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

Abrasives Hydrated silicaCalcium carbonateDicalcium phosphate dihydrateCalcium pyrophosphateAluminaPerliteSodium bicarbonate

Chemical Hydrogen peroxideCalcium peroxideSodium citrateSodium pyrophosphateSodium tripolyphosphateSodium hexametaphosphatePapain

Optical Blue 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 DentifricesVanessa 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 1972.

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, 2004. 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, 2012. Source: CBS News. Available from: www.beyondpesticides.org/dailynewsblog

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