Stannous Fluoride and Whitening.pdf

STANNOUS FLUORIDE Be able to describe the science behind the products to patients o Develop the knowledge and skills o Share science in the clinic care ASK who paid for the studies when you listen to research Make sure to not just get the toothbrush, but also get the toothpaste Make sure we as provi...

STANNOUS FLUORIDE Be able to describe the science behind the products to patients o Develop the knowledge and skills o Share science in the clinic care ASK who paid for the studies when you listen to research Make sure to not just get the toothbrush, but also get the toothpaste Make sure we as providers get answers to the patient’s assessment from the patient Antimicrobial o Silver: used for years o Stannous fluoride § Tin has antimicrobial activity (Stannous is TIN on periodic table) § Bacteriostatic: Disrupts bacterial cell wall by preventing cell growth, cell adherence, toxin production § Bactericidal: Causes cell lysis and death § Strep mutans metabolism can be disrupted making pH LESS acidic Why do we need chemistry intervention? ***Ex. adding stannous fluoride o Biofilm penetration and endotoxin neutralization (Densify toothpaste) o Remineralization of teeth o Prevention of erosion o Treatment and prevention on hypersensitivity Biofilm is matured and bacteria will release endotoxins (LPS) *** o TLR receptors wake up and recognize the LPS o Immune cells come in and create inflammation o Bacteria shed LPS à TLR receptors recognize and recruit immune cellsà inflammation/bleeding o Stannous fluoride neutralizes LPS, making LPS less variant § A change to stannous fluoride paste: 3.7x increased healthy soft tissue with a 51% reduced bleeding gums § Increase in oral health associated bacteria § Decrease in gingivitis associated bacteria § Decreased pockets down to 4mm providing gingivitis protection American chemist society has awarded stannous fluoride as Chemical historic landmark o Elements of stannous when added to toothpaste has benefits o 1955: first caries dentifrice that would stain o Stannous fluoride today DOES NOT stain teeth o MUST stabilize the stannous molecule to refrain from staining § 2 inactive ingredients (sodium gluconate and glycine) § Additional ingredient added for control § Fluoride is the active ingredient in most dentifrice that provides chemical and oral health benefit § The carrier of the fluoride molecule is the key to oral delivery Stannous fluoride helps with *** o Caries o Gingival inflammation o Erosion o Methyl sensitivity (tooth hypersensitivity): stannous occludes dentinal tubules Sensodyne: Potassium nitrate + sodium fluoride = sensitivity and prevention of caries What chemical is most resistant to caries? Fluorapatite Stannous fluoride forms a Stannous oxide barrier that protects against caries and further protects enamel There are MORE caries prone individuals than perio prone SLS o foaming agent o Irritates patient who have aphthous ulcers and mucosal sloughing o Densify is SLS free Erosion o Irreversible o Surface phenomenon o Dentin dissolves at pH 6.5 o Enamel dissolves pH 5.5 o Acid interaction w/ tooth is 10x more prone to mechanical wear o Stannous fluoride provides a barrier against acid interaction RDA: toothpaste abrasiveness (< 250 value of abrasiveness is safe) WHITENING Abrasives helps to whiten External bleaching: oxidative tooth whitening that works until saturation point reached Concentration + contact time = results 3:1 ratio in bleaching o Carbamide Peroxide 90% = Hydrogen peroxide 7% o Carbamide Peroxide 32% = Hydrogen peroxide 11% Hydrogen peroxide is NOT an ACID, it will not cause tooth erosion Chief complaint after whitening is SENSITIVITY o Transient sensitivity o Caused by dehydration Goal is to have a H2O2 microdroplets (hydrophilic- like tooth surface) on a hydrophobic carrier It takes 30 min to diffuse from carrier Light activated: wait 30 minutes to apply the light Crest developed crest emulsions o visibly whiter in 2 weeks o 3% hydrogen peroxide