1. DENTAL OTC PRODUCTS

2. OUT LINES :
Dental anatomy.
Common dental problems and OTC Products

3. DENTAL ANATOMY :

4. 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

5. 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.

6. 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

7. 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

8. 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 ..

9. 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 .

10. 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

11. 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

12. 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

13. 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 )

14. 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 ..

15. 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)

16. (d) Cosmetic whitening agents :
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)

17. 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

18. 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.

19. 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 )

20. **may contain baking soda as mild abrasive cleaner & neutralize acid.
(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

21. 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.

22. 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

23. 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

24. 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.

25. 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.

26. 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.

27. 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

28. Con, 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.

29. 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 days

30. 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) ( mg daily) to accelerate recovery .

31. (1) Valacyclovir (valtrex) for tmt of herpes labialis.
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 .

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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