Nonrx oral care fall 2024 - Part 1 PDF

Oral care products – Part 1 Nonprecription medications & products Denise Walbrandt Pigarelli, PharmD, BC-ADM From clipart-library.com Readings Required Textbook (20th edition) Chapter 31 – Prevention of hygiene-related oral disorders...

Oral care products – Part 1 Nonprecription medications & products Denise Walbrandt Pigarelli, PharmD, BC-ADM From clipart-library.com Readings Required Textbook (20th edition) Chapter 31 – Prevention of hygiene-related oral disorders Table 31-1: Guidelines for brushing teeth Table 31-2: Guidelines for using dental floss Chapter 32 – Orofacial pain and discomfort Table 32-1: differentiation of tooth hypersensitivity and toothache Figure 32-1: self-care for tooth hypersensitivity algorithm Figure 32-2: self-care for recurrent aphthous stomatitis algorithm Canvas Teeth whitening article Optional American Dental Association web page info about types of mouth rinses (link in Canvas) Objectives Identify the etiology of the following oral conditions: Caries Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis Minor oral mucosal injury or irritation Herpes simplex labialis Xerostomia Cheilitis (topic requested by students!) Tooth discoloration and staining Describe and signs & symptoms of each of the above oral conditions State the exclusions for self-care for each of the above oral conditions Discuss goals of therapy for each of the above oral conditions Explain complementary and non-drug options for the above oral conditions, as applicable Objectives – slide 2  For each medication associated with the applicable lecture conditions: Explain the mechanism of action State the medication’s indication Discuss the medication’s pharmacodynamics in terms of onset and duration of action Explain side effects and how to manage them Identify common drug interactions Analyze situations when to avoid use of the medication Appraise use the medication during pregnancy and lactation Discuss dosing aspects  For each agent associated with the respective lecture conditions: Discuss components/ingredients of the products/agents responsible for therapeutic action Explain appropriate use of the products/agents Explain side effects (if any) and how to manage them  Recommend appropriate nondrug/general care measures and oral care products for given case scenarios Case Study A 44-year-old adult asks you what they should use for tooth pain. They were diagnosed with tooth hypersensitivity on one occasion several years ago but haven’t had any problems since then. They brush their teeth twice daily and are careful not to eat sweets more than a couple times a week. They describe the pain as sharp and stabbing, and it occurs whenever they drink coffee. Which of the following options would be the most appropriate recommendation at this time for this person? A. Use a toothpaste containing baking soda & avoid coffee B. Make an appointment with a dentist and take acetaminophen or ibuprofen OTC until then C. Try a soft-bristled toothbrush & standard toothpaste with fluoride for a week D. Use a desensitization toothpaste with soft-bristled toothbrush twice daily for 2 weeks 5 Which of the following ingredients would be important to look for on the label of a product for someone with cheilitis? Select all that apply: 1. Aloe 2. Beeswax 3. Dimethicone 4. Lanolin 5. Paraffin 6. Petroleum jelly Background - tooth anatomy 7  Caries (cavities) prevention Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis From clipart-library.com (RAS) Minor oral mucosal injury or irritation Herpes simplex labialis (HSL) Xerostomia Cheilitis Tooth discoloration Presenting symptoms - caries No initial symptoms Progressive lesion on tooth Visualize Sensitive to stimuli (heat, cold, sweetness, chewing) Continuous pain ± difficulty chewing if lesion invades dental pulp Can progress to abscess and _________ Caries etiology Carbohydrates in diet Oral bacteria Host resistance alterations Orthodontic appliances __________ Medications Radiation therapy Tobacco product use Alcohol use Immune system dysregulation (chemo, Sjogrens, HIV/AIDs)  Refer! Do not self-treat Symptoms of toothache pain with or without chewing difficulty Localized swelling Hot or cold sensitivity Fever or headache Visualized lesion Entire tooth discoloration Bleeding, swelling or reddened gums Persistent mouth odor despite regular use of ________ toothpaste Goals of therapy – caries prevention Prevent or control dental plaque What is the difference between plaque & calculus? ? Plaque: Fresh/soft deposit Removed by __________ Calculus Harder form of plaque Removed by _________  Caries (cavities) prevention Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis From clipart-library.com (RAS) Minor oral mucosal injury or irritation Herpes simplex labialis (HSL) Xerostomia Cheilitis Tooth discoloration & staining Presenting symptoms Inflamed gingiva May progress to periodontal disease Gingivitis etiology Accumulation of supragingivival bacterial plaque Medications Calcium channel blockers Cyclosporine Phenytoin Reduced saliva flow _____________ Antidepressants Tobacco (smoked and smokeless) Pregnancy Hormones Connective tissue changes  Refer! Do not self-treat Swollen gums Gums that bleed with brushing or flossing Receding gums Gums that are darker____ Goals of therapy – gingivitis prevention Prevent calculus formation Remove and control supragingival plaque Complementary and non-pharmacologic options: caries and gingivitis prevention Dietary Plaque removal Avoid highly cariogenic foods Chewing sugarless gum x 20 min after a 15% or more sugar meal sticks to teeth Brushing & flossing (adults & children can remain in mouth after being chewed older than 5 years) Drink adequate water Manual Electric-consider battery power Toothbrushes Dental floss: at least ____ daily Types Dental floss Dental tape Tapered picks Waxed vs unwaxed Irrigating devices-removes minimal amount of plaque; supplement to brushing & flossing 18 True or False Waxed dental floss may help promote plaque build-up between teeth. A. True B. False 19 True or False Waxed dental floss may help promote plaque build-up between teeth. A. True B. False 20 Complementary and non-pharmacologic options: caries and gingivitis prevention Activated charcoal Limited data to support claims about teeth whitening/absorbing pigments & stains Novelty Probiotics Possible benefit for ________ Vitamin D Adequate vit D during pregnancy can reduce caries in children Xylitol Children: 2017 meta-analysis: no stat sig. benefit OTC Treatment Options Follow-up Recommendations Chemical plaque Professional dental cleanings management every ___ months Fluoride Dentrifrices (toothpastes) Fluoride-containing Tartar control Antiplaque/antigingivitis Whitening Botanical-based Mouthrinses 22 Toothpaste Use Adults: size of pea Children Frequency: BID Age to start brushing?_____ Type of brush/how often to Kind of toothpaste: fluoride change Spit but no rinse Soft Amount: Change every 3-4 months Younger than 3 years: size of rice Kind of toothpaste grain Fluoride-containing Older than 3 years: size of ___ Hold at 45 degree angle Supervise Where to brush Parental education Inner, outer, chewing surfaces Supervise, esp spitting & amount Flossing: at least daily Too much fluoride: flecks/stripes or brown spots on teeth, enamel pits Pediatrics. 2014;134:626-633 23 Prevention of caries & gingivitis: Pharmacologic Methods Dentrifrices Categories of ingredients MOA: act directly on oral Abrasive bacteria or disrupt plaque Humectant components to aid in Sweetener mechanical removal Surfactant 3 functions: Binder/thickener 1. Help remove plaque, stain 2. Reduce ___________ Flavor 3. Enhance personal appearance Anticaries activity agent (often) Products Powders Gels, pastes 24 Dentrifrice abrasive categories & ingredients Low abrasion: 10-25% silica abrasives Mild abrasion: baking soda High abrasion: 40-50% Dicalcium phosphate Calcium pyrophosphate Calcium carbonate Alumina trihydrate 25 Fluoride: anticaries agent Sodium fluoride ->remineralize, strengthen weakened enamel, Sodium monofluorophosphate reduce gingivitis, reduce sensitivity Stannous fluoride -> above + adds protective layer over teeth to prevent plaque ->slight tooth staining if use continuously x 2-3 months; removed at ____________ Fluoride 27 A little humor for your day… Other Dentrifrice Ingredients Whitening dentrifrices NOT tooth-bleaching products Ingredients: baking soda; titanium dioxide; or aluminum oxide + citrate salt + papain; peroxides Chemotherapeutic agents may be combined in a whitening dentrifrice Fluoride Potassium nitrate Stanous flouride Metal salts Essential oils Hydrogen peroxide Sodium bicarbonate 29 Plaque control mouthrinses Ingredients Aromatic oils Antimicrobials (quaternary ammonium compounds: cetylpyridinium chloride) Phenol MOA Aromatic oils: antibacterial, local anesthesia Anticrobials: bactericidal activity Phenol: local anesthetic, antiseptic, bactericidal activity See today’s Canvas module for link to ADA mouthrinse page 30 Mouthrinse Cautions Adverse effects Occasional burning, irritation of oral mucosa; may cause sloughing of oral epithelium Cautions Mouth ulcers or irritation: only use under dental advice Keep out of reach of children Supervise use in children Alcohol content issues Poisoning Oral cancer 31  Mouthrinse Use 1. 1 to 2 tablespoonsful 2. Swish 30 seconds 3. Spit Most effective _______brushing except ______ if contains fluoride 1 to 2 times per day Avoid eating/drinking x __ min afterward Supervise children younger than 12 yrs 32 Plaque control with gum MOA Increased saliva flow Mechanical removal of ______ Use Chew after eating as well as other times of day Sugarless gum only 33  Caries (cavities) prevention Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis From clipart-library.com (RAS) Minor oral mucosal injury or irritation Herpes simplex labialis (HSL) Xerostomia Cheilitis Tooth discoloration & staining Presenting symptoms & causes Symptoms Causes Bad breath caused by volatile Systemic Medications: TCAs, first-gen sulfur compounds (VSCs) antihistamines, oxybutynin, meclizine, Parkinson’s meds Kidney/liver failure Cancer Ketosis Oral Poor hygiene Xerostomia Foods/beverages ______ or onions tobacco 35  Refer! Do not self-treat Medical conditions associated with halitosis Persistent halitosis despite good oral hygiene Halitosis Prevention Remove cause if possible Mechanical See caries prevention Tongue brushing Chemical Zinc salts, chlorine dioxide MOA Zinc salts: reduce receptor binding for VSCs Chlorine dioxide: breaks _______ bonds, oxidizes VSC precursors 37  Caries (cavities) prevention Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis From clipart-library.com (RAS) Minor oral mucosal injury or irritation Herpes simplex labialis (HSL) Xerostomia Cheilitis Tooth discoloration & staining Oral pain causes Etiologies 1. Exposure of dentin (erosion, broken tooth, faulty tooth repair) 2. Injury to mouth or lips or with RAS or herpes simplex labialis 3. nerve pain of face, facial herpes zoster, cluster headaches Dentin/tooth hypersensitivity 2 aspects for development Exposed dentin Dentin tubules open to _________and tooth pulp Symptoms: short & stabbing/sharp Thermal, chemical (acid) or physical (pressure) stimulus to exposed dentin or reach open tubule: tubule ___________increased->nerve stimulation-> pain 39 Presenting symptoms Pain from hot, cold, sweet or sour liquids Pain from hot or cold air on teeth See Table 32-1 to differentiate from toothache  Refer! Do not self-treat Toothache Mouth soreness associated with dentures Fever or swelling Loose teeth Bleeding gums Broken teeth Severe tooth pain started or worsened by hot, cold, or chewing Trauma to the mouth Goals of therapy 1. Repair damaged tooth surface via appropriate toothpaste 2. Correct inappropriate ___________technique Complementary and non-pharmacologic options Stop triggers (acidic foods, aggressive toothbrushing) Avoid toothbrushing within 30-60 min of acidic foods/drinks Correctly brushing teeth with __________toothpaste OTC Treatment Options Follow-up Recommendations Standard toothpaste with Standard toothpaste with fluoride fluoride & soft bristled brush Desensitizing toothpaste Resolved after 7 days? Yes: continue regimen Potassium nitrate 5% in No: see 14 days as below fluoride-containing toothpaste Arginine 8% + calcium 14 days of desensitization carbonate toothpaste Resolved? Yes: switch to __________ toothpaste No: dental referral 44 Potassium nitrate 5% + fluoride (in toothpaste) MOA: depolarizes nerves in tubules & pulp to block perception of stimuli; seals exposed dentin Indication: tooth hypersensitivity Pharmacodynamics: Onset: 2 weeks (pharmacist rec); may need 4 to 6 weeks (dental prof rec) Duration: duration of use & beyond Side effects: ? Dosing: brush with _____ strip BID Drug interactions: ACEi, ARB, potassium-sparing diuretics: increased risk hyperkalemia Sodium or stannous fluoride: calcium in foods/supplements Avoid: high abrasion toothpastes, whitening toothpastes Pregnancy: no concern Lactation: no concern Arginine 8% + calcium carbonate MOA: depolarizes nerves in tubules & pulp to block perception of stimuli Indication: tooth sensitivity Pharmacodynamics: Onset: 2 weeks Duration: same as potassium nitrate 5% Side effects: ? Dosing: same Drug interactions:? Avoid: using ________toothpaste at same time Case Study A 44-year-old adult asks you what they should use for tooth pain. They were diagnosed with tooth hypersensitivity on one occasion several years ago but haven’t had any problems since then. They brush their teeth twice daily and are careful not to eat sweets more than a couple times a week. They describe the pain as sharp and stabbing, and it occurs whenever they drink coffee. Which of the following options would be the most appropriate recommendation at this time for this person? A. Use a toothpaste containing baking soda & avoid coffee B. Make an appointment with a dentist and take acetaminophen or ibuprofen OTC until then C. Try a soft-bristled toothbrush & standard toothpaste with fluoride for a week D. Use a desensitization toothpaste with soft-bristled toothbrush twice daily for 2 weeks 47  Caries (cavities) prevention Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis From clipart-library.com (RAS) Minor oral mucosal injury or irritation Herpes simplex labialis (HSL) Xerostomia Cheilitis Tooth discoloration & staining Recurrent Aphthous Stomatitis Canker sore or aphthous ulcer Etiology Unknown for most patients Triggers: stress, local trauma, food allergy/gluten sensitivity, hormonal changes, genetic predisposition Systemic diseases (e.g. SLE, allergies, IBD, nutritional deficiencies, HIV) Signs & symptoms Epithelial, circular ulcer on nonketatinized, movable mouth surfaces Last 5 to 14 days, 0.5 to 2 cm 49  Refer! Do not self-treat If underlying cause Lesions present 14 days or more Frequent recurrence Sx of systemic illness Self-care ineffective Goals of therapy - RAS 1. Relieve pain & irritation 2. Heal lesions 3. Be able to eat/drink & do usual oral care 4. Prevent __________ infection 5. Prevent recurrence Complementary and non-pharmacologic options Correct any diagnosed nutritional deficiencies Avoid food allergy triggers Avoid spicy/acidic foods if active lesions Avoid textured foods that can irritate lesions Apply ice to lesions x 10 minutes; max 20 minutes in an hour DIY salt water rinses (table salt in tap water, swish then spit) OTC Treatment Options Follow-up Recommendations Pharmacologic therapy 7 days of treatment or 14 Topical days since lesion/s first 1. Oral debriding & wound appeared cleansing agents Side effects of topicals: see 2. topical oral anesthetics medical provider 3. topical oral protectants 4. oral rinses Systemic : analgesics 53  RAS Pharmacologic Therapies Oral debriding and wound cleansing agents Dosage/administration Carbamide peroxide 10% to 15% in Drops of carbamide peroxide anhydrous glycerin or hydrogen peroxide applied Hydrogen peroxide 3% (DIY) x 1 min Sodium perborate monohydrate Rinse: carbamide peroxide Sodium bicarbonate (DIY) drops on tongue, mix with saliva, swish x 1 min MOA: release of molecular oxygen (DIY) 50:50 mix of hydrogen Use: up to 4x daily x 7 days peroxide 3% & water: swish x 1 min Side effects Sodium perborate Mouth tissue irritation monohydrate powder: Short-term tooth hypersensitivity dissolve in 1 oz water & use right away Black hairy tongue DIY: __________ paste Avoid: toothpastes containing Expectorate! sodium lauryl sulfate 54 Topical Anesthetics for RAS *Benzocaine 5% to 20% *Butacaine sulfate 0.05% to 0.1% *Dyclonine 0.05% to 0.1% Hexyresorcinol 0.05% to 0.1% Menthol 0.04% to 2% Phenol 0.5% to 1.5% Phenolate sodium 0.5% to 1.5% Benzyl alcohol 0.05% to 0.1% Salicylic alcohol 1% to 6% 55 Topical oral protectants & rinses for RAS Barrier protectants Rinses MOA 1. protect Listerine® 2. decrease friction Saline rinse (1 to 3 tsp salt 3. provide temporary relief Coat ulcers with topical oral in 4 to 8 oz warm tap protectants water) Orabase®, Zilactin® _______ adhesive Dissolvable patch: hold on lesion x 10- 20 seconds to adhere; dissolves over ____ hours 56  Caries (cavities) prevention Gingivitis Halitosis Tooth hypersensitivity Recurrent aphthous stomatitis From clipart-library.com (RAS) Minor oral mucosal injury or irritation Herpes simplex labialis (HSL) Xerostomia Cheilitis Tooth discoloration & staining Minor Oral Mucosal Injury/Irritation Etiology Dental procedures Accidental injury: biting tongue/cheek, abrasion from sharp foods Do NOT self-treat: same list as tooth hypersensitivity Refer! Goals of therapy 1. Control discomfort 2. Aid healing 3. Prevent secondary bacterial infection Nonpharmacologic therapy Sodium bicarbonate Baking soda ½ to 1 tsp in 4 oz water; swish x 1 minute then expectorate; discard extra; fresh each time Saline rinse MOA: debride, clean wound, stimulate health Salt 1 to 3 tsp in 4 to 8 oz warm water Ice x 10 minutes (max 20 min in an hour) 58 Pharmacotherapy of Minor Oral Mucosal Injury/Irritation Same as RAS: 1. Topical analgesics and anesthetics 2. Oral protectants 3. Oral debriding/wound cleansing Astringents: tissue contraction, stop secretions When to refer patient?  Sx persist after 7 days treatment or 10 days of initial injury  Sx ______ during treatment  Sx of infection develop (fever, redness, swelling) 59