Dentifrices
Agents used with toothbrushes to clean and polish the teeth. They can be in the form of paste, gel, or powder. An ideal dentifrice:
- Should be nonirritant.
- Should not demineralize the enamel.
- Should have pleasant taste and odor.
- Should not produce marked abrasion on the teeth.
Read And Learn More: Pharmacology for Dentistry Notes
The ingredients include:
Dentifrices Active ingredients- Anticaries agents
- Anticalculus agents
- Antiplaque or antigingivitis agents
- Desensitizing agents
Dentifrices Inactive ingredients- Antihalitosis agents
- Abrasives
- Binders
- Humectants
- Surfactants/detergents
- Buffering agents
- Sweetening agents
- Flavouring agents
- Dyes
- Titanium dioxide
- Preservatives
Dentifrices Active Ingredients
- Anticaries agents: They are fluorides like sodium fluoride, sodium monofluorophosphate, and amine fluoride, and nonfluorides like xylitol, calcium and/or phosphate, and metals (zinc, aluminum).
- Fluorides: Fluoride exchanges with hydroxyl ions to form calcium fluorapatite, which is more stable in acid than calcium hydroxyapatite. This makes the outer layers of the enamel harder, so teeth are resistant to acid attack.
- It prevents the decalcification of enamel by acids and prevents caries. Sodium fluoride and stannous fluoride are the commonly used fluoride salts.
- Xylitol: It is a nonfermentable sugar; hence, demineralizing acids are not produced – help to prevent caries. Xylitol is not used by the bacteria as an energy source, thereby preventing bacterial growth and multiplication. It is present as an anticaries agent in toothpaste and some chewing gums.
- Fluorides: Fluoride exchanges with hydroxyl ions to form calcium fluorapatite, which is more stable in acid than calcium hydroxyapatite. This makes the outer layers of the enamel harder, so teeth are resistant to acid attack.
- Anticalculus (anti-tartar agents): Calculus or tartar is a form of mineralized and hardened dental plaque. It is caused by the continual accumulation of minerals from saliva and gingival fluid on teeth. Anticalculus agents are tetra potassium and sodium pyrophosphate, zinc compounds, and triclosan/copolymer.
- Tetrapotassium and sodium pyrophosphate: They stabilize the calcium level in the saliva and affect the growth of calculus. They also have antimicrobial action.
- Zinc compounds: For example, zinc citrate inhibits plaque formation and bacterial growth. It inhibits crystal growth.
- Triclosan/copolymer (polyvinyl methyl ether/maleic acid): It has antibacterial and anti-inflammatory action, hence reducing plaque formation and gingivitis. The copolymer helps to retain the triclosan intraorally for a longer period of time.
- Antiplaque (antigingivitis agents): They include triclosan/copolymer, stannous fluoride, and zinc citrate.
- Desensitizing agents: They are potassium nitrate, citrate, chloride, stannous fluoride, or strontium chloride. They reduce dentinal hypersensitivity by blocking the transmission of neural signals or occluding dentinal tubules.
- Antihalitosis agents: They include essential oils, chlorine dioxide, triclosan/copolymer, stannous fluoride, sodium hexametaphosphate. Zinc salts reduce halitosis by inhibiting production of volatile sulfur compounds.
Dentifrices Inactive Ingredients
- Abrasive agents: For example, calcium carbonate (chalk), dibasic calcium phosphate, silica, magnesium carbonate, aluminum oxide, and magnesium trisilicate.
- They are fine powders used to clean and polish teeth by mechanical action. They should remove debris and stain from the teeth without causing marked abrasion on the teeth.
- Binding agents: They bind the solid and liquid phases in toothpaste and stabilize the toothpaste. They are not present in the toothpowder. They could be natural, for example, gum arabic, mucilage of tragacanth, bentonite, or synthetic like sodium carboxymethyl cellulose and magnesium aluminum silicate.
- Humectants: They are present in toothpaste only, e.g. glycerine, sorbitol, and polypropylene glycol ether. They are also known as antidrying agents. They prevent loss of water from the paste, thus preventing it from becoming hard.
- Detergents: They generate foam and decrease surface tension. They help to loosen deposits from the surface of teeth while cleaning, breaking down stains and deposits, for example, sodium lauryl sulfate, sodium lauryl sarcosinate, sodium stearyl fumarate.
- Sodium lauryl sarcosinate also inhibits hexokinase (an enzyme that converts sugar to acids) and has bacteriostatic action. Sodium lauryl sulfate also promotes the entry of fluoride into dentine and has antibacterial actions. It can cause aphthous ulcers on regular use.
- Buffering agents: They control the pH of the toothpaste, ensuring that it is neither too acidic nor too alkaline. Sodium bicarbonate neutralizes acid formed as a result of action of bacteria on food lodged in between the teeth.
- It also acts as a mild abrasive and helps to remove superficial stains on the teeth. It has antibacterial action.
- Sweetening agents: They give a sweet taste to the toothpaste and improve its taste, for example saccharin sodium, sucrose, lactose, sorbitol. Saccharin is the commonly used sweetener, as it is a noncarbohydrate and does not undergo fermentation. Xylitol is a sweetener that does not undergo fermentation and also has anti-caries effect.
- Flavoring agents: They include peppermint oil, oil of wintergreen in combination with essential oils of clove, eucalyptus, cinnamon, etc.
- They make the toothpaste more palatable, provide a fresh sensation during and after brushing, and help to mask the taste of detergents.
- Dyes/coloring agents: They are used for cosmetic purposes to make the toothpaste attractive, e.g. titanium dioxide for white pastes and food dyes for coloured pastes, for example, liquor rubric (red colour), methylene blue (blue colour), chlorophyll (green colour).
- Preservatives: Sodium benzoate, methylparaben, and ethylparaben – prevent growth of microorganisms.
- Whitening agents: Abrasives, enzymes (papain), dimethicone, peroxide, sodium tripolyphosphate are some of the whitening agents present in toothpaste.
Uses Of Dentifrices
To maintain oral hygiene by removal of food debris and plaque – prevent caries, gingivitis, halitosis, periodontal diseases; for removal of stains on the teeth, etc.
Adverse Effects Of Toothpaste
- Most of the ingredients present in toothpaste have a potential for causing allergic or irritant reactions. The commonly implicated ingredient for such reactions is flavoring agent.
- Others that have been reported to cause contact allergic reactions include foaming agents (sodium lauryl sulfate), preservatives (sodium benzoate, parabens, and polyethylene glycol), essential oils (tea tree oil and propolis), and antibacterials (triclosan).
- Tartar-control toothpaste containing pyrophosphates have also been reported to cause allergy.
- Reactions include cheilitis, circumoral dermatitis, stomatitis, and canker sores.
- Cheilitis is inflammation of the lips, which is manifested as redness, itching, dryness, and scaling.
- Circumoral dermatitis is manifested as pruritic perioral erythema. Perioral dermatitis is an inflammatory condition characterized by tiny papules or pustules commonly in the perioral area.
- Contact stomatitis can also occur. It affects the gums (gingivitis), tongue (glossitis), and inside of the cheek. Patient complains of a burning sensation and pain inside the mouth. There is redness, swelling, and peeling of the affected area.
- Flavoring agents like peppermint, spearmint, menthol (all derived from mint), cinnamon aldehyde, and anethole (derived from anise and fennel) can cause cheilitis and circumoral dermatitis. Propolis (antiseptic) can cause allergic contact cheilitis, stomatitis, and perioral eczema.
- Canker sores (painful ulcers inside the mouth) can be caused by sodium lauryl sulfate. It causes drying of the soft tissues inside the oral cavity, making them susceptible to irritants in food.
- Erythema and fissures in the perioral area can be produced occasionally by anti-tartar agents like pyrophosphate.
- The toothpaste should be discontinued and alternative toothpaste should be used. Some cases may require treatment with steroids.
- Fluorosis can occur due to swallowing of toothpaste containing fluorides in children. The risk depends on the amount of toothpaste swallowed and the concentration of fluoride. Children should be encouraged to spit out the excess toothpaste while brushing their teeth.
- Damage to the enamel can occur with some whitening agents.
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