Toothpastes PDF

Toothpastes Founda-ons in Clinical Skills and Prac-ce Aim To gain an understanding of the components of toothpastes and their role in pa4ent care. 2 Intended learning outcomes By the end of this lecture you should be able to: 1. Have an understa...

Toothpastes Founda-ons in Clinical Skills and Prac-ce Aim To gain an understanding of the components of toothpastes and their role in pa4ent care. 2 Intended learning outcomes By the end of this lecture you should be able to: 1. Have an understanding of the func4ons of a toothpaste. 2. Appreciate the role of the various non ac4ve ingredients present in toothpastes. 3. Explore the various ac4ve ingredients in toothpastes and their role in pa4ent treatment and care. What is a Toothpaste? Toothpaste is a paste or gel den4frice used with a toothbrush to clean and maintain the aesthe4cs and health of teeth. Toothpaste is used to promote oral hygiene It contains an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, helping to remove superFcial staining and delivers ac4ve ingredients (most commonly Huoride) to help prevent tooth decay (dental caries) and gum disease (gingivi4s). Salt and sodium bicarbonate (baking soda) are among materials that can be subs4tuted for commercial toothpaste. Large amounts of swallowed toothpaste can be toxic. WHY? Fluoride is poisonous if enough is swallowed Wikipedia/ Google 2021 5  History Toothpastes came into general use in 19th Century Britain in the form of tooth powders. But you can trace toothpaste use back to Ancient Egypt and Ancient Rome. The early toothpowders used in Victorian Britain contained things such as salt, pulverised brick, chalk and coal. Google images 2021 7 Toothpastes have evolved drama4cally over the years and there are many varie4es on the market, they are constantly being updated with new ones appearing on the shelves all the 4me! Google images2021 8 For the public and our patients the toothpaste market can be a confusing one………………what do they choose? Led by advertising? Or advice from Friends of Family? Google images 2021 9 It is important that we, as Health Care Professionals, try to keep up to date with current trends and changes in the toothpaste market in order to advise and guide our pa4ents in the most appropriate choice of product for their individual needs. Speareducation.com/google images 2021 10 So let’s start with the basics……. Func-ons Prevent and reduce caries by applying Fluoride to the den44on. Assist the removal of plaque and superFcial stain from the den44on. Prevent gingival inHamma4on by the inclusion of an4microbials. Achieve desensi4sing ac4on by inclusion of desensi4sing agents. Achieve improvement in appearance by inclusion of whitening agents Provide an increase in conFdence by improving the breath. Make the toothbrushing experience a more pleasurable one.. 11  Toothpaste constituents are divided into….. ACTIVE NON- ACTIVE www.declore.com/google images2021 12 Toothpastes NON ACTIVE CONSTITUENTS Emulsi(er/Binding agents 1-5% Agents that hold all the ingredients together, stopping the solid and liquid components of the paste separating during storage and increasing their stability and extending their shelf life. Examples of commonly used agents are:. Carragheenates, Alginates, Carboxymethyl cellulose, Colloidal Silica & Acacia gum 14 Detergents/Foaming agents 1-2% These provide the bubbly foam in the paste They help to loosen debris They help to distribute the paste around the mouth They can create dryness and associated issues in some people Commonly used agents are: Sodium Lauryl Sulphate & Sodium N-lauryl Sarcosinate 15 Humectants 10-30% These keep the toothpaste moist and prevent it from hardening on exposure to air. Commonly used humectants include: Water, Glycerine and Propylene glycol Preservatives 0.05 -1% These prevent contamination of the paste by bacteria, therefore maintaining the purity of the product and increasing it’s shelf life Examples used are: Alcohol, Benzoates and Phenols Google images 2021 17 Sweeteners These are non fermentable sugars which are used to sweeten the paste and therefore enhance it’s taste and acceptability, as well as masking the taste of other ingredients Examples used : Sorbitol, Saccharin and Xylitol Google images 2021 18 Flavourings These mask the Uavour/ taste of other ingredients, especially sodium lauryl sulphate and make the paste more palatable and pleasant to use. Examples of commonly used Uavours: Peppermint, Spearmint, Aniseed, Eucalyptus, Lemon and Menthol, Wintergreen( Methyl Salcylate) Google images 2021 19 Colouring agents These are added to make to paste more eye catching/attractive. DiWerent dyes are used in diWerent products and some pastes use more than one in a product. Examples are: Chlorophyll and Titanium Dioxide Google images 2021 20  Polishing agents/Abrasives 20- 40+% Have a mild abrasive action on the teeth, and help to control and remove some superXcial stain. Commonly used agents include: Calcium carbonate, Dicalcium phosphate , Silica particles, Sodium Chloride, Zirconium Silicate, Calcium Pyrophosphate and Hydrated Alumina Google images 2021 21  https://youtu.be/oDpDFAjPgFM 22 Toothpastes ACTIVE CONSTITUENTS The active ingredients are added to various toothpastes in order to provide possible additional beneXts. The most commonly added active ingredient is FLUORIDE which is present in over 95% of toothpastes available on the market. 24 Fluoride is added to help prevent caries by making the tooth surface more resistant to acid attack and encouraging remineralisation. There are 3 main types of Fluoride used in toothpastes: Sodium Mono\uorphosphate MFP Sodium Fluoride NaF Stannous Fluoride Sn F2 25  Low level Fluoride toothpastes( under 1000 p.p.m) are not recommended Children 0-3 years should use( smear) of paste over 1000 p.p.m Children 3-6 years (pea size ) 1350 -1500 p.p.m Over 6 years, adolescents and adults 1350- 1500 p.p.m Over 10 years and high risk may be prescribed toothpaste with 2800 p.p.m Very high risk adults nay be prescribed toothpaste with 5000 p.p.m 26 Google images 2021 27 Google images 2021 28 Advice to patients is to……. Brush twice a day with a Uuoride toothpaste. Fluoride amount should be based on age, risk factors and other Uuoride sources. Use a spit and don’t rinse technique. Google images 2021 29 De-sensitising agents are added to many toothpastes in order to help with dentine sensitivity, which is a commonly experienced problem, aWecting over 50% of adults. Various desensitising agents are used including: Strontium Chloride Potassium Chloride Potassium Nitrate Sodium Citrate Strontium Acetate Calcium Sodium Phosphosilicate ( Novamin) 30 Sensodyne.com 2021 Google images 2021 31 Anti plaque/antimicrobial agents are added to some toothpastes to help restrict the formation and development of plaque bioXlm by having an antibacterial eWect on the bacteria in plaque. TRICLOSAN is an example of an anti plaque agent in toothpastes. It is believed to work by preventing bacteria from producing a certain enzyme that is needed for that bacteria to proliferate Other agents use include: Zinc Citrate Trihydrate Chlorhexidine Sodium Ricioleate 32 Whitening agents in toothpastes have become popular in recent years however their eWect is often minimal despite manufacturer’s claims! The main eWect ( if any ) of these agents in a toothpaste you buy from the shelf is possible superXcial stain removal. For true whitening of the teeth, other techniques ( Bleaching carried out by a registered Dental Professional) would be required for any signiXcant tooth whitening. Google images 2021 33 Most whitening toothpastes rely on either: Optical brightening eWects, removal of stain by proteolytic enzymes, or additional abrasive action. Agents include: Charcoal, Sodium Bicarbonate, Silica, Carbamide Peroxide. Remember, increased abrasive action may cause sensitivity in some individuals and increase abrasion of the tooth structure. 34 Anti calculus ( anti Tartar) agents. Very little evidence that these agents make a signiXcant diWerence in calculus formation, but their claim is that the addition of agents such as: Calcium Pyrophosphates and Sodium Hexametaphosphate Will interfere with the mineralisation of plaque, interfering with the crystal formation of calculus. They have no eWect on established calculus deposits, which need professional removal. Wikipedia 2021 35 Class work: Time to discuss your findings on the following: 1. Investigate abrasiveness of a product ranked by RDA ( Relative dentine abrasion) value. 1. What easily sourced products are SLS free? When would we recommend these? 2. What Natural/Herbal toothpastes are available? Are they all Fluoride free? 3. When a patient asks us what toothpaste should they use…………… what should we consider? 36