* Introduction and types of dental products with examples; * Dentifrices: Calcium Carbonate and Dicalcium phosphate. + Dental caries/dental plaque, Anti-caries agent: Role of fluoride as anticaries agent, consequences of fluoride overdosing, Sodium Fluoride and Stannous fluoride.a Enamel: Hard caleified (consists primarily of calcium phosphate and calcium carbonate) tissue covering dentin of the crown of tooth. Crown: The crown is the visible portion of tooth above the level of the gums. Gingiva (gums): Soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted, Pulp Chamber: The space occupied by the pulp. Neck: The area where the crown joins the root. Dentin: That part of the tooth that is beneath enamel and comentum, Alvealar Bone (jawbone) : The part of the jaw that surround the roots of the teeth, Root Canal: The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp. Root; Embedded in the socket are one to three roots. Cementum: Hard connective tissue covering the tooth root, giving attachment to the periodontal ligament. Periodontal Ligament; A system of collagenous connective tissue fibers that connect the root of a tooth to its alveolus,|) SWTRODUCTION TO DENTAL PRODUCTS « The inorganic compounds and their formulations which are used in maintaining the oral and dental hygiene are known as dental preducts. + Dental products include anticaries agents , polishing agents, and desensitizing agents.(2 SLASSIFICATION OF DENTAL PRODUCTS Dental products includes » Anticaries sonia: These are the agents which help in prevention of dental decay. e.g. Sodium fluoride, stannous fluoride, sodium monofluorophosphate « Cleaning agents (Dentifrices/ Polishing agents): Dentifrices are agents used along with a toothbrush to clean and polish natural teeth. They must be abrasive to some degree to remove the stains from the teeth. They are supplied in paste, powder, gel or liguid form. e.g. Calcium carbonate, Dibasic calcium phosphate, calcium Phosphate, sodium metaphosphate « Desensitizing Agents: These reduce sensitivity of teeth to heat and cold. Examples include strontium chloride and zinc chloride.- WNTICARIES AGENTS E.G. SODIUM FLUORIDE, STANNOUS FLUORIDE, SODIUM MONOFLUOROPHOSPHATE * Dental caries, or tooth decay, involves a gradual demineralization (softening) of the enamel and dentin. If it is not treated then microorganisms may invade the pulp, causing inflammation and infection. * Dental caries (tooth decay) is infectious disease, also called as dental plaque, in which acid formed by the action of oral microbial flora on carbohydrates, Dental plaque is a biofilm or mass of bacteria that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is characterised by decalcification of tooth accompanied by foul smell.© The microbial flora (primarily streptococcus mutans und lactobacillaceae) present in the mouth act on carbohydrates (taken in tea and food) and produce acids, especially lactic acid, Calcium salts are dissolved in acidic media, remaining organic matrix is easily digested by the prowolytic enzymes and cavities are formed * Dental caries can be prevented and oral and dental hygiene can be maintained with the help of dentifrices. Dentifrices are the products that enhance the removal of stain and dental plaque by the toothbrush. The most accepted approach to prevent caries includes flossing and brushing accompanied by administration of fluoride either intemally or topically to the teeth.Mechanism of action of Fluoride: * The deposited fluorides on the surface of teeth prevent the action of acids or enzymes in producing cavities, * Fluoride is anticariogenic as it replaces the hydroxyl ion in hydroxyapatite with the fluoride ion to form fluorapatite in the outer surface of the enamel. * Fluorapatite hardens the enamel and makes it more acid resistant. It is also possible that fluorides may possess some antibacterial activity and help in remineralization of enamel * A trace of amount of fluoride in drinking water is enough to prevent dental caries. Fluorapatite has also shown antibacterial activity.Fluorapatite Formation Ca,(PO,)(OH), (Hydroxyapatite) Cag(PO)F, (Fluorapatite) (A) (A) Fluoride ions (replace hydroxyl groups (OH In hydroxyapatite to form ‘uorapatite In the tooth enamel. (8) A potion of the apatite crystal ates Is ‘depicted showing the replacement of hydroxide for fuoride Fluoride Reactivity Remineralization with the presence of F pH4.5-5.5, ‘Tooth enamel — >Administration and Effects of over dose of Fluoride: * Fluoride can be administered by two routes, orally and topically. * Fluoride can be administered orally as sodium fluoride tablets or drops added in water or fruit juice. Fluoride when administered internally is readily absorbed from the gastrointestinal tract, partially deposited in the bone or developing teeth and the remainder gets excreted by the Kidneys.* A small quantity (0.5 -L PPM) of fluoride thus becomes necessary to prevent caries. However, if more quantity of fluoride (more than 2-3 PPM) is ingested it is carried to bones and teeth and gives rise to mottled enamel known as dental fluorosis. Persons receiving slow continued ingestion of fluoride may suffer from mottling of teeth, increased density of bones, gastric disturbances, muscular weakness, convulsions and even heart failure. * Addition of fluoride to the municipal water supply, known as fluoridation is able to help in reducing and preventing dental caries, * Topical fluoride solution, mouthwashes and gels are less effective than orally administered fluoride. Sodium fluoride tablets or solution of sodium fluoride in a dose 2.2 mg/day is generallySodium fluoride Molecular formula: NaF Preparation: It may be prepared by neutralizing hydrofluoric acid with sodium carbonate. 2HF+NaCO; == 2NaF + H:0+C02 Another method includes the double decomposition of calcium fluoride with sodium carbonate wherein insoluble calcium carbonate can be removed by filtration. CaF, + NaCO; = 2NaF + CaCOs Properties: A white powder or colourless crystals. Soluble in water practically, insoluble in ethanol (95%).Identification * Givesreaction A of sodium salts. © Add about 4 mgto a mixture of 0.1 ml of alizarin red solution and 0.1 ml of zirconyl nitrate solution and mix; the colour changes to yellow. Test for purity: It is tested for appearance of solution, Acidity or alkalinity, chlorides, fluorosilicate, sulphates and loss on drying. Assay: Weigh accurately about 80 mg, add a mixture of 5 ml of acetic anhydride and 20 ml of anhydrous glacial acetic acid and heat to dissolve. Cool, add 20 ml of dioxan. Titrate with 0.1 M perchloric acid, using crystal violet solution as indicator, until a green colour is produced. Carry out a blank titration.* Action and uses « Sodium fluoride due to its fluoride ion is an important agent in dental practice for retarding or preventing dental caries, Fluoridised teeth have been resistant to microorganisms causing dental caries. It also decreases microbial acid production. ' + Sodium fluoride in 2 % aqueous solution is widely used topically; occasionally the solution is applied to the surface of dry teeth periodically aver several times in a year. ‘ * Application: 1.5 to 3 ppm (equivalent to 0.7 to 1.3 ppm of fluoride ion) in drinking water; topically as a 2% solution to the teeth,+ Caution: When consumed in larger doses, sodium: fluoride is poisonous. High fluoride water greater than 3 ppm) brings about motiling of teeth, gastric disturbances, etc. Stiller larger doses may lead to systemic toxicities effecting central nervous, cardiovascular, musculo-skeletal and respiratory systems. Sometimes, sodium fluoride is used as domestic insecticide. Greater precaution is to be taken to prevent children getting access to such preparation.fe: Stannous fluoride is a valuable adjunct in the prevention of caries and is considered to be superior to sodium fluoride for two reasons i) simplified pplication ii) greater effectiveness, ' + The first advantage is supported by the fact that single application of 8 % aqueous solution to the tooth surface is enough for every 6 months to | year, while, a 2 % sodium fluoride is applied 4 times during a 10 days period + The second advantage derives from the fact that the stannous ion increases the anticariogenic action of fluoride ion so that both ions contribute towards clinical effectiveness.Gh Stannous fluoride Molecular formula: SnF Molecular weight: 156.7 Tin fluoride solution is obtained from using tin fluoride capsules by dissolving in water. A fresh solution (about 8.0 %) finds use in dentistry, Properties: It is a white crystalline powder having unpleasant astringent-salty taste. It is soluble in water but insoluble in alcohol and organic solvents, Aqueous solution of stannous fluoride deteriorates rapidly on standing because of oxidation of stannous cation to stannic form causing turbidity. Thus stannous fluoride solution must be freshly made.« Identification; To 5 mal of solution (1 in 100) in a test tube add 2 mil of cakium chloride test solution: a fine, white precipiste of calcium fluoride i formed. Mix on a spot ple 2 drops of solution (1 in 100} with 2 drops of silver nitate test solution: a brown-black prciitte is formed. * Uses: «+ ttisused to prevent dental caries, similar to sodium fluoride and sodium monofluorophosphate in the form of solution, gel, mouth wash or dentifrice (toothpaste), It has unpleasant taste and may cause discolouration of ‘teeth on overusage. +A freshly repared 8 % solution of stannous fueride is applied to the cleaned teeth. A single application has ‘been reported to be sufficient for six to 12 months.Anticaries Antibacterials Anti-malodour Whiteners Anti-tartar Anti-hypersensitivity Others Amine fluorides,Calcium phosphate,Calcium pyrophosphate, calcium trimetaphosphate Nicomethanol fluorhydrate Potassium fluoride,Sodium fluoride (NaF) 1450-1500 ppm (< 600 ppm in child paste) Sodium monofluorophosphate (Naz FP0:)Stannous fluoride, Xylitol Chlorhexidine Fluorides, Hexetidine,Hydrogen peroxide Plant extracts Potassium peroxydiphosphate Sanguinarine Siliglycal,Sodium bicarbonate Stannous pyrophosphate, Triclosan,Urea peroxide, Xylitol Zine chloride Zinc citrate Zinc trihydrate Chlorhexidine Triclosan, Zinc chlorideZinc citrate Benzalkonium chloride, Calcium carbonate, Calcium phosphates Carboxymethyl cellulose, Citroxaine, Pentasodium triphosphate Potassium tetra pyrophosphate, Sodium benzoate Sodium bicarbonate, Sodium tripalyphasphate Azocyclaheptane diphosphonate, Potassium pyrophosphate, Tine chloride, Zine citrate Formaldehyde, Potassium citratePotassium chloride,Potassium nitrate Sodium citrate Sodium fluoride Stannaus fuoride Strontium chloride Enoxolone Essential oils, KeratinPanthenol, Permethal Provitamin BS,Tocopherol Vitamin EB. CLEANING AGENTS (DENTIFRICES/ POLISHING AGENTS): « Dentifrices contain agents for cleaning tooth surfaces and providing polishing effect on the cleaned teeth. These agents are abrasive in nature, They are responsible for physically removing plaque and debris. The overall effect provides whiteness to the teeth, Dentifrices are applied as powders or pastes. + Examples include dicaleium phosphate, sodium metaphosphate, calcium pyrophosphate, calcium carbonate and calcium monohydrogen phosphate * The main drawback is that it will not be able to clean surfaces inside cavities and crevices between teeth, even if the material reaches them during application. The cleaning action is dependent upon abrasive property and the rubbing force used. Pumice is too abrasive for daily use in a dentifrice.Dibasic calcium phosphate/Dicalcium Phosphate It is also known as dicaleium phosphate or dicaleium orthophosphate or calcium hydrogen phosphate. It occurs as a dihydrate (Call POs.21b0). When exposed to air, il efMloresves losing water to form anhydrous dibasic calcium phosphate (CalTPO,) Ina very fine powder form, it finds use in dentifrices. It provides good flow properties and ts odourless and tasteless, Preparation: [t may be prepared by reacting natural solution of calcium chloride with disodium hydrogen phosphate CaCl; + Na;ITPO; ss CalTPO,+2NaCl]Uses: «This salt is having 1:1 ratio of calcium to phosphorus. [tis most frequently recommended for oral administration as an electrolyte replenisher. 4 Asasall il is able to supply both calcium and phosphorus which is needed for the growth in children, pregnant woman and lactating mothers + Lxtemnally it finds use as dentifrice having cleaning action. The moderate abrasive quality makes il suitable for toothpaste and tooth powders,Calcium carbonate (Molecular formula: CaCO;) Tthas been regarded as one of the most abundant and widely distributed of caleium salts. In nature, it is found as chalk, marble, lime stone, aragonite and calcite and one of the main constituents of corals, pearls and shells, Preparation: On commercial scale, calcium carbonate is obtained by mixing the boiling solutions of calcium chloride and sodium carbonate and allowing the resulting precipitate to settle down. Cah + NaCOr = CaCO3 + 2NaCl The precipitate is collected on calico filter, and washed with boiling water, until it becomes free from chloride ions, Finally, the precipitate is dried,Properties: It occurs as fine, white, micro-crystalline powder. It is odourless and tasteless. It is stable in air. It is almost soluble in water and alcohol. Calcium carbonate neutralises acids with effervescence. CaCOs+2 HC] em CaCl + CO) + HO Identification: It gives reactions which are characteristic of calcium and carbonates. Uses: Precipitated chalk, which is having a fine powdery texture, is used in dentifrice, both powders and pastes It furnishes both abrasive and antacid effect in the mouth. If forms a common ingredients of tooth powder and toothpaste. ¢ Itis having a tendency to cause constipation and hence it is usually administered alternatively or along with magnesium salts. ¢ Itis rapidly acting non-systemic antacid. It neutralizes gastric acid and forms calcium chloride.C. DESENSITIZING AGENTS: + Desensitizing agents reduce the pain in sensitive teeth caused by cold, heat or touch. These products should be non-abrasive and should not be used on a regular basis unless directed by a dentist. Examples include strontium chloride (Sensodyne®) and zine chloride (Listerine®). « The exact mechanism of action of desensiting agents is not known with certainty. However they act probably like local anaesthetic.STRONTIUM CHLORIDE (SRCL,) Preparation: Itis prepared by adding strontium carbonate to hydrochloric acid until effervescence gets ceased. The solution is filtered, concentrated and allowed to crystallise. $CO3+2HCL sm SrChh +H) + COs Uses: It acts desensitising agent in dental remedies.ZINC CHLORIDE (ZNCL,) Preparation: It is prepared by heating granulated zine with hydrochloric acid. When evolution of hydrogen ceases, the solution is filtered and evaporated to dryness. Zn + 2HCl + ZnCh + Hy Uses: * Itisused as an antiseptic astringent to the skin and mucous membrane as a 0.5-2.0% solution. * It is used as an active ingredient to prepare magnesia cements for dental fillings and certain mouthwashes. * Itis also used as dentin desensitizer, topically as a 10% solution to the teeth. It is for topical use only and is administered as solution and mouthwash.