Introduction to dental and oral products available in pharmacies, their uses and pharmacist role.

2. 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.

3. 1- DENTAL CARIES :
Def. : formed by growth and implantation of cariogenic
microorganisms.
Causes:
1-Bacteria : produce acids (lactic acid) that demineralize enamel.
2-Diet: food with high concentration of sugar.
OTC Products :
- ONLY help to alleviate the pain
until visiting the Dentist !
Ex: Lidocain ,, benzocain ,,
Or Oral analgesics : -Acetaminophen -Aspirin

4. 2- Plaque and calculus:
 Causes :
- Plaque: sticky substance formed by the attachment of bacteria to the
pellicle which is thin , 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!
OTC Products :
1-Toothbrushes:
- Soft , rounded , nylon bristles..if Hard can be irritant to gum.
- Must get changed every three months.

5.  2-Irrigating devices :
Types:
(a) Pulsating (low and high pressure water steam)
(b) Steady (constant water pressure )
- Ex. Hydro-pik oral irrigator
3-Dental Floss :
- Available waxed , non-waxed , thick ,thin, flavored or unflavored..
- May be coated with additives such as baking soda and fluoride .
- Selection of dental floss depend on tightness of tooth contact.
- Ex. Oral –B .. Johnson & Johnson

6.  4- Dentifrices : products that enhance the removal of stains and
dental plaque by toothbrushes…Include :
 (a) Toothpastes:
- Decrease dental caries, mouth odor & enhance personal appearance.
 INGREDIENTS:
1-Abrasives : responsible for removing plaque
- Ex. silicates , sodium bicarbonate, Dicalcium phosphate , calcium
carbonate …ect
2-surfactants : foaming agent and removing debris
Ex. SLS … Sensodyne doesn’t contain SLS.
3- humectants : prevent preparation from drying ex. glycerin.
4-falvoring agent: saccharin.

7. 5-suspending agents: add thickness to product
Ex. Gum tragacanth
6-fluoride : is an anticariogenic..form fluorapatite on the enamel which
is harder, less soluble and more acid resistant.
- MOST beneficial if used from birth through age 12 or 13
- fluoride is toxic in 5-10mgkg…Acute fluoride toxicity causes nausea
vomiting and diarrhea.
- Max concentration approved in toothpaste is 260 mg per container.

8.  (b) 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.
 (c) Desensitizing agents: reduce the pain in sensitive teeth caused by
cold , heat , acids, sweets ..should be non-abrasive
- Eg : 5% potassium nitrate compounds

9.  (d) Mouthwashes : contain astringents , demulcents ,detergents ,
flavors, germicidal agents and fluoride. FOR :
 1- cosmetics purposes : freshen the breath , non-therapeutic.
- Most popular that contain medicinal phenol & mint .
 2-antiplaque: contain the same active ingredients
as Anticalculous dentifrices.
- Ingredient :
(i) cetylpyridinium chloride (CPC) :
for plaque and gingivitis. Eg. Cepacol , oral – B
(ii) chlorhexidine :
Eg. Colgate PerioGard.
- Staining is a result for long use.

10.  (e) Dental Gums:
Uses:
- 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 prevent cavities in the teeth.
- Also Contain Xylitol.
- Not a substitute for brushing and flossing.

11. 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 and Gargles
- Acetaminophen (oral analgesic)
- Seek the advice of dentist!

12. 4- Lesions:
 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
& wound-cleansing agents.
- To control the pain & shorten duration
of current lesions and prevent new lesions.
(1) Protectants : Orabase , dental adhesives & benzo tincture .
(2) Local anesthetics : benzocaine (5%-20%) or butacaine or Benzyl
alcohol (0.05%-0.1%) or Menthol (0.04%-2%)
Eg. Orajel ,Benzodent , Zilactin-B

13. 5- 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 leads to soft tissue deterioration .. And provide
medium for bacteria and fungal growth ..
** Daily use not recommended ..
Eg Fixodent .. ORAfix .. Sea-Bond and Effergrip.

14. Pharmacist’s responsibilities to patient using
these products :
(1) Refer the patient to a dentist in serious cases.
(2) patients should be informed about how to use recommended
products .. The duration of use , the expectation of using the
product.
(3) if a nonprescription product doesn’t improve a condition or if
worsens you should disconnect the use of product and dentist
should be contacted.