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

COMMON DENTAL PROBLEMS &OTC PRODUCTS

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- PLAQUE 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- PLAQUE 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- PLAQUE 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

CON.

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

CON.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

Not preferred for long use and exposed root surface

CON. TOOTHPASTE 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 Tartar Control Whitening )

CON. TOOTHPASTE 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 **Max concentration approved in

toothpaste is 260 mg per container ..

CON.

(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)

CON.

(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)

CON.

(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

CON.

(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.

CON, 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 )

CON.

(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- GINGIVITIS

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 DISEASE.

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-ACUTE NECROTIZING ULCERATIVE GINGIVITIS (ANUG) 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-TEMPOROMANDIBULAR 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-CANKER 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.

CON.

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

CON,

(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-BRx 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 teaspoons of water swish then expectorate , dnt eat I hr after admin.

(3) Thalidomide : treatment of AIDS associated oral canker sores.

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

CON.

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 2nd infection developed .

**lip sunscreen if the sores is caused by sun

**L-lysine (a.a) (300-1200mg daily) to accelerate recovery .

CON.

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 .

COMMON 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.

CON.

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.

PROPHYLAXIS 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 600 mg (adults) 20 mg\kg

(children)B-cephalexin 2 g(adults) 50mg\kg

(children)C-azethromycin or 500 mg (adults) 15 mg\

kg (children) 1 hr before procedure.

OTC 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 ).Dnt soaked in hot water as may distort the

appliances.

OTC 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.

PHARMACIST’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 disconnect the use of product and dentist should be contacted