Dental Products

The Teeth Adult Teeth An adult has 32 permanent teeth. The incisors and canine teeth tear and cut food, and premolars and molars are used to grind and crush. The four back teeth are called the wisdom teeth (or third molars). Internal Structure of Teeth The three main parts of a tooth are the crown, neck and root. The crown (the part of the tooth seen - above the gums) is covered by a protective, bony layer of enamel, and the root of the tooth is covered by a sensitive, bonelike substance called cementum. A hard substance known as dentin surrounds the pulp, which contains nerves (sensing heat, cold, pain, and pressure) and blood vessels (nourishing the tooth). The gums (or gingiva) fit around the teeth, and the roots of the teeth fit into sockets in the jawbone. Lining the sockets is a tissue called periodontium.

Permanent teeth => 32 (Adult) Permanent teeth => 32 (Adult) Incisors: Canines : Premolars: Molars (include wisdom teeth) Incisors: Canines : Premolars: Molars (include wisdom teeth) 4/4 : 2/2 : 4/4 : 6/6 4/4 : 2/2 : 4/4 : 6/6

Anatomy of a Tooth This illustration shows the anatomy of a tooth and gums as well as the supporting structures that surround a tooth. The left side shows healthy gums and bones and the right side shows unhealthy supporting structures. Not all teeth have one root. For example: The molars on the top arch have three roots, whereas, the molars on the bottom arch have two roots.

Blood vessels - carry nutrients to the tooth. Bone - alveolar bone forms the tooth socket and provides it with support. Cementum - the layer of hard bone-like tissue covering the root of the tooth. Cemento-enamel junction - the line where the enamel and cementum meet. Dentin - the hard yellow tissue underlying the enamel and cementum, making up the main bulk of the tooth. Enamel - the hard, white outer layer of the tooth. Gingiva - the gum tissue surrounding the tooth. Ligament - the connective tissue that surrounds the tooth and connects it to bone. Nerves - relay signals such as pain to and from your brain. Pulp - located in the center of the tooth, it contains the arteries, veins and nerves. Root canal - canal in the root of the tooth where the nerves and blood vessels travel through. Glossary of Terms:

Dental Caries  The outer coating of teeth is called enamel.  The hard core of teeth covered by enamel is called dentin.  Dental caries is he progressive loss of tooth mineral, followed by bacterial invasion into the demineralized tooth.  It is the disease produced by metabolic end products of certain microorganisms that result in dissolution of the inorganic components of enamel,dentin,cementum and degradation of their organic structures.  Dental caries can be defined as a destructive process causing decalcification of the tooth enamel and leading to continued destruction of enamel and dentin and cavitation of the tooth is known as dental caries.

Dental Caries Mechanism of Caries  Food particles accumulate on the surface of the teeth.  Food debris, mucin and microorganisms coat the surface of the teeth and gradually forms a thin film known as dental plaque.  Dental plaque usually aids the dental decay process by forming pockets or crevices on the teeth surface in which dietary food particles (e.g., carbohydrates) lodge to a greater extent and gets metabolized by Lactobacillus bacteria and forms lactic acid.  Lactic acid causes decalcification of enamel and dentin leading to formation of cavities called dental caries.

Normal enamel

Dental Caries

Fluoride sources Water fluoridation 0.8ppm Toothpaste 1000ppm (adult) 400ppm (child) Fluoride tablets 1mg per tablet Fluoride varnish 12300ppm

Toxicity of fluoride Toxic oral dose is 5.0 mg/kg bodyweight

Dental Fluorosis  Dental fluorosis occurs during tooth development especially between the ages of 6 months to 5 years, from the overexposure to fluoride.  Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite ; when fluoride is present, fluorapatite is created.  In high concentrations fluoride can cause yellowing of teeth, white spot, and pitting or mottled of enamel, consequently the teeth look unsightly.  Fluorosis can not occur once the tooth has erupted in to the oral cavity. At this point fluorapatite is beneficial because it is more resistant to dissolution by acids (demineralization). The incidence of dental decay in those teeth is very small.

Fluorosis Not - fluorosis Fluorosis

Fluoride and Fluorosis

Dentifrices  Dentifrices are dental products like toothpastes, toothgels and toothpowders.The purpose of a dentifrice is to assist the mechanical effect of the toothbrush to remove the dental plaque.  Dentifrices can be of three types which are as given below:  Dentifrices Containing Anticaries Agents  Dentifrices Containing Polishing & Cleaning Agents  Dentifrices Containing Desensitizing Agents

Dentifrices Containing Anticaries Agents Anticaries agents are used to prevent or treat caries. Inorganic Anticaries agents are Fluorides & Phosphates.  Fluorides:  The most commonly used Anticaries agents are fluorides.Fluoride can be administered orally and topically.The most convenient oral dosage form is the fluoridation of the public water supply.This is usually done in the developed countries by adding sodium fluoride or a fluorosilicate,yielding a fluoride concentration of o.7 to 1 ppm. This is equivalent to an average daily intake of 2.2 mg of NaF based on person drinking 6 glasses of water  The mechanism by which fluorides inhibit caries formation are- By decreased acid solubility of enamel & By bacterial inhibition.

 Official fluoride containing Anticaries products are: 1)Sodium Fluoride(NaF): 1.5 to 3 ppm in drinking water or topically as a 2% solution to the teeth. 2)Stannous Fluoride (SnF 2 ): It combines with tooth enamel to form an insoluble film of tin oxide, tin phosphates and calcium fluoride which inhibits acid penetration.It is for topical use only.  Phosphates: Some phosphates salts are also useful in reduction of caries. CaHPO 4 NaH 2 PO 4 Na 2 HPO 4 Dentifrices Containing Anticaries Agents

Toothpastes,Tooth powders & Mouth washes Toothpaste: Toothpaste is the most popular form of dentifrice. The ingredients used in the preparation of tooth paste can be classified as follows: Cleaning & polishing materials, Detergent & foaming materials, Humectants, Binding agents, Sweetening & flavoring materials, Miscellaneous materials (therapeutic ingredients, whitening agents, preservatives etc). Tooth powders: Toothpowders are still in demand although they are less popular than toothpastes as dentifrices. The composition of modern tooth powders is basically that of a toothpaste without the humectants, water and binding agents. Smokers Tooth powders: They are intended to remove tartar and stains from the teeth. They include calcium carbonate, tricalcium phosphate as cleaning and polishing agents. Mouthwashes: Mouth washes are liquid dental preparations for removing bad odors and to give a clean, refreshing feeling in the mouth. Mouthwashes containing antiseptic and astringent materials are used for gingivitis and treatment of sore and tender gums. In addition to aqueous alcoholic volatile oils they contain small amount of inorganic agents like sodium bicarbonate and borax.

Stannous fluoride0.4% Stannous pyrophosphate1% Calcium pyrophosphate39% Glycerin10% Sorbitol (70% solution)20% Water29.6% Miscellaneous Formulating agents Composition of Fluoride Tooth Paste (Crest ® )

Fluoride Tooth Paste (Colgate ® ) Sodium monofluorophosphate (MFP)0.76% Insoluble sodium metaphosphate41.85% Anhydrous dicalcium phosphate (CaHPO 4 )5% Sorbitol11.9% Glycerol9.9% Sodium N-lauroyl sarcosinate (Gardol)2% Water24.4% Miscellaneous Formulating agents4.2%

Abrasivity of Dentifrice Products ProductAbrasivity Index 1Pepsodent with zirconium silicate26 (23-29) 2Colgate with MFP51 (46-56) 3Ultra-Brite64 (52-82) 4Macleans (regular and spearmint)68 (66-72) 5Close up87 (70-101) 6Plus White110 (91-141) 7Plus White Plus132 (96-181) 8Smokers Tooth Paste202 ( )

Cosmetic Dentifrices BrandCompositionAbrasivity Close Up ® Silica's of controlled particle sizeModerate Excitement ® CaHPO 2.2H 2 OLow Macleans ® CaHPO 4.2H 2 OModerate Pearl Drops Tooth Polish ® Hydrated AlPO4 and CaHPO 4.2H 2 O Moderate Plus White ® CaHPO 4 and CaHPO 4.2H 2 OModerate to High Plus White Plus ® CaHPO 4 and CaHPO 4.2H 2 OModerate to High Ultra Brite ® CaHPO 4 and CaHPO 4.2H 2 OModerate Vote ® SilicaModerate to High

 Cleaning and polishing materials are used as a means of removing stains on the teeth and usually contribute about half of the total weight of dentifrices.  The most commonly used cleaning and polishing agents are:  Insoluble sodium metaphosphate (NaPO 3 )  Anhydrous calcium monohydrogen phosphate (CaHPO 4 )  Hydrous calcium monohydrogen phosphate (CaHPO 4.2H 2 O)  Dicalcium phosphate  Calcium pyrophosphate (Ca 2 P 2 O 7 )  Calcium carbonate (CaCO 3 )  Pumice:  Pumice is a substance of volcanic origin consisting chiefly of complex silicates of aluminum, potassium and sodium. It is also used by dentists for prophylaxis (teeth cleaning). However it is too abrasive for daily use in a dentifrice. Dentifrices Containing Cleaning & Polishing Agents

 Desensitizing agents are used in dentifrices to reduce the sensitivity of the teeth to heat and cold.  The most commonly used desensitizing agent is Strontium chloride (SnCl 2 ). e.g. Sensodyne ® contains Strontium chloride.  Formalin is also used as desensitizing agent in some dentifrices. But this desensitizing agent is not described in Accepted Dental therapeutics. e.g. Thermodent ® contains Formalin.  Ammoniacal Silver Nitrate Solution was official as a dental protective and desensitizing agent but it is no longer an accepted desensitizing agent today. Dentifrices Containing Desensitizing Agents

Other Official Dental Products Zinc Chloride (ZnCl 2 ) Category: Astringent; Dentin desensitizer. For External use: Topical to the teeth as a10% solution. Zinc Eugenol Cement It contains zinc acetate, zinc stearate and zinc oxide in addition to eugenol, cotton seed oil and rosin. This preparation is widely used by the dentists for their sedative effect on pulpal pain, particularly when restoring teeth with deep carious lesions.

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