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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