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
C OMMON DENTAL PROBLEMS &OTC P RODUCTS 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- P LAQUE 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- P LAQUE 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- P LAQUE 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
C ON. 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
C ON. 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
C ON. T OOTHPASTE INGREDIENTS 2-surfactants : foaming agent and removing debris Ex. SLS … sensodyne doesnt 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 )
C ON. T OOTHPASTE 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..
C ON. (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)
C ON. (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)
C ON. (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
C ON. (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.
C ON, 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 )
C ON. (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- G INGIVITIS 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 D ISEASE. 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-A CUTE NECROTIZING U LCERATIVE 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-T EMPOROMANDIBULAR 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-C ANKER 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.
C ON. 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
C ON, Protectants : Orabase, dental adhesives & benzo tincture. Local anesthetics : benzocaine (5%-20%) or butacaine or Benzyl alcohol (0.05%- 0.1%) or Menthol (0.04%-2%) Eg. Orajel,Benzodent, Zilactin-B Rx 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
C ON. 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 2 nd infection developed. **lip sunscreen if the sores is caused by sun **L-lysine (a.a) (300-1200mg daily) to accelerate recovery.
C ON. 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.
C OMMON 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 doesnt heal, unexplained bleeding *Risk factors: smoked &smokless tobacco. & alcohol.
C ON. 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 shouldnt be administered until checking with Dr. S\E that dont require medical attention : nausea, vomiting. Appetite loss or hair.. And trouble sleeping.. Ondansetron or metoclopramide can be useful for this cases.
P ROPHYLAXIS 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.
O TC 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.
O TC 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.
P HARMACIST 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 doesnt improve a condition or if worsens u should disconnect the use of product and dentist should be contacted