DH II Module 4 Dentifrices Mouthrinses and Oral Irrigation

  1. An active or ________ ingredient is an additive that
    produces a therapeutic effect on either the hard or soft tissues
  2. An inactive ingredient is an additive that
    is necessary to make the toothpaste thick, hold together, clean efficiently, or have a particular color or flavor for consumer appeal
  3. The basic inactive ingredients of toothpaste include
    • Water (the main ingredient)
    • A cleaning/polishing agent (abrasive)
    • A humectant (retains moisture)
    • Preservatives
    • Binders (thickeners)
    • Flavoring/sweetening agents
    • A detergent (foaming action)
  4. 60-80% of the inactive ingredients of dentifrices include
    • Water
    • Humectants
    • Abrasives
  5. An abrasive is a _______ agent and is used to
    • cleaning and polishing
    • produce a smooth tooth surface
  6. What are the three most common abrasive agents and their subtypes
    • Phosphates
    • Dicalcium phosphate dihydrate (common dietary supplement)
    • Calcium pyrophosphate (also a dietary supplement)
    • Carbonates
    • Sodium bicarbonate (baking soda)
    • Calcium carbonate (chalk)
    • Silicas (the main component of sand)
  7. What is the Mohs scale
    A 10-point scale that classifies minerals from softest (1) to hardest (10) and can be used to classify the abrasive particles in toothpaste
  8. Another method used to determine the abrasiveness of toothpaste besides the Mohs scale is the _______. The FDA recommended limit is ______ and the ADA recommended limit is ______
    • Relative Dentin Abrasitivity (RDA) index
    • 200
    • 250
  9. What is the purpose of the Humectant and what are the substances used in dentifrices
    • Retain moisture in the product
    • Prevent hardening on exposure to air

    • Glycerol (absorbs water)
    • Xylitol
    • Sorbitol: High concentrations are used as binders in gel dentifrices
  10. What is the purpose of the Preservatives and what are the substances used in dentifrices
    • Prevent mold and bacterial growth in the product
    • Prolong shelf life

    • Sodium benzoate (type of salt)
    • Alcohol
    • Dichlorinated phenols
  11. What is the purpose of Binders and what are the types used in dentifrices
    • Stabilize the formulation
    • Prevent separation of the solid and liquid ingredients during storage

    • Mineral colloids
    • Natural gums
    • Seaweed colloids
    • Synthetic cellulose (manmade chemical compound)
    • “Natural” dentifrice manufacturers tend to use the plant-based products
  12. What is the purpose of detergents and what are the types used in dentifrices
    • Lower surface tension (allowing water to spread out)
    • Penetrate and loosen surface deposits
    • Emulsify/disperse the flavor oils
    • Contribute to the foaming action

    • Cocamidopropyl betaine (from coconut oil)
    • Sodium N-lauryl sarcosinate
    • Sodium lauryl sulfate (the most common, probably because it is inexpensive)
  13. What is the caution with using sodium lauryl sulfate
    • Sodium lauryl sulfate can be an irritant
    • It is linked to recurrent aphthous ulcers in some patients
    • If this occurs, recommend a dentifrice containing cocamidopropyl betaine such as Sensodyne Pronamel or Colgate Luminous
  14. What types of flavoring agents used in dentifrices
    • Essential oils (peppermint, wintergreen, clove, or cinnamon)
    • Artificial noncariogenic sweeteners
    • Glycerol
    • Sorbitol
    • Xylitol
  15. What is the caution with using the cinnamon essential oil
    can cause a burning sensation, tissue sloughing, contact stomatitis, or allergic reactions
  16. Therapeutic (active) ingredients target ________ and include _________
    • the prevention of oral disease or target a specific condition
    • Anti-caries
    • Anti-biofilm/Anti-gingivitis
    • Anti-calculus
    • Anti-oral malodor (Halitosis)
    • Anti-sensitivity
  17. What are the most common fluorides (anti-caries) added to dentifrices
    • Stannous fluoride (SnF2)
    • Sodium fluoride (NaF)
    • Sodium monofluorophosphate (abbreviated to MFP, chemical formula Na2PO3F)
  18. ________ was the 1st fluoride added to a dentifrice formulation and what are its side effects? The tin ion in it has
    • Stannous fluoride
    • Side effects of stannous fluoride include the potential for staining the teeth and tissues as well as altered taste
    • anti-caries, anti-plaque, and anti-gingivitis effects
  19. The most widely used dentifrices contain a combination of what kind of fluorides
    sodium fluoride (24%) and sodium monofluorophosphate (76%)
  20. What are three effects of Sodium Bicarbonate
    • It neutralizes bacterial acids that initiate demineralization and dental caries
    • It has very low abrasitivity, but can effectively remove extrinistric stains
    • It also inhibits volatile sulfuric compounds (VSCs) to reduce oral malodors
  21. Xylitol is a naturally occurring sugar substitute that has _________ properties
    • anti-cariogenic and antiplaque
    • It reduces the levels of Streptococcus mutans
    • Its anti-plaque properties include the ability to loosen plaque biofilm from around the tooth surface as well as reducing the formation of biofilm
  22. What are some Anti-calculus "tartar control"  therapeutic agents and it's properties
    • Sodium Hexametaphosphate
    • The most effective ingredient shown to have anti-calculus capabilities
    • Pyrophosphate Salts
    • Pyrophosphate is the next most effective ingredient in reducing calculus formation
    • Pyrophosphates, as well as flavoring agents, have been implicated in tissue sloughing and a burning sensation
    • Zinc chloride and zinc citrate
    • Zinc chloride and zinc citrate are used alone or in combination with other anti-calculus chemicals to prevent calculus accumulation or break down calculus formation
  23. What is triclosan and what are its properties
    • a broad spectrum antimicrobial agent that has anti-calculus, anti-plaque and anti-inflammatory properties and is effective in preventing gingivitis
    • When triclosan is combined with a copolymer of polyvinyl methoxyethylene and maleic acid (PVM/MA) its substantivity is increased (meaning it can adhere to the teeth and gums longer)
  24. Substantivity is the ability of a therapeutic agent to
    adhere in the oral cavity and to continue to be released over a period of time
  25. What are some factors that contribute to dentinal hypersensitivity
    • Gingival recession
    • Loss of enamel
    • Toothbrush abrasion
    • Erosion
    • Abfraction
    • Acidic foods
    • Periodontal surgery
    • Occlusal hyperfunction
    • Cusp grinding
    • Instrumentation
    • Cosmetic tooth whitening
  26. Desensitizing agents used in treatment are classified by what mode of action
    • Inactivation of the nerve membrane (hyperpolarization)
    • Occlusion of the open dentinal tubules
  27. What is the function of Potassium Nitrate
    Anti-sensitivity agents (also a salt and a preservative) works as a nerve calming agent rather than a barrier
  28. __________ is the most effective agent for reduction of dentin hypersensitivity
    5% potassium nitrate
  29. What is the function of Strontium Chloride
    Anti-sensitivity agents (a salt) that occludes (forms a barrier) dentinal tubules
  30. As an Anti-Sensitivity agent Stannous fluoride (0.4% or 0.454%) produces a
    protective smear layer and the precipitation of calcium fluoride crystals, which physically block exposed dentinal tubules
  31. Dentifrices responsible for stain removal do so either _____ or ______
    physically or chemically
  32. Physical whitening occurs through ________ while Chemical whitening dentifrices _______
    • abrasives that remove stain
    • produce the effect by changing tooth color
  33. Chemical whitening dentifrices usually contain _______ or _______
    hydrogen peroxide or carbamide peroxide
  34. Physical whitening (abrasive) dentifrices contain one or more of the following
    • Sodium bicarbonate (mild abrasive)
    • Dicalcium phosphate dehydrate (mild abrasive)
    • Calcium carbonate (moderate abrasive)
    • Aluminum silicate (very abrasive)
    • Alumina (very abrasive)
  35. What are the three ways or producing Reduction of Oral Malodor (Halitosis)
    Chlorine dioxide, essential oils, and zinc chloride reduce volatile sulfur compounds (VSCs)

    Triclosan/copolymer reduces oral malodor by controlling bacteria

    Stannous fluoride combined with sodium hextametaphosphate can reduce VSC production
  36. Cosmetic mouthrinses _______ bad breath
    temporarily reduce
  37. In order for a mouthrinse to get an ADA seal the company
    must submit scientific evidence that the product is safe and effective
  38. The American Dental Association (ADA) has approved what two mouthrinses for controlling and treating plaque biofilm and gingivitis
    • Chlorhexidine Gluconate (Rx, prescription)
    • Listerine (OTC, over-the-counter)
  39. Mouthrinses can have beneficial affects on oral tissues but rinsing is ineffective against the _________ flora because it can only deliver
    • subgingival
    • an agent less than 2 mm into the sulcus or pocket
  40. Basic mouthrinse ingredients include
    • Water
    • Makes up the largest percentage by volume
    • Flavoring agent
    • Provides a pleasant taste
    • Astringents
    • Ethyl alcohol
  41. What astringents are put in mouth rinses and what is their purpose
    citric acid and zinc chloride

    Provide an invigorating sensation in the mouth
  42. What is the percentage of ethyl alcohol in mouth rinses and what is their purpose
    Many products contain 11-27% alcohol

    • Acts as a solvent and a taste enhancer
    • Can contribute to an antibacterial effect
  43. What is the mechanism of action of CHX and what is the substantivity?
    • It attaches to and breaks the bacterial cell membrane causing the death of the cell (lyses)
    • It also binds to pellicle to prevent biofilm accumulation

    8 to 12 hours
  44. What are some recommended uses of CHX
    • Preprocedural rinse to reduce bacterial load prior to instrumentation that produces aerosols
    • After periodontal debridement or surgery
    • Patients who are at a high risk for dental caries
    • Immunocompromised individuals who are more susceptible to infection
    • Temporary use for individuals who do not or can not perform adequate self-care with mechanical devices (e.g. patients that have oral lesions from cancer Tx)
  45. What are some issues to discuss with a patient when chlorhexidine is recommended
    • Staining of teeth, soft tissues, tooth-colored restorations, margins of restorations, and pits and fissures
    • Possible increase in supragingival calculus formation
    • Possibility of an altered taste perception
    • Minor irritation to soft tissues, lips, and tongue
    • Superficial desquamation of the oral mucosa
  46. CHX is inactivated by ______ therefore advise the patient to wait ________ after brushing before rinsing with chlorhexidine
    • sodium lauryl sulfate and some fluorides (ingredients in some toothpastes)
    • 30 minutes
  47. What is the mechanism of action of Quaternary Ammonium
    binds easily to oral tissues but has low substantivity

    causes the cell membrane to leak, which eventually leads to cell death
  48. _________ is the most commonly used quaternary ammonium
    Cetylpyridinium chloride (CPC)
  49. What are some familiar brands of Quaternary Ammonium
    • Cepacol
    • Scope
    • Act (also has sodium fluoride)
    • Crest Pro-Health can contribute to temporary, brown tooth discoloration
    • Crest has an alcohol-free formulation
  50. The most familiar essential oil mouthrinse is
  51. Essential oils of spices and herbs have ___________ properties
    antibacterial and antifungal
  52. Essential oils of mouthrinses include
    • Thymol (oil of thyme)
    • Eucalyptol (eucalyptus oil)
    • Menthol (peppermint oil)
    • Methylsalicylate (wintergreen oil)
  53. The American Academy of Pediatrics recommendations for children’s mouthrinses
    • Alcohol content be limited to less than 5%
    • Package volume be minimal to prevent lethal dosages (small bottles)
    • Bottles should have child safety caps
  54. What is the mechanism of action of Hydrogen peroxide
    • the release of oxygen that acts to debride the area
    • It alters bacterial cell membrane by increasing permeability
    • It has a slight antimicrobial effect
  55. Hydrogen peroxide is recommended for _______ use only. Prolonged use of ___% hydrogen peroxide rinse can result in ________
    • short-term
    • 3%
    • gingival irritation and delayed tissue healing
  56. ________ is an example of a commercially available hydrogen peroxide rinse
    Peroxyl 1.5%
  57. What are some Self-Prepared Mouthwashes
    • Hypertonic sodium chloride (saline solution)
    • Reduces swelling
    • ½ to 1 tsp. salt dispensed in 4 to 6oz of warm water
    • Sodium Bicarbonate (neutralizes acids)
    • ½ to 1 tsp. baking soda dispensed in 4 to 6oz of warm water
  58. ______ is sold as a prebrushing rinse and contains

    a detergent-sodium benzoate mixture and it also contains Triclosan.
  59. Oral irrigation is defined as the
    targeted application of a pulsated or steady stream of water or other irrigant for preventive or therapeutic purposes
  60. Irrigation can be an effective __________ and ________ bacterial plaque but pulsated water can _______
    • adjunctive therapy
    • does not remove
    • remove the bacterial toxins (bacterial by-products) therefore reducing bleeding and gingival inflammation
  61. When a tip is directed perpendicularly to the long axis of the tooth (as it should be used), what two zones of hydrokinetic activity (motion of fluid) are created
    • Zone 1: impact zone, where the irrigant makes initial contact
    • Zone 2: flushing zone, where the irrigant is deflected from the tooth surface subgingivally
  62. Soft rubber oral irrigation tip (flexible) is designed to be placed at _______ and is placed ______
    • a site-specific areas subgingivally
    • approximately 2 mm subgingivally
  63. Tapered plastic tip (monojet) designed to be used ________ and is placed at the _________
    • supragingivally
    • gingival margin
  64. The ________ is the regulatory agency for oral care product
    Food & Drug Administration (FDA)
Card Set
DH II Module 4 Dentifrices Mouthrinses and Oral Irrigation
DH II Module 4 Dentifrices, Mouthrinses, and Oral Irrigation