A pharmaceutic compound used with a toothbrush for cleaning and polishing the teeth. They are supplied in paste, powder, gel or liquid form.

1. Removal of plaque and debris. 2. Acts as a vehicles for active ingredients. 3. Calculus control. 4. Anti-caries. 5. Desensitization action. 6. Fresh breath.

1. Acceptable taste, color, flavor and consistency. 2. Components shouldn’t cause any detrimental effects with prolonged use.

1. Active Ingredients (therapeutic agents): 1-2% a) 1 or 2 fluoride compounds (eg. NaF). b) Agents which potentiate fluoride effect. c) Anti-calculus agents (eg. Pyrophosphate). d) Chemical plaque control agents (eg. Triclosan).

2. Abrasive particles: Salts as: Di-calcium phosphate, calcium carbonate, hydrated aluminum oxide. 3. Detergents (Foaming agents): Surface active agent (e.g. Sodium-lauryl sulfate). 4. Flavoring agents, coloring agents: (2-3%) e.g. Peppermint, green apple which must be compatible with other components.

5. Sweetening agents: e.g. saccharine, sorbitol. 6. Water : (20-40%). 7. Humectants : (20-40%) for moisture retention as it prevents hardening or loss of water from the dentifrice. e.g. glycerol, propylene glycol. 8. Thickening Agents : (1-2%) adjust the texture as it: a) Regulates the viscosity. b) Stabilizes the dentifrice. c) Prevents separation of solid –liquid phases of the tooth pasteeg. e.g Natural gum, synthetic cellulose. 9.Buffer system and preservatives:

Risk Effects : a) The risk of fluoride ingestion which may cause fluorosis. b) Snf causes staining and gives unpleasant taste when combined with acetic acid (orange juice) c) Its reported that Na-lauryl sulfate caused hypersentivity reaction in some patients, which appeared as apthous ulcers, as it drys the oral tissue causing damage to underlying tissue. d) Also that it alteres the taste as it decreases the perception of sweetness.

I. Fluoridated toothpaste : A. Active ingredient – Inorganic fluorides:  Sodium Fluoride (NaF) 0.22% (has a good caries inhibition effect and no staining)  Sodium Monofluoro phosphate (MFP) 0.76% (has a good caries inhibition effect and no staining)  Stannous Fluoride (SnF) 0.4% (some pigmentation were reported)

B. Organic Fluorides : Amine Fluoride. C. Combination of fluoride compounds:  NaF + MFP (most common).  Amine F + SnF  Amine F + NaF (least common)

1. Availability of free Fluoride ions: The available F ions that is capable of reacting with enamel surface on brushing. 2. Accessibility of Fluoride ions: Maybe improved by frequent removal of dental plaque particularly on proximal surfaces. 3. Clearance Time: it is the amount of time taken for the oral cavity to be free of F. this can be prolonged by: a) Increasing the F concentration of the toothpaste. b) Increasing the daily frequency of F toothpaste using.

 Facilitate the delivery of topical fluoride to large number of people.  Decrease caries prevalence.  Most common and simplest way to maintain elevated fluoride concentration.

 Ingestion of the toothpaste in infants and children which may cause fluorosis.

To minimize the risk of ingestion of Fluoride, parents should be instructed to: 1. Brush twice/day, under parental supervision for at least 1 minute.  <3 years old → No tooth paste or Smear layer.  3-6 years old → Pea sized of low fluoride toothpaste.  >6 years old → Family tooth paste.

2. Parents should be instructed to safely store the fluoridated toothpaste to avoid children eating the paste from the tube. 3. Pediatricians should put in consideration all sources of fluoride before prescribing F supplements. 4. And low F toothpaste shouldn’t be used in areas where the water supply isn’t fluoridated. 5. Manufactures should be instructed to reduce the diameter of the tube orifice. 6. And should market low fluoride toothpaste for children.

II. Low fluoridate toothpaste:  Used in children < 6 years old.  Average 500 ppm.  Not as effective as conventional toothpaste caries prevention, which is only significant for fluoride concentrations of 1000 ppm and above.  The decision of what fluoride levels to use for children under 6 years should be balanced between the caries susceptibility and the risk of fluorosis.

III. Non – fluoridated toothpaste: Active ingredient : 1. Chlorophyl (0.1% Na Cu chlorophyllin)  Reduce bacterial growth.  Reduce acid formed in dental plaque. So, it is used as caries preventive material and gingival disease preventive agent.

2. Antibiotic (penicillin - triclosan): Destroy or de- activate the micro- organisms associated with oral diseases. 3. Ammonium (di- basic ammonium phosphate or urea): Ammonia and urea have anti- cariogenic effect by neutralizing acid which is produced by the bacteria in dental plaque. Urea has enzyme inhibiting effect by its protein denaturation properties.

IV. Toothpaste for Periodontal Disease:  Chlorohexidine: Broad spectrum bactericidal agent (cataionic).  Triclosan: - Non charged, phenolic antiseptic. - Anti- inflammatory. - Broad spectrum anti- microbial agent, so it treats gingivitis and decrease calculus build up. - But have moderate anti- plaque properties because of its rapid release from oral binding sites.

V. Toothpaste for Hypersensitivity: Active ingredient: Strontium chloride 10% Potassium Nitrate 5% by desensitization as the depolarizing action of the K ion resulting in the decrease of dentinal sensory nerve activity.

Arginine and calcium carbonate (Pro- argin technology) Seal dentin tubules with a plug that contains arginine, calcium carbonate and phosphate. This plug, which is resistant to normal pulpal pressures and to acid challenge, effectively reduces dentin fluid flow and thereby relieves sensitivity.

VI. Whitening Toothpastes: One of the key functional ingredients is the abrasive system. This has been augmented with other chemical or optical ingredients and in general whitening toothpastes have become complex formulations with multiple combinations of these ingredients in order to deliver improved whitening benefits.

 Ingredients: a) Abrasive system: (salt e.g. Ca Carbonate, Sodium Bicarbonate, Ca pyrophosphate) Remove surface stains but does not lighten the color of the teeth. During tooth brushing, the abrasive particles can become trapped between the toothbrush bristle and the stained tooth surface, since the abrasive is physically harder than the stain, the stain can be removed leaving a cleaned tooth surface. It is clear from this mechanism that abrasive cleaning primarily influences only extrinsic stains and does not greatly influence any underlying intrinsic discoloration or the natural shade of the tooth.

b) Chemical ingredients : ( e.g. 1% H Peroxides, 0.5% Ca oeroxide, enzymes ) The efficacy of peroxide is well established in certain delivery formats such as trays, strips whereas the application of peroxide in toothpaste is much more challenging in terms of formulation factors and the relatively shortened exposure times. However, despite these challenges, toothpaste containing oxidative chemistries such as peroxide and sodium chlorite have been described and reported to decrease tooth yellowness, increase lightness and remove extrinsic tooth stains of tooth samples in vitro compared to a silica and sodium bicarbonate control toothpaste.

c) Optical ingredients: (e.g. blue covarine) Following brushing extracted teeth in vitro, the blue covarine has been shown to be deposited onto the tooth surface and to give a yellow to blue color shift with an overall improvement in measureable and perceivable tooth whitening.

VII. Regenerate Enamel Science: Consists of an advanced toothpaste for daily brushing and a Boosting Serum (with two custom-fit mouth trays) for monthly application at home. When used in combination with the daily advanced toothpaste, the serum boosts the advanced toothpaste effectiveness, enhancing the powder of enamel regeneration. With NR-5 technology and the fluoride in its formulation, the boosting serum provides focused protection against the effects of enamel erosion and acid attack.

VIII. Natural Toothpastes: Toothpastes containing natural ingredients only as: - Mineral salts - Peppermint - Chamomile - Herbs - Can contain fluoride or be fluoride free - Free of Na lauryl sulfate

The effectiveness of a herbal- based toothpaste was examined and it was found out that the herbal- based toothpaste was as effective as the conventionally formulated dentifrice in the control of plaque and gingivitis.