ORAL AND DENTAL CARE PRODUCTS

•Keeping the teeth and oral cavity clean and fresh has been part of the human daily routine for a long time.

• In the past, dental care products were primarily cleansing aids, which were used to remove debris and polish the teeth.

• Today, the majority of dental care products offer additional benefits in the prevention of common dental problems such as caries or gingivitis.

•ANATOMY AND PHYSIOLOGY OF THE HUMAN ORAL CAVITY

• The human oral cavity includes the lips, buccal mucosa, salivary glands, gums, teeth, palate (which forms the roof of the mouth), tongue, and floor of the mouth.

• It is the most complex and most accessible microbial ecosystem of the human body. Its parts all provide different surfaces for microbial colonization.

• The constant production of saliva and the presence of sugars and amino acids from foods provide nutrients for microbial growth.

•Generally, in a single subject, it is usual to find between 20 and 50 species of bacteria at healthy oral sites. At the diseased sites, there is a tendency for higher numbers of different species to be present, perhaps 200 or more

•As for its anatomical structure, a human tooth can be considered to consist of three major parts:

1. the crown, which is visible and extends above the gum (gingiva)

2. the root, which sits in the upper or lower jawbone and remains invisible until recession of the gum exposes some of the root surface

3. the neck, which is the boundary between the root and the crown.

• The dental cavity (pulp cavity) contains the pulp, a soft connective tissue containing nerves and blood vessels.

• The pulp cavity receives blood vessels and nerves through a narrow canal, the root canal located at the base of the tooth.

•Dentin-forming cells are also found here, on the boundary of the dental cavity and dentin.

• Each tooth consists of three hard substances that resemble a bone: enamel, dentin, and cement.

• Enamel is the hardest substance in the human body; it is the white outer part of the tooth.

• Its function is to prevent the tooth from wearing away under the pressure of chewing.

• The calcium in our enamel, which is present in the form of hydroxyapatite, starts dissolving below pH 5.5. The pH of fruit juices and many carbonated drinks is known to be below this pH.

• Extensive consumption of such drinks may change the pH in the oral cavity and facilitate the chemical dissolution (i.e., demineralization) of dental calcium and phosphate.

• Saliva can buffer the pH up to a certain extent; however, repeated exposure to such acidic drinks can greatly increase demineralization.

•Under normal conditions, closer to pH 7 (neutral), such as periods between meals, the enamel tends to reacquire mineral ions (remineralize) from the saliva and minor carious lesions may be repaired.

• The demineralization and remineralization processes can have a crucial impact on the hardness and strength of the tooth enamel.

•Dentin forms the largest portion of the tooth; it is a yellowish bone-like layer surrounding the dental cavity.

• At the crown, the dentin is covered by the enamel.

•Dentin is less dense than enamel; thus, it is more porous, softer, more sensitive, and more susceptible to decay and wear if exposed.

• At the root, dentin is covered by the cementum, which is a special connective tissue.

• It binds the roots of the teeth firmly to the gums and jawbone.

• THE MOST COMMON ORAL AND DENTAL CARE PROBLEMS

• There are many oral and dental diseases that may result from poor dental hygiene.

• The most common problems include plaque formation, dental caries, tartar formation, gum disease, tooth sensitivity, dental stain, and bad breath.

• Plaque is a sticky, colorless film of bacteria and sugars that constantly forms on our teeth.

• It is the main cause of cavities and gum disease and can harden into tartar if not removed daily.

•Dental caries, also known as tooth decay and cavities, is a universal problem affecting all ages and all geographic locations around the world.

• It can be defined as a disease resulting in the breakdown and destruction of the enamel due to demineralization (i.e., loss of calcium and phosphate from the enamel).

• It appears as tiny brown holes on the surface of the teeth.

•When eating sugars, the cariogenic bacteria (i.e., caries-causing), particularly Streptococcus mutans, in plaque produce acids that attack enamel.

• The firm adherence of the bacteria to the teeth keeps these acids in contact with the teeth. Over time, the acids lead to breakdown of the enamel, and this is when caries can form.

• It is widely accepted that regular use of fluoride, i.e. in toothpaste and drinking water, is extremely effective in preventing dental caries.

•Because water fluoridation is not available in many countries, toothpaste is globally considered to be one of the most important sources of fluoride.

• Today, the majority of toothpastes contain fluoride in an amount that is high enough to prevent the formation of cavities.

• Tartar, otherwise known as dental calculus, is a plaque that is hardened (calcified) on the teeth.

• It can also form beneath the gums and can irritate the gum tissues.

• It gives plaque more surface area to grow and can be a causative factor in other dental diseases.

• In the long term, it causes a yellowish-brownish discoloration to the teeth.

•As tartar is hardened on the teeth, it cannot be removed by simple brushing; it has to be mechanically removed by dental professionals.

•Gum disease, otherwise known as periodontal disease, is an infection of the gums that can progress to affect the bone that surrounds and supports the teeth.

• It is the major cause of teeth loss among adults.

• This disease is caused by plaque formation. Plaque can be removed by regular brushing and flossing; however, if not removed, it can eventually lead to infection and inflammation.

• The early stage of periodontal disease is called gingivitis (i.e., inflammation of the gums).

• It often results in gums that are red and swollen and may bleed easily.

• This stage, however, is usually reversible since the connective tissue and the bone are not yet affected.

• If gingivitis is left untreated, it can advance to periodontitis (which means inflammation around the teeth). At this stage, the gums pull away from the teeth and form small pockets below the gumline.

• These pockets can trap food and plaque and eventually lead to more severe infection and inflammation.

• If not treated, the bones, gums, and tissue that support the teeth are destroyed. As a result, the teeth can become loose and may eventually fall out.

• Tooth sensitivity is a common dental condition

• Patients experience brief episodes of sharp well-localized pain when subjected to various stimuli, such as cold and hot drinks and food, brushing, and air currents.

• The teeth can become sensitive for various reasons, including worn tooth enamel, worn fillings, gum recession, tooth decay, a cracked tooth, tooth roots that are exposed as a result of aggressive brushing, gum disease, or even dental procedures can lead to temporary sensitivity.

•Depending on the cause, tooth sensitivity can be treated in several ways.

• A self-treatment option is the use of anti-sensitivity toothpaste.

•Dental stains, or tooth discoloration, are spots or small areas on the teeth contrasting with the rest of the teeth color.

• They may be caused by multiple local and systemic conditions, which are typically classified as being either intrinsic or extrinsic.

• Intrinsic discoloration means that the enamel and/or dentin in the tooth darken, and therefore, the teeth get a yellow tint.

•Discoloration may be caused by dental materials, caries, trauma, infections, medications (such as tetracyclines), and even excessive fluoride intake while the teeth are still developing.

• Extrinsic stains are caused by certain molecules and metal ions found in our diet. Such ingredients include coffee, tea, wine, and tobacco.

• Bad breath, otherwise known as oral malodor or halitosis,

•While malodor can be the result of a number of various factors, including certain foods, tobacco, alcohol, certain medications, gum disease, digestive, or metabolic disorders, it has been shown that, for 9 out of 10 people, the cause of their oral malodor originates in the mouth.

• The bacteria in the oral cavity produce a range of malodors. These bacteria are influenced by eating, drinking, oral hygiene, and sleep.

• Saliva production in the mouth facilitates the clearing away of bacteria.

•During sleep, when there is a reduced flow of saliva in the mouth, bacteria build up, leading to oral malodor in the morning

• TOOTHPASTE

• Toothpaste is a mild cosmetic detergent for cleaning the teeth.

• Initially intended to freshen the breath and remove deposits from teeth, the evolution of toothpaste has also made it a vehicle for the protection of teeth from cavities, calculus formation, and gum diseases.

• Inactive Ingredients

•Abrasives are typically insoluble inorganic ingredients that clean and polish the teeth to remove debris and residual surface stains.

• TOOTHPASTE

•When selecting abrasives, there are a number of factors that should be taken into consideration, including their hardness, toughness, chemical inertness, and particle size and shape.

• Abrasives should not damage the gums, enamel, and dentin.

• Calcium-based abrasives should be avoided in toothpastes containing sodium fluoride since the formation of an insoluble calcium salt decreases the active fluoride concentration.

• Calcium-containing abrasives are significantly more compatible with sodium monofluorophosphate than with sodium fluoride

• Surfactants aid in cleaning and foaming. Typically, anionic surfactants are used in toothpaste formulations since they have a powerful cleaning efficacy and are generally compatible with the other ingredients.

•Originally, soap was used; however, it is strongly alkaline and, therefore, incompatible with some other components, and it has an unpleasant odor and a bitter taste.

• Thickeners, Due to its presence, the toothpaste can stand on the brush and does not run into the bristles.

• Sweetening agents are important for product acceptance

• Sweeteners should always be considered in partnership with flavors

• Sweeteners are usually applied in a very small concentration due to their highly sweet taste.

• They can be utilized to mask the taste of the raw ingredients and not necessarily to provide only a sweet taste.

• Therefore, companies manufacturing toothpaste

•do not use sugars for providing the formulation with a sweet taste because it causes caries. Instead they use sugar derivatives

•Humectants prevent the paste from drying out (i.e., they retain moisture), locking of the cap to the nozzle, and hardening to an unacceptable level. At the same time, they provide shine and some plasticity to the paste.

•Water

•Preservatives

• Flavoring agents

•Coloring agents

• pH regulators

•Active Ingredients

•Anticaries components are used to prevent cavities; they strengthen the tooth enamel and remineralize tooth decay.

• Two main types of anticavity actives are available on the market: fluoride and nonfluoride components

• Fluoride components include sodium monofluorophosphate, sodium fluoride, and stannous fluoride.

• The mechanism of action of fluorides includes initiating and speeding up remineralization and slowing down demineralization.

• Saliva in itself is able to supply the enamel with lost minerals, e.g. calcium and phosphate ions, when the pH is above 5.5 (to a certain extent).

• In the presence of fluoride (from water or toothpaste), fluorohydroxyapatite forms in addition to hydroxyapatite, and this creates supersaturated solution outside the enamel.

• Therefore, calcium and phosphate ions are more efficiently recovered if fluoride is present in the saliva and bacterial biofilm.

• Fluorohydroxyapatite is less soluble than hydroxyapatite and is, therefore, more resistant to subsequent demineralization when acid challenged.

• It is very important to keep the fluoride ions in a stable state. If insoluble salts are formed, the anticaries activity is lost.

•Antiplaque and antigingivitis components

•Most antiplaque and antigingivitis agents in oral use are antiseptics or antimicrobials that kill or inhibit bacteria causing plaque and gingivitis.

• The two most frequently used ingredients are stannous fluoride and triclosan.

• Stannous fluoride’s mechanism of action involves its bacterial killing (i.e., antibacterial) effect and inhibitory effect on bacterial enzymes.

•Antihypersensitivity agents are used to protect the exposed tooth surfaces and the gingival margin.

•Potassium components, such as potassium nitrate (in 5%), potassium chloride, and potassium citrate, desensitize the tooth nerve endings.

•Other ingredients, such as strontium chloride (which is incompatible with fluoride though), stannous fluoride (in 0.454%), and calcium sodium phosphosilicate, reduce the permeability of dentin and prevent the nerve endings to be stimulated.

•Anticalculus/tartar control ingredients prevent calculus formation on the surface of the teeth through controlling mineralization (they are also called crystal growth inhibitors).

• Examples for such ingredients include pyrophosphates, e.g., tetrasodium pyrophosphate (TSPP), tetrapotassiumpyrophosphate (TKPP), disodium dihydrogenpyrophosphate; phosphonates, e.g., sodium hexametaphosphate (SHMP); zinc salts, e.g., zinc citrate, zinc chloride, and zinc lactate; as well as a copolymer of methyl vinyl ether and maleic anhydride (PVM/MA).

• Whitening Ingredients:

• Non-bleaching whitening products contain agents that work by physical or chemical action to help remove surface stains only.

• Any toothpaste containing abrasives provide whitening action as they remove stains from the teeth.

• For more efficient results, chemical action may also be utilized where positively charged ingredients (e.g., SHMP) bind to the negatively charged stain molecules.

• Bleaching agents actually change the natural tooth color.

• They contain peroxides, such as hydrogen peroxide and carbamideperoxide, that help remove deep (intrinsic) and surface (extrinsic) stains.

•Antimalodor Ingredients:

• Ingredients used include flavors to freshen breath by masking the bad odor.

• They have only a temporary action since as saliva relatively quickly washes away the flavoring ingredients.

•Antibacterial agents are also used to kill the bacteria causing bad breath. They offer a longer-term benefit, and, opposed to flavors, they can actually treat the source of the problem.

•MOUTHWASH

•Mouthwash is a solution that is aimed to refresh the breath by swishing the product around the mouth, followed by spitting it out.

• Similar to toothpaste, it may also have additional benefits, such as prevention against tooth decay, gingivitis, plaque formation, or tartar formation, or a combination of these.

• Inactive Ingredients

• Solvents

•Generally, two main solvents are used in mouthwash formulations, water and alcohol (i.e., ethanol).

•Alcohol has an antibacterial activity, acts as an astringent, and contributes to the fresh feeling provided by the product. It may also help stabilize the product by solubilizing the flavoring oils.

•Humectants increase the viscosity of the product and result in a good mouthfeel.

• They also inhibit “crystallization” around th closure.

•Without these ingredients, the products would have a harsh chemical-like taste/feel.

• They may also contribute to the sweetness.

• Flavoring Agents

• Sweeteners

•Colorants

• Surfactants are used in mouthwash formulations to solubilize the flavoring oils and stabilize the products.

• They can provide foaming action on use, with this action they contribute to the cleansing effect of the product.

• Examples include nonionic surfactants, such as poloxamers and polysorbates, such as polysorbate 80, as well as anionic components, such as sodium methyl cocoyl taurate and sodium lauryl sulfate.

•Astringents can serve as temporary deodorizers that mask bad breath.

•Preservatives: Although alcohol has an antibacterial activity, its antibacterial profile may not cover all microorganisms that frequently contaminate such formulations.

•Mouthwashes are basically water/humectants systems, which is a perfect environment for microbial growth.

• Therefore, most formulations contain additional preservatives as well.

•Active Ingredients

•Antiplaque/Antigingivitis Agents:

•Chlorhexidine is a very effective agent to reduce plaque formation and gingivitis; its disadvantages include staining of the teeth, taste modification, and increased calculus formulation

• Essential oils

• cetylpyridinium chloride (its disadvantage is that anionic surfactants inactivate it, so it is usually not recommended to use after brushing)

• triclosan

•Anticaries Agents

•Antihypersensitivity Agents

•Antitartar Agents

•Whitening Agents.

• TOOTH WHITENING AIDS

• Tooth bleaching is an oxidative process that alters the light absorbing or light reflecting nature of the tooth structure, increasing its perception of whiteness.

• free radicals produced by hydrogen peroxide interact with pigment molecules to produce a whitening effect.

• Enamel dehydration during bleaching may also result in a temporary whitening effect as enamel dehydration alone is capable of producing a significant, visible tooth shade reduction.

•Gels and solutions are typically applied using a custom bleaching tray.

• It is inserted into the mouth after brushing the teeth for a shorter (half an hour) or a longer (even 8–10 h) period of time.

• Strips are usually made of polyethylene and polypropylene polymers coated with an adhesive gel on one side.

•As the strip is placed on the teeth, the gelling agents, such as carbomer, polyvinylpyrrolidine (PVP), and acrylate polymers, start swelling, providing adhesiveness and appropriate coverage on the tooth surface.

• The strips are placed on the teeth for about half an hour.

•Most bleaching products are hydrogen peroxide based, although some contain carbamide peroxide.

•Hydrogen peroxide is a highly reactive chemical; it is a strong oxidant and can form free radicals.

• It is available on the market as an aqueous solution containing up to 33–37% pure hydrogen peroxide and other additives to prevent product decomposition.

• Carbamide peroxide decomposes to release hydrogen peroxide in an aqueous medium: 10% carbamide peroxide yields approximately 3.5% hydrogen peroxide.

•Most frequent side effects of teeth whitening include transient mild-to-moderate tooth sensitivity, gingival irritation, and release of some components of fillings.

•Gels of high hydrogen peroxide concentrations, such as those for in-office bleaching, should be used with appropriate gingival protection to avoid severe damage.

•DENTAL FLOSS

•Dental floss is a thin filament used to clean the areas in the oral cavity, which are more difficult to reach with a toothbrush (such as the surface between the teeth as well as the teeth and the gums).

•Dentists recommend flossing as a critical part of any daily oral care routine.

•Dental floss is generally recommended to use before brushing as the fluoride (from this way the toothpaste) has a better chance of reaching between the teeth.

•Dental floss may be treated with flavoring agents, such as mint, to make flossing more pleasant.

•Waxes help introduce the floss between the teeth.

• Examples include beeswax, carnauba wax, and jojoba wax.

• Even active ingredients may be deposited on the strings, including antitartar ingredients and fluoride.

•Dental tape is similar to dental floss.

• The only difference is in the shape of the filaments.

• Floss has a round cross section, and the tape has a very thin, almost rectangular cross section that helps clean wider spaces between the teeth.

• Ingredients Causing Safety Concern

• Fluoride The biggest issue with accidentally or intentionally swallowed toothpaste is its fluoride content.

• Fluoride is an effective active ingredient when used topically; however, even relatively small doses can induce symptoms of acute fluoride toxicity if consumed.

• The probably toxic dose of fluoride is generally accepted to be 5mg fluoride ion per kg body

• Early symptoms include gastrointestinal pain, nausea, vomiting, and headaches. It should be noted, however, that toxicity symptoms also occurred at much lower doses (0.3 mg).

• According to the FDA’s recommendations, children under the age of 6 should use only a pea-sized amount of toothpaste.

• Fluorosis.

•Dental fluorosis is a change in the appearance of the enamel.

• These changes can vary from barely noticeable white spots in mild forms to staining and pitting in the more severe forms.

•Dental fluorosis can occur only when younger children consume too much fluoride, from any source, over long periods when permanent teeth are developing under the gums.

•Only children aged 8 years and younger can develop fluorosis because this is when permanent teeth are developing under the gums.

• Fluorosis does not develop after the teeth have erupted into the mouth.

•Most cases of fluorosis result from taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.

• There are anti-cavity toothpastes on the market for children 2 years of age and older. However, until about age 6, children have poor control of their swallowing reflex and frequently swallow most of the toothpaste placed on their brush.

• Parents should provide kids with only a small (pea-sized) amount of toothpaste and make sure that children do not swallow it.

•Use of flavored toothpaste is not recommended since it may encourage swallowing.

• Fluorosis is not a disease; it does not affect the function of the teeth.

• The spots and stains left on the teeth are permanent and may also darken over time; therefore, fluorosis is considered a cosmetic condition.

•Hydrogen Peroxide

•Overuse may result in severe damage to the teeth and gum; however, more severe damage is caused by accidental consumption (swallowing of a whitening solution, for example).

• Ingestion of hydrogen peroxide may cause irritation of the gastrointestinal tract with nausea, vomiting, blood vomiting, and foaming in the mouth; the foam may obstruct the respiratory tract or result in pulmonary aspiration.

• Painful gastric distension and belching may be caused by the liberation of large volumes of oxygen in the stomach.

• It is very important, therefore, to make sure that children do not use such formulations, and even adults have to pay attention not to swallow gels or solutions after a whitening treatment