in the presence of steam( process called
ACTiVATION)
o removes substances that have been previously absorbed and most probably
reduces the bigger particles into smaller particles having greater surface area
1ml finely divided charcoal has a total surface area of 1000 sq. m.
must be preserves in well closed containers
general purpose antidote
Cupric sulfate
CuSO4.5H2O
Blue vitriol, blue stone, copper sulfate, Caparrosa Azul, Piedra Lipis
Deep blue triclinic crystals
Nauseous, metallic taste
Effloresces slowly in dry air
Acid to litmus
Antidote for phosphorus poisoning

Emetic(300mg)
Astringent on tonic( 10 to 30 mg)
TABLETING AIDS

Diluents : filler materials which bring the tablets up to acceptable size


Physiologically inert
LACTOSE: most common diluent
Inorganic agents such as CALCIUM SULFATE and COLLOIDAL SILICON DIOXIDE are also used

Calcium sulfate
CaSO4
Gypsum, alabaster, satin spar, light spar for the dehydrate calcium sulfate
Anhydrous or contains two molecules of H2O of hydration ( CaSO4.2H2O)
Fine to slightly yellow white odorless powder
Anhydrous form marketed as DRIERITE used as rechargeable laboratory and industrial
desiccant( drying agent)
Tablet diluent( both anhydrous and dihydrated forms)
Plasters of Paris
o CaSO4.1/2H2O
o Used as supportive casts by physicians
o Dental impressions by dentists
Colloidal Silicon Dioxide
SiO2
Submicroscopic fused silica prepared by the vapor phase hydrolysis of a silicon
tetrachloride(SiCl4) at 1100C
Tablet diluent
Suspending agent
Thickening agent

LUBRICANTS

Added to mixture to help remove tablets from their cases


Insoluble soaps ( heavy metals of fatty acids)
CALCIUM STEARATE and MAGNESIUM STEARATE ( has waxy properties)

SUSPENDING AGENTS

Altering the surface character of the solvent (surfactants) and other thickening agents

Bentonite
Al2O3.4SiO2.H2O
Soap clay, mineral soap, wilkinite

Native colloidal, hydrated aluminum silicate


Slight earthly taste
Hygroscopic
Swell in water to approx. 12 times its volume(Enables to form highly viscous suspensions
or gels)
Does not swell in inorganic solvents
Suspending agent
Stabilizer in many industrial emulsions
Exerts detergent effects ( used in soaps and cleansers
Clarifying agent with marked absorptive powers( for dyes and other coloring materials)

Chapter IX Radiopharmaceuticals and contrast media

Nucleus
Contains protons and neutrons
Surrounded by electrons
Electrons = protons
Protons = atomic number
Isotopes
Same atomic number(same no. of protons) but different mass numbers(diff. no. of
neutrons)
Same chemical and physical properties
Different kinetics or rate of chemical reaction

When radioactive isotopes DECAY, they emit particles or quantities of energy that are characteristics of
the particular isotope involved.
Major particles of decay:

Alpha particles
Heaviest and slowest
Helium nucleus containing 2 protons and 2 neutrons
Atomic mass of 4 and atomic number of 2
Move at relatively slow speed (0.1 the speed of light)
Penetrating power is very low
Stopped by a sheet of paper or tin sheet of aluminum
Emitted from elements having a atomic number greater than 82

Beta particles
Negatively charged species having a mass of an electron

Move at a faster velocity (0 .9 the speed of light)


Emission from element do not affect the mass number but the atomic number
More penetrating power ( penetrate almost 1 inch thickness of aluminum)
Travel up to 10 to 15 cm
NEGATRONS:
o emitted by unstable nuclei having neutrons in excess of protons
o If the neutron /proton ratio exceeds stable limits , a transformation occurs, with
the expulsion of beta radiation
o Decay into the next highest atomic number
POSITRON:
o Having a positive charge
o Emitted from nuclei having a proton/neutron ratio above stable limits
o Protons transforms into neutrons accompanied by the emission of a positron
o Decay to the next lowest atomic number
Gamma Radiation
A photon of electromagnetic radiation
Demonstrates both wave and particle properties as do electros and beta particles
Ray is short wavelength like x ray
Travel at a speed of light
No mass and no charge
Very high energy giving them excellent penetrating power
Stopped by very thick lead
Emitted from the lowering of the nuclear energy level of the element but no elemental
change is noted unless one of the other types of radiation is also emitted
Always accompanied by other radiation
If alone, it will involve the transition of a metastable state of an isotope either to a
stable form or to a form of the same isotope which will continue to decay by other
means
K-capture: process where x ray radiation is the same as gamma rays
o This type of radiation is produced by isotope with an unstable proton/neutron
ratio but with insufficient energy to emit with a positron
o The nucleus capture an electron from the so called K SHELL ( 1s orbital) which
combines with a proton to form a neutron
o Energy comes largely from the necessary electronic rearrangements
o Decay to the element having the next lowest atomic number
Biological effects of Radiation
Depends upon a number of factors related to:
o Ability of the radiation
o Particular tissue
o Surface are exposed
o Dose rate

Destructive aspect of radioactivity is related to its interaction with molecules present in


the tissue forming abnormal amounts of ion and/or free radicals
Chemical species can alter the local pH and serve to initiate free radical chain reactions
resulting in the production of peroxides or other toxic compounds
Leads to necrosis the complete destruction of organ or tissue

Internal Administration of radioisotopes


Used internally for therapeutic and diagnostic purposes
Isotopes important as radiopharmaceuticals are:
o Those emitting beta and gamma radiation since they can penetrate body tissues
o Isotopes which can be concentrated in a specific manner in certain organ or
cells. (131 I in thyroid tissue)
o Isotopes which should be eliminated from the body easily and aside from the
associated radioactivity, they and the decay products should be of low toxicity

Radiopharmaceutical preparations:
Preparations
synonym
Sodium chromate Cr
Chromitope sodium
51(atomic mass) injections
rachromate - 51
Gold Au 1998 Injection
Aurcoloid 198, Aureotope,
Auroscan
Sodium Iodide I 123 solution
Iodotope I 125

Sodium Iodide I 131 Capsules


and Solution

Iodotope I - 131

Sodium rose Bengal I 131


Injection

Robengatope I - 131

Sodium Iodohippurate I 131


Injections
Chlormerodin Hg 197 injection
and Hg 203 Injections
Sodium Phosphate P 32
Solution

Hippuran - 131

Technetium Tc 99m Injection

Sodium Pertechnetate

Cyanocobalamin Co-57 and


Co-60 Capsules and Solutions

Phosphotope

Uses/organ
Determination red blood cell,
volume
Scintillation scanning of the
liver
Function of the thyroid gland;
scanning of the thyroid gland(
position and possible tumor
location)
Blood and plasma volumes
and determination of cardiac
output
Radioactive tracer in the
determination of liver
function
Determine kidney function
Scintillation of the kidney and
brain
treatment of polycythemia
vera (increase in RBC) and
localization of intraocular
tumors
Brain scanning for
determining the presence and
location of neoplastic lesions
Diagnostic agent for
pernicious anemia

Radiopaque Contrast Media


Chemical compounds containing elements of high atomic number which will stop the
passage of x rays
Barium Sulfate
o BaSO4
o Barium Meal, Sulfato de Bario, esophotrast
o The title should always be in full to avoid confusion with the poisonous barium
sulfide and barium sulfite
o Fine white odorless bulky powder, free from grittiness
o Used as opaque contrast medium in the roentgenographic examination of the
intestinal tract and stomach so that they maybe photographed.