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An active or ________ ingredient is an additive that
produces a therapeutic effect on either the hard or soft tissues
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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
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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)
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60-80% of the inactive ingredients of dentifrices include
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An abrasive is a _______ agent and is used to
- cleaning and polishing
- produce a smooth tooth surface
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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)
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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
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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
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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
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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
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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
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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)
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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
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What types of flavoring agents used in dentifrices
- Essential oils (peppermint, wintergreen, clove, or cinnamon)
- Artificial noncariogenic sweeteners
- Glycerol
- Sorbitol
- Xylitol
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What is the caution with using the cinnamon essential oil
can cause a burning sensation, tissue sloughing, contact stomatitis, or allergic reactions
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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
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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)
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________ 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
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The most widely used dentifrices contain a combination of what kind of fluorides
sodium fluoride (24%) and sodium monofluorophosphate (76%)
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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
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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
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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
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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)
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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
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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
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Desensitizing agents used in treatment are classified by what mode of action
- Inactivation of the nerve membrane (hyperpolarization)
- Occlusion of the open dentinal tubules
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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
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__________ is the most effective agent for reduction of dentin hypersensitivity
5% potassium nitrate
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What is the function of Strontium Chloride
Anti-sensitivity agents (a salt) that occludes (forms a barrier) dentinal tubules
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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
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Dentifrices responsible for stain removal do so either _____ or ______
physically or chemically
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Physical whitening occurs through ________ while Chemical whitening dentifrices _______
- abrasives that remove stain
- produce the effect by changing tooth color
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Chemical whitening dentifrices usually contain _______ or _______
hydrogen peroxide or carbamide peroxide
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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)
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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
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Cosmetic mouthrinses _______ bad breath
temporarily reduce
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In order for a mouthrinse to get an ADA seal the company
must submit scientific evidence that the product is safe and effective
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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)
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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
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Basic mouthrinse ingredients include
- Water
- Makes up the largest percentage by volume
- Flavoring agent
- Provides a pleasant taste
- Astringents
- Ethyl alcohol
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What astringents are put in mouth rinses and what is their purpose
citric acid and zinc chloride
Provide an invigorating sensation in the mouth
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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
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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
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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)
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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
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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
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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
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_________ is the most commonly used quaternary ammonium
Cetylpyridinium chloride (CPC)
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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
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The most familiar essential oil mouthrinse is
Listerine
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Essential oils of spices and herbs have ___________ properties
antibacterial and antifungal
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Essential oils of mouthrinses include
- Thymol (oil of thyme)
- Eucalyptol (eucalyptus oil)
- Menthol (peppermint oil)
- Methylsalicylate (wintergreen oil)
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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
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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
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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
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________ is an example of a commercially available hydrogen peroxide rinse
Peroxyl 1.5%
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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
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______ is sold as a prebrushing rinse and contains
Plax
a detergent-sodium benzoate mixture and it also contains Triclosan.
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Oral irrigation is defined as the
targeted application of a pulsated or steady stream of water or other irrigant for preventive or therapeutic purposes
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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
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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
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Soft rubber oral irrigation tip (flexible) is designed to be placed at _______ and is placed ______
- a site-specific areas subgingivally
- approximately 2 mm subgingivally
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Tapered plastic tip (monojet) designed to be used ________ and is placed at the _________
- supragingivally
- gingival margin
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The ________ is the regulatory agency for oral care product
Food & Drug Administration (FDA)
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