OTC Dentifrices  Whitening  Hypersensitivity  Triclosan Ghazaleh Bazyar, Vanessa Cook, Jane Hoffmann

Whitening Toothpastes  Two factors impact tooth color:  Intrinsic color of the tooth  Extrinsic stains  Whitening products work either by:  Removing stains  Bleaching of the teeth

Whitening Toothpaste Ingredients  Whitening toothpastes are usually made of two ingredients:  Abrasives for polishing  Chemical additives for breaking down stains  Optical additives providing whiteness appearance optically.

Whitening toothpaste ingredients Tooth whitening agents AbrasivesHydrated silica Calcium carbonate Dicalcium phosphate dihydrate Calcium pyrophosphate Alumina Perlite Sodium bicarbonate ChemicalHydrogen peroxide Calcium peroxide Sodium citrate Sodium pyrophosphate Sodium tripolyphosphate Sodium hexametaphosphate Papain OpticalBlue covarine

Abrasives Effectiveness  Effectiveness of abrasives depends on properties of their constituent particles such as:  Hardness  Shape  Size  Size distribution  Concentration  Optimized to reduce hard tissue wear while increasing the level and speed of whitening

Chemical Agents: Peroxides  Difficult to achieve effectiveness due to short exposure time.  However, still see improvements with peroxide formulations  1% hydrogen peroxide/sodium bicarbonate  0.5% calcium peroxide

Chemical Agents: Proteases  Proteases could be effective in breaking down pellicle.  Recent successful formulation:  Papain (protease enzyme), aluminia, and sodium citrate

Optical Methods  Blue covarine deposits on the tooth.  Creates a yellow to blue shift in tooth color and increase general appreance of whitness.  Combined with silica-based toothpastes can affect both extrinsic and intrinsic tooth color.  Since blue covarine product creates the optical illusion of whitening it works almost immediately.

Conclusions  Whitening toothpastes are effective, however, they require some time to show their effect.  For example, when used twice a day, it usually takes 2-4 weeks to see the effect of whitening.  Excessive use might damage tooth enamel.

Dentinal Hypersensitvity Research  According to the literature, toothpastes containing potassium citrate are effective for reducing dentin hypersensitivity in 85% of cases.  Potassium compounds are considered to prevent triggering of the intradental nerves by blocking their action potentials.

OTC Hypersensitivity Dentifrices Vanessa M. Cook Foothill College Dental Hygiene

How dentifrices combat hypersensitivity  Over the counter dentifrices:  Are self applied for mild to moderate sensitivity.  Must be applied regularly for therapeutic effects.  Tubule Occlusion.  Nerve Hyperpolarization  Rx dentifrices:  Fluoride Varnish w/ 5% Sodium Fluoride

What Causes Hypersensitivity?  Inadequate smear layer.  Increased number of dentinal tubules.  Exposed dentin.  Enamel loss.  Gingival recession.  Hydrodynamic Theory: Sensations are transmitted to the nerves in the pulp via fluid in tubules.

Nerve Hyperpolarization  Nerves are bombarded with Potassium ions making nerve less sensitive to future stimulus. Active ingredient: Potassium Nitrate Potassium Chloride Varieties available: Aquafresh Sensitive Maximum Strength Colgate Sensitive Fresh Sensodyne

Tubule Occlusion  Reduces the radius of dentinal tubules:  Active Ingredients  Stannous Fluoride  Calcium Phosphate compounds.  Silica

 Use of Polymethyl vinyl ether maleic acid as a adhesive  Saliva testing and acid challenge testing.  Importance of particle size in tubule occlusion

Triclosan In Dentifrice: Does It Deserve Our Professional Recommendation?

2,4,4’-trichloro-2’-hydroxydiphenyl Ether (Triclosan)

Some Interesting Facts That We Should Know As Hygienists:  Mostly antibacterial properties, some antifungal and antiviral  Used for over 30 years, originally confined to health care settings in surgical scrubs in  Marketed under the trade name Microban® when used in plastics/clothing.  Used to kill bacteria on skin and other surfaces  Found in soaps, cosmetics, deodorants, and office products. Glaser, Aviva. The ubiquitous triclosan, a common antibacterial agent exposed. Pesticides and You; Beyond Pesticides/Natiional Coalition Against the Misuse of Pesticides, Vol. 24 No. 3, Web Aritcle.

Mechanism of Action:  Blocks the active site on bacteria necessary for building cell membranes and reproducing.  Works for up to 12 hours  Last year, Colgate-Palmolive announced it will remove triclosan from its product line of dish/hand soaps.  Colgate Total brand dentifrice not included in this plan. Author not listed. Johnson & Johnson to phase out triclosan, regulators remain unresponsive. Washington (DC): Beyond Pesticides/National Coalition Against the Misuse of Pesticides. 17 August, Source: CBS News. Available from:

Effects of Triclosan On Human Health:  As of August 2012, evidence on safe exposure levels unclear.  Studies show impaired muscle function in fish/mice  Shown to be an endocrine disruptor; affects male/female reproductive hormones and possible fetal development. Possible links to breast cancer.  Alters thyroid function  Evidence of contamination of waterways, present in fish, umbilical cord blood, and human milk.  Present in urine of 75% of U.S. population  FDA has expressed concern over antibiotic resistance  CDC states unknown health effects at this time  EPA accelerating review to 2013, ten years ahead of schedule

What Are the Benefits of Triclosan in Dentifrice?  Effective in the reduction of gingivitis and stabilization of periodontal disease.  Non-ionic properties, blends well in dentifrice  Colgate Total introduced in 1990’s, 0.3% triclosan  Approved by FDA, endorsed by ADA  Provides effective level of plaque control

How About Some Statistics? Many studies have been done on the effects of triclosan in dentifrice. I chose a few to review and the results are as follows:  6 month clinical studies showed up to 58.9% reduction in plaque scores, and up to 41.9% reduction in gingivitis.  Slower plaque re-growth  Provided a reduction in clinical attachment loss of 50% when compared with a control dentifrice.  Reduced the likelihood of gingivitis progressing to periodontitis  Reduction in oral malodor  Significant reduction in the number of bleeding sites  Slows progression of periodontal disease  Inhibitor of lab grown bacteria and harvested plaque

QUIZ TIME!!!  What does PVM/MA do? A: Acts as a “glue” to help occlude dentinal tubules

QUIZ TIME!!!  What is considered the safest level of exposure to Triclosan in humans? A: Evidence at this time is unclear as to what is safe.

Ouiz Time!!!!  What chemical additive gives the illusion of instant whiteness to teeth? A: Blue Covarine. It creates a yellow to blue shift in tooth color making the tooth appear white.

FIN