Name of Institution

Amity Institute of Pharmacy

B. Pharm., Semester one
Pharmacy
Dr. Pawan Kumar Porwal

1
 Name of Institution
Dental products

• Dentifrices,
• Role of fluoride in the treatment of dental caries,
• Desensitizing agents,

• Calcium carbonate,
• Sodium fluoride, and
• Zinc eugenol cement.
Age of tooth eruption Name of Institution
Dentifrices Name of Institution

• A preparation for cleansing and polishing the teeth; some contain agents for whitening.
– Fluoride inhibit formation of dental caries
– Triclosan help inhibit formation of gingivitis and plaque.

• Dentifrices are preparations meant to clean the teeth and other parts of oral cavity
(gums) using a finger or a toothbrush.
• They are available as tooth powder, toothpastes, gels, dental creams and even as dental
foams.
• They are meant to enhance the personal appearance of the teeth (daily removal of
pellicles) by maintaining cleaner teeth, reduction of bad odour (removal of putrifying
food particles from spaces between teeth) and also make the gum healthy.
Types of Dentifrices Name of Institution

• Toothpaste
• Used in conjunction with a toothbrush to help maintain oral hygiene
• Essential components are an abrasive, binder, surfactant and humectants
• Remove debris and plaque with some marketed to serve accessory functions such as
breath freshening and teeth whitening
• Tooth powder
• An alternative to toothpaste
• Comes in both a fluoride and non-fluoride version
• Tooth powder was generally used among the Romans
• They were reduced to a fine powder after having been previously burnt, and
sometimes mixed with honey
• Mouthwash
• Mouthwashes come in a variety of compositions, many claiming to kill bacteria that
make up plaque or to freshen breath
• In their basic form, they are usually recommended to be used after brushing but
some manufacturers recommend pre-brush rinsing
Abrasives/ Name of Institution

Polishing Agents
• These are solid cleansing materials which primarily, act by
removing the debris and residual stain from the teeth by
providing friction and secondarily by polishing the surface of
the enamel
• They generally comprise of 20-50% of the total formulation.
• Examples are silica, sodium metaphosphate, magnesium
trisilicate, precipitated chalk, tribasic calcium phosphate,
hydrated alumina
Advantages and Name of Institution

disadvantages
• Chalk or precipitated calcium carbonate: It is prepared by the double
decomposition of calcium chloride and sodium carbonate in an
aqueous solution.
– These are of low cost and are easily available in number of density grades,
ranging from light to extra dense.
– impurities present and variation in the abrasivity in different lots
• Calcium Phosphate: There are a variety of insoluble calcium
phosphates that are extremely popular and effective in dentifrices
formulation.
• Dicalcium phosphate, dehydrate is excellent and relatively low in
abrasion but is incompatible with most fluorides.
• Dicalcium phosphate, anhydrous is very abrasives and generally
used in low concentrations
• Insoluble sodium metaphosphate: is moderately abrasives and
compatible with fluorides but relatively costly
Silica as abrasives Name of Institution

• Hydrate silica’s are becoming increasingly popular choices as

dental abrasives. They are of two types.
• Abrasive silica
• Thickening silica
• Abrasive silica: are dense, relatively non absorbent, odorless
and tasteless powders. Commercial grade silica “xerogels” are
manufactured under specific manufacturing conditions and are
conspicuous by having such structures which are free void or
air spaces.
• Thickening silica: also referred to as “aerogels “commercially,
are extremely small size particles with very large surface areas
and have the capability of swelling and of thickening the
resulting pastes.
 Name of Institution
Toothpaste : Formulation

• These are either a surface active agent or a soap which is used to aid the action of
abrasives by reducing the surface tension and wetting, the surface of the teeth.
• They penetrate and loosen surface deposits, emulsify and suspend the debris, which
the dentifrices remove from tooth surface.
• Surface active agents are foaming agents employed at levels of 0.5-2% to provide
necessary foaming action.
• Sodium lauryl sacrosinate, sodium lauryl sulfoacetate and dioctyl sodium
sulfosuccinate
• The soap should be completely saponified, should contain 2% moisture, not more
than 0.3% free alkali, calculated as sodium carbonate
Toothpaste : Formulation Name of Institution

• Sweetening Agents
• These are added to mask the bitter tastes of ingredients specially foaming
agent and flavour oils.
• Nutritive sweeteners like carbohydrates cannot be used hence synthetic
compounds like saccharine, aspartame, cyclamates or potassium
acesulfane
• concentrations between 0.05-0.25percent
• Flavouring agents
• Dentifrices flavours belong to a class which not only satisfy the
requirements of the formula but also satisfy the psychology of the
consumer who is looking forward to fresh breath after brushing.
• Therefore they should help prepare a product which have a pleasant long
lasting effect and which preferably has a medicinal or freshening impact.
• Examples are spearmint oil, peppermint oil, oil of winter green, clove oil,
eucalyptus oil, anise oil, sassafras oil etc.
• The flavours are generally used at level between 0.2-2percent.
Toothpaste : Formulation Name of Institution

• Binding/Gelling Agents
– Binders are natural or synthetic gums used in dentifrices formulations to hold the liquid
and solid constituents in the form of a smooth paste.
– They increase the body and viscosity of the liquid phase as well as the final formulation,
preventing liquid bleeding from the paste.
– concentrations between 0.9-2.0percent of the formulations.
– Natural synthetic gums, resins and other hydrocolloids may be employed. The most
popular binder is “carboxy methyl cellulose”
• Water
– Deionised water should be used to formulate toothpastes
• Humectants
– These are one of the liquid components of a toothpaste.
– They are incorporated to prevent moisture loss and drying out of dentifrices so that the
viscosity of the product is maintained.
– In opaque paste they are generally employed in concentrations of between 20%-40%.
– Clear gels are formulated with as much as 80%. Most frequently used are sorbitol,
glycerol and propyl glycol.
Toothpaste : Formulation Name of Institution

• Preservatives
– Formulations of toothpastes require the incorporation of preservatives to maintain the quality and stability
of the product.
– Some preservative action is obtained by the flavouring oils and chloroform present. A mixture of 0.15%
methyl paraben is effective as a preservative.
– Some flavouring (volatile) oils, chloroform, methyl hydroxyl benzoate, propyl hydroxyl benzoate are the
common preservative used in toothpastes.
• Therapeutic Agents
– All toothpaste doesn’t contain these agents.
– These are added in specially formulated medicated toothpaste has either bacterial,
bacteriostatics, enzymes-inhibiting or acid neutralizing qualities.
– They thus reduce dental disease prevents mouth odour.
– Chlorophyll fluoride salt, urea, triclosan, dibasic ammonium phosphate penicillin,
chlorhexidine, sodium dehydroacetae, neem extract are added for there therapeutics agents.
Toothpaste : Formulation Name of Institution

• Therapeutic Agents
– All toothpaste doesn’t contain these agents.
– These are added in specially formulated medicated toothpaste has either bacterial,
bacteriostatics, enzymes-inhibiting or acid neutralizing qualities.
– They thus reduce dental disease prevents mouth odour. Chlorophyll fluoride salt, urea,
triclosan, dibasic ammonium phosphate penicillin, chlorhexidine, sodium dehydroacetae,
neem extract are added for there therapeutics agents.

Miscellaneous Agents
– Titanium dioxide may be added as a whitening agent whenever desired.

– Buffers salts such as sodium phosphate may be used to maintain pH at the desired levels.
Certified colors may be added
 Role of fluoride play Name of Institution

in preventing tooth decay

• Fluoride
– Compound form of fluorine. A trace element, halogen. Very reactive gas.
– Not found in free elemental form in nature
– Major source is from water – artesian wells
– Found in soils rich in fluorspar, cryolite, and other minerals
• Fluoride treatment regimens have been developed to prevent dental caries.
• Systemic fluoride is easily absorbed and is taken up into the enamel during
the period of pre- eruptive tooth formation.
• The predominant beneficial cariostatic effects of fluoride in erupted teeth
occur locally at the tooth surface.
• This could be achieved by fluoridated toothpaste, fluoride-containing water,
fluoridated salt, etc. maintaining elevated intra- oral fluoride levels of the
teeth, dental biofilm and saliva throughout the day.
 Fluoride and dental caries Name of Institution

• Communal Water Fluoridation

• Most effective, practical, feasible and economical public health measure for
preventing caries.
• Greatest resistance to caries and greatest amount of fluoride deposition are
acquired by starting the intake as early as possible and using it continuously
• Other factors to the decline of caries
• Greater dental health awareness
• Expansion in dental resources
• Application of preventive dentistry
• School Water Fluoridation
• Fluoridated with levels of three to seven times the optimum for communal water
fluoridation resulting to reduction in caries incidence
• Fluoride Tablets
• Ingestion daily beginning at 5 – 9 years: permanent teeth can still be significantly
protected from caries
Fluoride and dental caries Name of Institution

• Lozenge is much preferred than tablets or drops

• Prenatal Fluoride Supplement
• Fluoride Supplements (Infants and Children)

• Fluoride Rinses
• Sustained Release Delivery Systems
• Fluoridated Milk

• Fluoridated Salt
Dentinal hypersensitivity Name of Institution

• common clinical condition usually associated with exposed

dentinal surfaces
• clinically described as an exaggerated response to application
of a stimulus to exposed dentine, regardless of its location
• True hypersensitivity can develop due to pulpal inflammation
and can present the clinical features of irreversible pulpitis,
i.e., severe and persistent pain, as compared with typical short
sharp pain of DH
• Dentine hypersensitivity is characterized by short, sharp pain
arising from exposed dentine in response to stimuli, typically
thermal, evaporative, tactile, osmotic or chemical and which
cannot be ascribed to any other dental defect or pathology
MECHANISM Name of Institution

• Three major mechanisms of dentinal sensitivity have been proposed in the

literature:
• Direct innervation theory

• Odontoblast receptor

• Fluid movement/hydrodynamic theory

• Direct innervation theory: nerve endings penetrate dentine and extend to

the dentino-enamel junction
– Direct mechanical stimulation of these nerves will initiate an action potential

• Odontoblast receptor theory states that odontoblasts acts as receptors by

themselves and relay the signal to a nerve terminal
• Hydrodynamic mechanism: Fluid force
Clinical management of Name of Institution

DH
• Classification of desensitizing agents
• Mode of administration
– At home desensitizing agents
– In-office treatment
• On the basis of mechanism of action
• Nerve desensitization
– Potassium nitrate
• Protein precipitation
– Gluteraldehyde
– Silver nitrate
– Zinc chloride
– Strontium chloride hexahydrate
Classification of
desensitizing agents Name of Institution

• On the basis of mechanism of action

• Plugging dentinal tubules
• Lasers
– Sodium fluoride Neodymium:yttrium aluminum garnet (Nd-
– Stannous fluoride YAG) laser
– Strontium chloride GaAlAs (galium-aluminium-arsenide laser)
– Potassium oxalate Erbium-YAG laser
– Calcium phosphate • Homeopathic medication
– Calcium carbonate Propolis
– Bio active glasses (SiO2–P2O5–CaO–Na2O)
• Dentine adhesive sealers
– Fluoride varnishes
– Oxalic acid and resin
– Glass ionomer cements
– Composites
– Dentin bonding agents
Oxalates Name of Institution

• Oxalates can reduce dentinal permeability and occlude dentinal tubules

• Thirty percent potassium oxalate had shown a 98% reduction in dentinal
permeability
• The oxalate reacts with the calcium ions of dentine and forms calcium oxalate
crystals inside the dentinal tubules as well as on the dentinal surface
• This results in a better sealing as compared with an intact smear layer
• This can be attributed to the removal of the calcium oxalate crystals by
brushing or dietary acids
• Portland cement: It helps to occlude the dentinal tubules by remineralization
MANAGEMENT Name of Institution

STRATEGY
• Take a detailed clinical and dietary history.
• Differentially diagnose the condition from other dental pain conditions.
• Identify and manage etiological and predisposing factors.
• In case of mild-to-moderate sensitivity, advice at-home desensitizing therapy.
• If there is no relief or in case of severe sensitivity, initiate in-office treatment.
• In extreme cases, if patient does not respond to the therapy and there are
individual teeth exhibiting the symptoms, then endodontic therapy can be
initiated.
• A regular review should be made with an emphasis on prevention of the
condition.
Calcium carbonate Name of Institution

• The most commonly accepted hypothesis of the etiology of dental caries is

that acids produced by the fermentation of carbohydrate foods penetrate
the plaque in sufficient concentration to dissolve the inorganic salts of the
enamel.
• Particles of calcium carbonate, commonly used in toothpaste as an
abrasive.
• The arginine complex is responsible for adhering the calcium carbonate
particles to the dentin or enamel surface
• Calcium carbonate is not very soluble and releases very low levels of
calcium into the oral cavity
Remineralization strategies Name of Institution

• Fluoride
• The effect of fluoride on different dental
tissues such as enamel and dentin may
vary during remineralization
• Fluoride can get incorporated into
hydroxyapatite forming
fluorohydroxyapatite, which has a lower
solubility
• Amine fluoride may markedly increase
enamel microhardness in comparison to
NaF
– Sodium fluoride,
– Sodium silico-fluoride,
– Stannous fluoride and
– Sodium monofluorophosphate
Zinc oxide-eugenol cement as Name of Institution
dental material
• Zinc oxide-eugenol cements are considerably better tolerated by tissue than
other dental materials
• As they alleviate pain and are bacteriostatic and antiseptic, they are well
tolerated by patients.
• The cements are good insulators and possess better sealing properties than
zinc phosphate cements.
• Because of their poor mechanic properties, the conventional zinc oxide-
eugenol cements are mainly used as temporary fixing contents and filling
materials, for gingival dressings and together with filling materials as
impression materials.
• Recently, reinforced zinc oxide-eugenol cements and cements containing
ethoxy benzoic acid (EBA) have been developed.
• These new cements have considerably better mechanic properties and are
therefore used for cement bases, indirect capping, long-term temporary
fillings and in selected cases as definite fixing cements.