oral health products for home use: what should i recommend

oral health products for home use: what should i recommend
UPDATE ON ORAL HEALTH PRODUCTS:
HOW TO MAKE INFORMED CHOICES
Karen Baker, M.S.Pharm., Associate Professor
I. Regulation and Evaluation
A. Federal Trade Commission (FTC)
D. Canadian Dental Association (CDA)
B. Food and Drug Administration (FDA)
E. Health Protection Branch of Canada
C. American Dental Association (ADA)
II. Information Sources for Dental Professionals
A. ADA




Headquarters phone (312) 440-2500, (800) 621-8099
Internet: http://www.ada.org
Council on Scientific Affairs, Ext. 2840
Professional Product Review published quarterly at www.ada.org/goto/ppr
B. ADA Additional Oral Health Benefit Required for Demonstration of Superiority
 Manual/powered toothbrushes, floss and interdental cleaners, oral irrigators – 15% gingivitis
 Chemotherapeutic agents to control gingivitis – 20% gingivitis
 Fluoride-containing dentifrices – 10% improvement in caries reduction
 Regeneration of periodontal tissues – 25% gain in periodontal attachment levels
C. Dental Product Comparison & Ingredients List Websites
 www.dentalproductshopper.com
 www.dentalcompare.com
 www.dentalcare.com; www.colgateprofessional.com;

www.dailymed.nlm.nih.gov/dailymed - best for complete ingredients and package photo
D. Professional Newsletters and Evidence-Based Resources
 "National Dental Practitioner Based Research Network”-NationalDentalPBRN.org
 Monthly newsletter on practitioner database study results
 Adds credibility and excitement to your practice without undue time demands
 "Clinician’s Report and Dental Hygiene Report" – www.cliniciansreport.org
 edited by Dr. Gordon Christensen and published each month
 paper or online subscriptions available. Cost is $95/$165 or $35/$165 (DH)
 "Nutrition Action Health Letter" – www.cspinet.org
 edited by Michael Jacoboson – nonprofit “food police”
 to order Fax 202.265.4954, cost is $24/year, $42/ 2 years for both US and CA versions
 "Dental Advisor and Dental Advisor Plus"-www.dentaladvisor.com
 edited by Drs. John Farah and John Powers and published 4/6 times yearly
 "Dental Advisor" $59/year with first year online subscription FREE
E. Promotional Literature/Product Ingredient Sources
 www.dentaldepot.com,, www.dentist.net. www.dentalcare.com
 Dental Products Report is free online and paper at www.dentalproductsreport.com
 Reality. Product Evaluations Publications. www.realityesthetics.com
 Dentistry Today ,free at www.dentistrytoday.com
 Just4Teeth.com,wide assortment of mechanical and chemical products
F. Alternative Dental Product and Healthcare Quackery Prevention Resources
 Natural Medicines Comprehensive Database,800.995.8712, www.naturaldatabase.com
 PhytoNet-www.exeter.ac.uk/phytonet, e-mail: phytonet@exeter.ac.uk
 www.foodnews.org; www.ific.org, www.quackwatch.org, www.naturowatch.org
 www.consumerlab.com, www.mskcc.org/mskcc/html/11570.cfm
 free sites like www.science-basedmedicine.org and www.supplement-geek.com.
III. Mechanical Plaque Removal Products
A. Powered Oral Hygiene Devices Available for Retail Sale
Available Powered Devices
Brand (DA rating%)
[most useful]
Braun Oral-B Vitality
Precision Clean
[C,G]
Manufacturer
Oral-B Labs
Price
$29T
ADA
Seal?
Gingivitis
No
Yes
Reduction
USA 800.543-2577
Product Characteristics
Compact, non-slip grip with small, cup-shaped
oscillating brush. Two minute timer. Full
charge lasts 5 days. 7600rpm.
Braun Oral-B Vitality
Sensitive Clean[C,G]
Oral-B Labs
$29T
Yes
Yes
(1) Two moving brush heads, two minute
timer. Full charge lasts 5 days. 7600rpm
Oral-B Black 7000 with
Bluetooth wireless
Smartguide(C,G,O)
Oral-B Labs
$219T
(39)
No
Yes
Sonic pulsations with ultra-speed oscillations.
(8800rpm) Pressure sensor,40,000/minute,
speed control settings
Oral-B Genius 8000
Oral-B
ProfessionalCare 3000
[G,I,P]
Oral-B Labs
Oral-B Labs
$175T
$99T
(30)
No
No
Yes
Yes
Customized brushing experience
40,000 pulsations/min, 8800rpm
Pressure sensor, three brushing modes
Oral-B Prof Care 1000
[C,G,O]
Oral-B Labs
$65T
No
Yes
40,000 pulsations/min, 8800 rpm, pressure
sensor, one brushing mode
Braun Oral-B
Professional Care
Smart Series 5000
-with SmartGuide
Oral-B Labs
$160T
No
Yes
40,000/8800,4 speeds, “Smart Guide Displays”
Pro Series is Bluetooth enabled with phone app
No
Yes
Visible timer for enhanced compliance
Braun Oral-B
CrossAction PowerMax
Oral-B Labs
$15
No
No
Replaceable brush heads, bristle indicator for
replacement, rechargeable power
Braun Oral-B
CrossAction Power
Oral-B Labs
$6
No
No
Replaceable brush heads, bristle indicator for
replacement, battery powered
Braun Oral-B Pulsar
Vibrating Micropulse
35 Soft or 40 Medium
Oral-B Labs
$6
No
No
Battery powered, pivots & pulses, fully
disposable-product not designed to be opened
Braun Oral-B Stages
for Kids
Oral-B Labs
$7
No
No
Rotating power head brushes in 6 ways,
disposable handle, battery powered, brush head
NOT replaceable
Church&Dwight
www.spinbrush.c
om
(1) $5
(2) $6
(3) $6
(4) $6
No
Yes
(1) Brush heads replaceable, battery powered
(2) Spinning head & multi level bristles, battery
powered, replaceable head
(3) Spinning head and stationary “V” cut
bristles which are angled in 3 directions, color
signaling bristles, battery powered, replaceable
head
Crest Spinbrush
(1) Classic
(2) Classic Clean
(3) MultiAngle
(4) Kids
2
©Karen Baker, M.S. Pharm, 06/01/17
(4) Brush heads NOT replaceable, battery
Crest Spinbrush Pro
(1) Clean
(2) Whitening
Church&Dwight
(1) $7
(2) $8
No
Yes
(1) Replaceable brush head, combination of
spinning head and up-n-down bristle
movement, battery powered (2AA)
(2) Dual action brush head w/ whitening
bristles, battery powered, replaceable head
Conair
(1) $60T
(25)
(2) $28
(3) $28
Yes
Yes
Oralgiene USA
www.timemachin
etoothbrush.com
$40
Yes
No
(1) 2 speeds, no power base, 2 minute autoshutoff, travel case, 1 yr warranty, CRA-2.3
(2) Color Indicator Ring, rechargeable
(3) 8-Tuft Brush head, rechargeable, grip
handle
Cleans 6 dental surfaces at once, entire mouth
in 1 minute. Any TP OK. 300 strokes/min
Plaque Control 3000
[G,O] (87)
Waterpik Tech
$39
Yes
No
Circular brushing motion and contoured
bristles. Any TP OK.
Reach Power Brush
J&J
www.jnj.com
$16
Yes
No
Center bristles rotate 3,000rpm
Outer blue bristles don’t move
Rota-dent ProCare
[I,O,P]
DenMat
Lompoc, CA
$130T
($55)
W/D
Yes
Colgate Palmolive
Company
www.colgate.com
Colgate Palmolive
Company
$7
No
No
Most tested in perio maint.pts. office training
needed. 3 brush types available. Gel TP is OK
Microfilament brush tips, 90,000 filament
sweeps per second
Dual action head, rotating bristles, curved neck,
replaceable heads
$8
No
No
Dual action head, rotating bristles, soft rubber
polishers remove stains
Butler Company
$7
No
No
Oscillating action bristles, larger handle,
replaceable heads, battery powered
Wisdom
Toothbrushes
Limited
$8
No
No
Oscillating movements, battery powered, nonreplaceable brush heads, angled neck, two
power cleaning settings
Tao Clean
$199
No
No
Baby Buddy Sonic 360
Compac Ind.
$40
No
No
2 speeds up to 40,000 vibrations/minute,UV
light charger base,waterproof for use in shower
Battery-powered, 2 minute timer with flashers
every 30 secs. Round gentle brush for children
3-8 years and can be used without toothpaste.
Issa Sonic Silicone TB
Issa Mini for Kids
Issa Mikro for Babies
Foreo
$199
$119
$99
No
No
No
No
No
No
Phillips Sonicare
$179
No
Yes
Interplak Power Plaque
(DPI9) [C,G,I,O,P] (92)
(2) RTG3CSR
(3) NT7CS
Time Machine
[C,G,DEX] (86)
800-633-6363
www.conair.com
www.denmat.com
Colgate Motion
Colgate Motion
Whitening
GUM Kids
Wisdom Spinbrush II
SONIC ACTION
Aura Clean Sonic TB
Sonicare Diamond
Clean [G,I,P]
11,000 vibrations/minute, 2 types of brush
heads, 30 sec and 2 minute timers, waterproof
for use in shower, 365 uses on one charge and
each brush head lasts a year
31,000 vibrations per minute, 5 speeds,
Holds charge for 3 weeks, has charging
function in travel case. High end of Sonicare
product line.
3
©Karen Baker, M.S. Pharm, 06/01/17
Sonicare For Kids
[C]
Phillips Sonicare
Sonicare.com
$70T
No
Yes
Sonicare FlexCare
(1)RS930
(2)R910
Both T
1) $169
2)$149
Sonicare Xtreme e3000
$39.99T
Sonicare HealthyWhite
R732
R710
Sonicare Essence and P
(1) e5500
(2)e5300
Both T
$139.99
$119.99
No
Yes
No
Yes
$120T
$100T
No
No
Yes
Yes
(1) integrated sanitizer, smart timer,
(2) smart timer, Quadpacer
No
Supersonic
[C,G,O] (87)
Sonic-1 Cybersonic
Oral Care Toothbrush
UltraSonex (84)
Kid-friendly ramp up to 2min brushing over
90 days. Two speeds and two brushhead sizes.
Three different front plates to customize.
Cushions on brushhead and easygrip.
Yes
2 AA batteries, for pre-teens and teens
Phillips
3 modes – clean, sensitive, clean&white
2 modes-clean, clean&white
(1) Quadpacer 30-sec interval timer, recharge
indicator, 2 minute smartimer, angled neck
(2)No quadpacer, only 1 brushhead
American
Dentronics
760.757.5380
Amden Inc.
$80
(40)
No
No
Not available retail, 31,000strokes/minute,
Brush and floss are available.
$70T
No
No
47,000 strikes/min, uses harmonic resonance, 2
brush heads, 2 attachments, “done-in-one”
timer
Salton-(Sonex Int)
$39T
No
No
Manual brush with 1.6 mil cycles per min.
Preset for 3 minutes. Avoid if cardiac
pacemaker pt. Any TP OK. CRA- 2.6
$119
No
No
18,000 strokes/min. plus 1.6 mill cycles/min.
800.233.9054
www.saltoninc.com
Ultima
Salton
C = child, G = gingivitis, I = implants, O= ortho, P = periodontitis, Dex = dexterity not required
B. Patient Selection Considerations for Powered Toothbrushes
1)
2)
3)
4)
5)
6)
Orthodontic Bands – smallest and least expensive brush heads with a 2 minute TIMER
Diffuse Sensitivity – sonic motion instead of rotation/oscillation
Stain Removal – small brush heads and timer designed to motivate for 2-3 minutes
Older Patients – inexpensive and reliable devices with little vibration
Young Children – motivational appearance and changing music for brushing period
Periodontal Disease – no powered toothbrush completely replaces interdental and subgingival devices
Recent Powered Brush Comparisons:
i) Am J Dent. 2013 Apr;26(2):68-74.
Plaque removal efficacy of oscillating-rotating power toothbrushes: review of six comparative clinical trials.
Grender J1, Williams K, Walters P, Klukowska M, Reick H.
ii) Cochrane Database Syst Rev. 2014 Jun 17;6:CD002281. doi: 10.1002/14651858.CD002281.pub3.
Powered versus manual toothbrushing for oral health.
Yaacob M1, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, Glenny AM
iii) A 12-week clinical comparison of an oscillating-rotating power brush versus a marketed sonic brush with self-adjusting
technology in reducing plaque and gingivitis.
Klukowska M, Grender JM, Conde E, Goyal CR.
J Clin Dent. 2013;24(2):55-61.
4
©Karen Baker, M.S. Pharm, 06/01/17
IV. Chemotherapeutic Products for Home Use
Chemotherapeutic Categories
1.
General Mechanisms of Action
 Decrease rate of new plaque accumulation
 Decrease or remove existing plaque
 Suppress growth of pathogenic microflora
 Inhibit production of virulence factors
2.
Application Method
Brush on dentifrices or gels
Mouthwash: pre-brushing or postbrushing
Mouthwash: pre-procedural
Irrigation: supra-gingival or sub-gingival
Local application reservoir
CATEGORY
Anionic Surfactants
Antioxidants
Bisbiquanides
Chelation Agents
Halogens
Metal Salts
Herbal Extracts
Oxygenating Agents
Phenolic Compounds
Quaternary
Ammonium
Compounds
Surface modifying
Agents
CHEMICAL CATEGORIES OF SPECIFIC AGENTS AND PRODUCTS
SPECIFIC AGENTS
PRODUCT NAMES
Detergents such as sodium lauryl
Pre-brushing rinses, almost all toothpastes
sulfate and cocamidopropylbetaine
Almost all toothpastes that foam in the mouth
Ferulic acid, phloretin, ECGC,vitamin C
Chlorhexidine *
Periosciences rinse and toothpaste, Protandim
Peridex, Periogard, ProSoL Paroex alcohol free, generics
EDTA (edathamil)
Chloramine-T
Chlorine Dioxide
Fluoride
Iodine/Iodophors*
Oxychlorosene
Povidone-iodine
Zinc Citrate or
Zinc Chloride
Tin*
Livionex Inc. Dental Gel, Los Gatos, CA
Chlorazene
Oxyfresh Rinse/Paste, Clos-Sys IIRinse/Paste, etc.
MFP= 14% F-, NaF= 45% F-, SnF2= 24% F-,
Ora-5, iClean Mouthrinse,
Kasdenol
Betadine, Perimed
TC (Aim, Close-Up,Tom’s of Maine)Lavoris,
Listermint, Viadent Advanced Care TP, Crest ProHealthTP,
Melaleuca*
Sanguinaria
Carbamide Peroxide
Perborates
Peroxides
Hexylresorcinol
Listerine* (thymol, Eucalyptol,
Menthol, methylsalicylate)
Phenol
Triclosan*
(Tufts Newsletter- Oct. 1998, Volume
16, (8) $3.00)
Benzethonium Chloride
Cetylpyridinium Chloride*
Confident Paste and Rinse, Tea Tree Products, etc.
AKA Bloodroot but can cause leukoplakia
Gly-Oxide, Proxigel, Triology Debriding Rinse
Amosan
Ortho-Fluor, Perimed, Peroxyl, “White Bottle” rinses
S.T. 37
Many generic formulations also available
Domiphen Bromide
Delmopinol*
Simethicone, dimethicone
Cepastat, Chloraseptic, Carmex Lip Balm
Mentadent-P (zinc citrate, NaF), Colgate Gum Protection
(2% copoLymer,NaF) Colgate Total (2% copolymer, NaF)
Scope, Crest Toothpaste with Scope
Cepacol, Crest Pro Health Viadent Rinse,BreathRx,
Colgate Total Advanced ProShield, Smart Mouth
Scope
PerioShield Mouthrinse by Sunstar Butler GUM
AP-24, Control Rx by Omnii
*Denotes a chemical proven to reduce gingivitis at least 20% more than brush twice daily with fluoride toothpaste
B.
Dentifrices [Approximately $1.8 Billion spent in 2015]
1.
ANTI-CAVITY
KID'S
MOUTHWASH
Types
ANTI-GINGIVITIS
DESENSITIZING
ANTI-CALCULUS
DEODORIZING
BAKING SODA
WHITENING
"NATURAL"
PROTECT ENAMEL
5
©Karen Baker, M.S. Pharm, 06/01/17
2. DENTIFRICE PRODUCT TABLES WITH IMPORTANT CHARACTERISTICS
a.
.
ADA Accepted Fluoride Dentifrice Characteristics
Product
F- Compound
Cleaning*
Abrasion* RDA+
Aim Cavity Protection (Church&Dw)
.80 MFP
/58
M
80
A&H Dental Care Advanced Cleaning
.24 NaF
M
106
with Baking Soda (Church&Dwight)
Aqua-Fresh Fl Protection (GSK)+++
.76 MFP
59 (3)
M
108+
Colgate Cavity Protection gel/paste+++
.76 MFP
39/(4/3)
M/L
68+
Colgate Enamel Health (Colgate)
.24 NaF
Colgate For Kids gel/paste (CP)+++
.243NaF
40/(4/3)
M/
77+
Crest Pro-Health “For Me” paste
.243NaF
Crest Cavity Protection paste/gel
.243 NaF
69/70(4)
M
115/96+
(P&G)+++
Crest Kids Sparkle Fun (P&G)
.243 NaF
80
Enamelon TP with ACP (Premier)
.45 SnF
39
Shane AloeSense (Aloesense.com)
.243 NaF
90
Tom’s of Maine Natural BS Fl TP
.80 MFP
49
Tom's of Maine Natural Fluoride
.80 MFP
59/(4)
93+
Spearmint or Wintermint (Colgate)
Tom’s of Maine Natural Fluoride for
.76 MFP
M
57
Children SillyStrawberry,OutrageousOM
*Consumer Reports, 9/1992 or 8/1998
+ADA Council on Dental Therapeutics, May 1993
Journal of Dentistry 20:283-286, 1992
++Oral Health Research Institute, Indiana Univ. RDA 92-69
#Available Rx only, not ADA accepted
+++ CDA Accepted
~Reported by Manufacturer
( ) Cleaning score in Consumer Reports 8/1998 on 1-5 scale
PATIENT POINTS:
1. NaF is the best fluoride compound for root caries risk and recession patients
2. SnF 0.4% is really about 970ppm which is similar to other OTC fluoride dentifrices
3. NaF is 45% fluoride, MFP is 14% fluoride, SnF is 24% fluoride
.
b. Prescription Strength Fluoride Dentifrice Characteristics
Product
F- Compound
Additional
RDA+
Ingredients
ClinPro 5000 1.1% NaF (3M ESPE)
1.1% NaF
5% Novamin
68
Cypress SF 5000 Plus (Cypress)
1.1% NaF
Denta5000 Plus (Rising Pharma)
1.1% NaF
Pyro and SLS
80
Fluoridex (Discus)#
1.1% NaF
May have KNO3
FluoriMax 5000 (Elevate Dental Care)
1.1% NaF
10% Xylitol
Prevident 5000 Plus (CP)#
1.1% NaF
80
Prevident Dry Mouth (CP)#
1.1% NaF
No SLS
110
Prevident Booster (CP)#
1.1% NaF
Penetrating Formula 110
Prevident Sensitive (CP)#
1.1% NaF
5% KNO3
90
Pro-Dentx (Pro-Dentec)#
1.1% NaF
90
Topex Renew (Sultan Healthcare)#
1.1% NaF
5% Novamin
109
*Consumer Reports, 9/1992 or 8/1998
+ADA Council on Dental Therapeutics, May 1993
#Available Rx only, not ADA accepted
PATIENT POINTS:
1. 5000ppm NaF remineralizes 25-35% better than 1000-1100ppm NaF
2. ClinPro and Renew haven’t been evaluated in human clinical trials as of 7/8/2010
3. Prevident Booster formula is primarily to increase compliance
4. 5000ppm NaF does not effectively REVERSE white spot lesions
6
©Karen Baker, M.S. Pharm, 06/01/17
c. ANTI-PLAQUE AND GINGIVITIS DENTIFRICES (*Two are ADA Accepted for Plaque/Gingivitis)
Product*
Cleaning
FRDA Other Ingredients
Act Dry Mouth (Chattem)
NaF
Optaflow technology, xylitol, licorice root extract
AP-24 (Nu-Skin)
MFP
Dimethicone, surfactants Poloxamer 407, 338
A&H Advanced Breath Care
29
MFP
Zinc citrate 2%, baking soda
Biotene paste and gel (GSK)
MFP
78
Glucose oxidase, lactoperoxide,CMPB
Biotene PBF paste (GSK)
MFP
78
Calcium lactate, mucinase, dextranase,CMPB
Close-Up Anti-Plaque (C&D)
62
SnF
85
Stannous pyrophosphate, zinc citrate
CloSys II (Rowpar)
53
Stabilized chloride dioxide 0.1%, no SLS
Colgate Total (CP)* +++
60/(3)
NaF
70
Triclosan 0.3%, Gantrez 2%
Colgate Total Antigingivits
NaF
Triclosan 0.3%, Gantrez 2%
Colgate Total Gum Defense
NaF
Triclosan 0.3%, Gantrez 2%
Crest ProHealth (PG)
SnF
155
Stannous Fluorite, Sodium hexametaphosphate
Crest ProHealth EnamelShield
SnF
144
Stannous Fluorite, Sodium hexametaphosphate
Crest Pro Health for Life
SnF
140
Stannous Fluorite, Sodium hexametaphosphate
Listerine EC paste/gel (J&J)
60/(4)
MFP
85
Essential oil ingredients as in the rinse
Livionex Dental Gel(Livionex)
“Activated” edathamil (EDTA) to chelate calcium
Oral Defense (BioGlobe Tech)
NaF
Cetylpyridiumium Cl, no SLS
Oxyfresh (Oxyfresh USA)
45
Stabilized chloride dioxide
Parodontax Toothpaste (GSK)
NaF
BS,CMPB& 6 herbs/gum bleeding, ,non-fluoride also
Plaque HD Disclosing (TJA)
NaF
Pyros, SLS, Annatto extract, EDTA, FD&C Blue 1
SmartMouth Advanced
MFP
Zinc Chloride 2% , .81% MFP
Clinical Formula (Triumph)
Tom’s of Maine Antigingivitis
68
Zinc citrate 2%, xylitol, baking soda
* Colgate Total and Crest ProHealth are ADA accepted for plaque/gingivitis reduction beyond regular fluoride toothpaste
PATIENT POINTS
1. Triclosan toothpaste reduces mild/moderate gingivitis 20-30% compared to regular fluoride toothpaste
2. Essential oils or zinc are about 16-19% effective at reducing gingivitis so are not ADA accepted.
3. Chlorine Dioxide toothpaste is NOT effective at reducing gingivitis but reduce oral malodor
4. Crest Pro-Health reduces mild/moderate gingivitis about 25% compared to regular fluoride toothpaste
5. Biotene toothpastes do not have specific anti-gingivitis ingredients other than fluoride.
6. Activated edathamil (EDTA) is a common food additive which is safe and may inhibit plaque formation.
d. BAKING SODA DENTIFRICES
Product
A&H Dental Care Smooth Spearmint (Church & Dwight)
Aquafresh Baking Soda (GSK)
Arm & Hammer Baking Soda (Church &Dwight)
A&H Dental Care Gel (Church &Dwight)
A&H Dental Care Paste (Church &Dwight)
A&H Enamel Care with Liquid Calcium (C&Dwight)
Aim Baking Soda Gel (Church & Dwight)
Close-Up Baking Soda Paste (Church&Dwight)
Colgate Baking Soda Paste (Colgate)**
Colgate TC Baking Soda and Peroxide Paste (Colgate)
Mentadent Baking Soda and HP Combo (Church&Dwi)
Pepsodent with Baking Soda Paste (Church&Dwight)
Peroxicare (Church & Dwight)
Sensodyne Baking Soda (GSK)
Tom’s of Maine BS Peppermint/Gingermint (Colgate)
*Indiana Oral Health Research Institute, 1999
FNaF
MFP
NaF
NaF
NaF
MFP
MFP
NaF
NaF
NaF
NaF
NaF
NaF
MFP
PATIENT POINTS
1. Higher baking soda content leads to lower
cleaning scores
.
% Baking++ % Hydrogen++ Cleaning+
Peroxide
RDA*
Soda
57
30
24
65
.5
(3)
7
100
62
30
55
35
65
28(2)
65
30
.5
80++
.5
120
25
51
0.50CaPeroxide
92
12
(4)
.75
118
5
(4)
80++
5
0.75NaCarbPerox
52
52
25
67
(3)
68
5
+Consumer Reports 9/98,++Per Manufacturer,**ADA
Accepted for Caries Reduction
2. Baking Soda and Hydrogen Peroxide have no
therapeutic effect singly or in combinatio
7
©Karen Baker, M.S. Pharm, 06/01/17
e. “Natural” Oral Health Products: Help or Hype?
1. What “Natural” Oral Health Products DON’T Contain
-Alcohol
-Artificial colors or artificial sweetners like saccharine
-Harsh chemical preservatives or dyes
-Sodium Lauryl Sulfate
-Triclosan or chlorhexidine
2. What “Natural” Oral Health Products DO Contain

















Aloe vera has a soothing and anti-inflammatory effect.
Calendula (Calendula officinalis) has soothing, anti-inflammatory properties that help heal irritated, tender gums. It also has a
mild antiseptic action. It is in the ragweed family and can cause allergic reactions in those allergic to ragweed.
Echinacea (Echinacea spp.), an immune-stimulating herb, helps combat infection; it is anti-inflammatory and antiviral.
Essential Oils, such as anise, cinnamon,clove, eucalyptus, fennel, lavender, peppermint, rosemary, spearmint, and thymol kill
bacteria
Goldenseal (Hydrastis canadensis) has anti-inflammatory, antiviral and antibiotic properties; it's good for healing and
preventing gum problems.
Grapefruit seed extract, made from the seeds and pulp of grapefruit, has antiseptic and antibacterial properties to fight infection.
Horsetail is rich in silica, vitamin E, selenium and other minerals. When used as a mouth rinse, it can help in coagulation,
decrease bleeding and heal oral infections.
Myrrh (Commiphora molmol) has antimicrobial and astringent properties that help to tighten the gums. It is considered one of
the best herbs for healing bleeding gums and mouth ulcers, and helps fight the bacteria that cause tooth decay and gum disease.
Neem (Azadirachta indica), long considered a top antibacterial herb in Ayurvedic healing, helps prevent plaque. Ayurveda, a
form of traditional medicine originating in India, is practiced in the western world, including the United States, as a form of
alternative or complementary medicine.
Oregon grape root (Mahonia spp.), possessing a high concentration of antimicrobial compounds and astringent properties, is
excellent for helping to prevent and heal gum problems.
Ozone or olive oil with ozone, for caries and bacteria reduction. Primarily used in Europe but growing in the U.S.
Peppermint (Mentha piperita) provides a pleasant, freshening flavor and sensation.
Sage (Salvia officinalis) has strong astringent properties, making it a favorite herb for tightening the gums and soothing a sore
mouth.
Tea tree (Melaleuca alternifolia), a potent antimicrobial essential oil, fights the bacteria that cause tooth decay and gum
disease. It is often used in combination with other natural herbs, such as rosemary, chamomile, echinacea, aloe and fresh mint.
Vitamin K strengthens teeth.
White oak bark (Quercus alba), a strong astringent, is helpful for healing swollen, tender and bleeding gums and mucous
membranes, and has a clotting and antiseptic effect.
Xylitol, a natural non-cariogenic sweetner made from birch trees has been clinically shown to prevent tooth decay
3. Common “Alternative” Ingredients and Clinical Evidence??
- Aloe Vera
* Wynn, R. Aloe Vera in Dentistry. AGD Journal Jan-Feb, 2005. More evidence is needed
-Antioxidants (pycnogenol, Vitamin E)
*Garewal HS, Katz RV, Meyskens F, et al. Beta-carotene produces sustained remissions in patients with oral
Leukoplakia: results of a multicenter prospective trial. Arch Otolaryngol Head Neck Surg 1999;125:1305-10
*Liede K, Hietanen J, Saxen L, et al. Long-term supplementation with alpha-tocopherol and beta-carotene and
prevalence of al mucosal lesions in smokers. Oral Dis 1998;4:78-83
*Benner SE, Winn RJ, Lippman SM, et al. Regression of oral leukoplakia with alpha-tocopherol: a community clinical
.
oncology program chemoprevention study. J Natl Cancer Inst 1993;85:44-7
-Coenzyme Q10 (Ubiquinone)
.
*Hanioka T, Tanaka M, Ojima M, et al. Effect of topical application of coenzyme Q10 on adult periodontitis.
Molec Aspects Med 1994;15:S241-8.
*Turunen M, Olsson J, Dallner G. Metabolism and function of coenzyme Q.
Biochim Biophys Acta 2004;1660:171-99
-Essential Oils (eucalyptus, rosemary, thyme(thymol 30-70%))
*Silva J, Abebe W, Sousa SM, et al. Analgesic and anti-inflammatory effects of essential oils of Eucalyptus.
J Ethnopharmacol 2003;89:277-83.
-Green Tea Extract
* Wu CD and Wei GX. Tea as a functional food for oral health. Nutrition 2002; 18 (5). 443-444.
*Krahwinkel T, Willershausen B. The effect of sugar-free green tea chew candies on the degree of
inflammation of the gingiva. Eur J Med Res 2000;5:463-7
.
*Li N, Sun Z, Han C, Chen J. The chemopreventive effects of tea on human oral precancerous mucosa lesions. Proc
Soc
Exp Biol Med 1999;220:218-24.
-Loturbark, Neem, Tulsi, Myrrh
.
* Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel--a 6-.
week clinical study. J Ethnopharmacol 2004;90:99-103
.* Antinociceptive action of Ocimum sanctum (Tulsi) in mice: possible mechanisms involved. J Ethnopharmacol
2003;88:293-6 * Myrrh is the oleo-gum resin exuded from fissures or cuts in the bark of Commiphora
species trees.*Kelm MA, Nair MG, Strasburg GM, DeWitt DL. Antioxidant and cyclooxygenase inhibitory phenolic
compounds from Ocimum sanctum Linn. Phytomedicine 2000;7:7-13.
-Melaleuca (Australian Tea Tree Oil)
Gingivitis Helped, But Not Plaque: In a DB PC study of 49
adults with severe chronic gingivitis given either TTO-gel (2.5%), chlorhexidine (CHX) gel (0.2%), or a placebo gel to
apply with a toothbrush twice daily, no adverse reactions to any of the gels were reported. The TTO group had
significant reduction in bleeding and gingivitis. However,TTO did not reduce plaque scores, which tended to increase
over the latter weeks of the study period. The effects of a tea tree oil-containing gel on plaque and chronic gingivitis.
Soukoulis S, Hirsch R. University of Adelaide, South Australia. Aust Dent J. 2004 Jun;49(2):78-83.
-Peelu (Miswak Chewing Stick)
*Use of miswak versus toothbrushes: oral health beliefs and behaviours among a sample of
Jordanian adults. RS Tubaishat, ML Darby, DB Bauman and CE Box pages 126–136
*Namibian Chewing Stick, Diospyros lycioides, Contains Antibacterial Compounds against
Oral
Pathogens Cai, L.; Wei, G.-X.; van der Bijl, P.; Wu, C. D. J. Agric. Food Chem.; (Article); 2000; 48(3);
909-914.
-Propolis (Bee Product)
* Santos FA, Bastos EM, Uzeda M, et al. Antibacterial activity of Brazilian propolis and fractions against
oral anaerobic Bacteria. J Ethnopharmacol 2002;80:1-7.
* Park YK, et al. Antimicrobial activity of propolis on oral microorganisms. Curr Microbiol 1998;36:24-8.
-Vitamin C (Ascorbic Acid)
*Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Dietary Vitamin C and the risk for
periodontal disease. J Periodontol 2000: 71: 1215– 1223
Most experts recommend getting antioxidants, including vitamin C, from a diet high in fruits, vegetables,
and whole grains rather than taking supplements (1440,3042).
E. Alternative Products for Caries Reduction and Control
1. Ozone Rickard GD, Richardson R, Johnson T, et al. Ozone therapy for the treatment of dental caries.
Cochrane Database Syst Rev 2004;(3):CD004153. No reliable evidence that ozone gas stops or reverses dental
decay.
2. Xylitol – proven reduction in caries rate with adequate GUM regimen
9
©Karen Baker, M.S. Pharm, 06/01/17
–must ingest 6-10 grams per day in 3-5 doses of gum chewed 5 minutes to be effective
Hershey IceBreakers Ice Cubes gum as 1.2g per piece so 5 pieces per day is therapeutic
Epic Xylitol gum has 1.05g per piece so 6 pieces per day is therapeutic
Xylimax Gum has .86g per piece so 7 pieces per day is therapeutic
Xylichew Gum has 1.0g per piece so 6 pieces per day is therapeutic
Spry Gum has .72g per piece so 8 pieces per day is therapeutic
F. Trends in Alternative Oral Health Care
1. Oral Detox Products for mercury vapor and other heavy metal toxins

For Mercury Amalgam Fillings: Bind and Eliminate Mercury Vapor and other toxic metals in the mouth
Oral Detox Pro™ is a dual-purpose mouth rinse that binds to mercury vapor excreted in the mouth from
amalgam fillings. More than 100 million Americans have silver amalgam fillings in their teeth. Dental
practitioners are being exposed to more and more mercury vapor as patients ask for these fillings to be repaired
or replaced. This high level of exposure is detrimental to all staff members’ health. Becoming mercury safe is
important for everyone’s health. Rinsing your patients' mouths with Oral Detox Pro™ during procedures binds to
the mercury vapor excreted in the oral cavity and surrounding air. This provides important health protection for
doctors, assistants, and patients.
Chloralytes (4 oz) liquid, Morin Lab Inc This unique liquid combination was formulated to assist the Biological Dentist
in protecting the patient before during, and after metal extractions. It can be used as a paste in the mouth during removals
and by those who do not like to take Chlorella in the form of capsules or powder. The 1st Cold Process liquid
CHLORELLA concentrate with a neural delivery system.
One 4 oz bottle Contains: 27,600mg. of Broken Cell Chlorella Pyrenoidosa & SELECTROLYTES“
Suggested Use: _ tblspn. (_ oz. approx.7.5 mL.) 1x daily with purified water at mealtime.
Warning: Consult your Licensed Healthcare Provider before using & keep out of the reach of children!
2. Oral Probiotics for favorable oral flora shifts
EvoraPlus – oral lozenge for conversion of pathogenic oral flora to favorable healthy flora – no evidence of
effectiveness
BreathBiotics – systemic supplement for restoration of normal flora and fresh breath – no evidence
Plaque HD – oral lozenge to accompany the toothpaste and mouthrinse system sold by dental offices
3. Periodontal Disease Treatment Product Lines
PerioSciences- “The PerioSciences approach is to work in concert with the body’s natural defense
system in the oral cavity. Saliva has natural antioxidants and natural anti-bacterial agents. The
antioxidants in PerioSciences products complement those in saliva, and our polyphenol components
work with the saliva’s antimicrobial agents. Altogether, our natural ingredients are gentle on soft oral
tissue, but provide powerful plant-based antioxidants and polyphenols to enhance the salivary system.”
-antioxidant-based toothpaste, rinse and gel marketed as “natural” as well as effective for
whitening
Review Papers: Antioxidants in Oral Care but no clinical trials
10
©Karen Baker, M.S. Pharm, 06/01/17
Compendium Of Continuing Education In Dentistry, Jan. - Feb. 2011, Volume 32, Issue 1
Reactive Oxygen Species and Antioxidant Defense Mechanisms in the Oral Cavity: A Literature
Review, San Miguel, Svoboda, et al. Baylor College of Dentistry
Summary of Research: Through dental procedures and the materials used in dentistry such as whitening,
environmental elements and self-induced materials such as nicotine, tissues in the mouth are exposed to many
types of free radicals or reactive oxygen species (ROS). An accumulation of free radicals, regardless of the
source, can lead to a condition called oxidative stress. Oxidative stress is linked to series oral disease such as
periodontal disease. Antioxidants fight oxidative stress. Antioxidants exist naturally in saliva and protect against
oral disease including periodontitis and oral cancer.
Compendium Of Continuing Education In Dentistry, March 2011, Volume 32, Issue 2
Use of Antioxidants in Oral Healthcare, San Miguel, Svoboda, et al. Baylor College of Dentistry
Summary of Research: There is increasing attention to the potential benefit from the use of antioxidants in the
field of dental medicine. Treatment of oral and dental health problems may include drug-free, natural
antioxidant remedies that are available in topical oral applications such as mouth rinse, gel, paste, gum, or
lozenge compositions. These topical antioxidant remedies help reduce free radical or reactive-oxygen species,
which are causative inflammatory factors in the progression of gingival and periodontal maladies .
3. “Green” Dental Practice – www.ecodentistry.org
 Natural Supplement and Alternative Dental Product References
 Natural Medicines Comprehensive Database
-“Gold Standard” for objectivity and comprehensive information
-patient handout option very useful and database can be searched by disease state
-priced at $15/month at www.naturaldatabase.com
 Nutrition Action Health Letter
-10 issues per year. Subscribe at www.cspinet.org for US or CA versions
- -nonprofit “food police” address dietary supplement controversies
-price $24/year or $42/24 months, to order fax 202.265.4954
Green Product Comparison Shopping Websites
-www.pristineplanet.com
-www.goodguide.com
-www.scorecard.org
-www.sustainlane.com
Natural Dental Product Websites
-www.dentist.net or www.dentaldepot.com or www.drugstore.com
-www.iherb.com or www.pacwestserv.com or www.bewellstaywell.com
-www.cosmeticingredientreview – for safety of all product ingredients – great for healthcare providers
-www.cosmeticsinfor.org – consumer site for information on product safety
Useful General Information Websites
-www.consumerlab.com -analytical reports on specific products – great for patients and you!
-www.nccam.nih.gov/health/ or www.nccam.nih.gov/health/
-www.asahq.org-“Herbals and Anesthesia”, www.supplement-geek.com for you and patients
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©Karen Baker, M.S. Pharm, 06/01/17
e. NATURAL DENTIFRICES
Product/Manufacturer
Claims
Auromere (www.auromere.com)
Invigorates/purifies
DentiCare Tooth Polish (Melaleuca, Inc.)
Benefits bleeding gums
Dentaforce (Bioforce)
Astringent/stimulant
Eco-Dent (Eco-Dent 888.Eco.Dent)
Hardens enamel w/o FCool Mint (Nature’s Gate)
Antiseptic/ “free” calcium
Healthy Teeth & Gums toothpaste
Prevent cavities/fight gingivitis
(www.thenaturaldentist.com)
Homeodent (Boiron-Borneman)
No-mint
Jason Toothpaste (www.jasonBest tasting natural toothpaste!
natural.com)
Gum support/perio protection
Kiss My Face (KMF)
Pure and natural
MCT Oil Toothpaste (The Dirt)
Blows others out of the water
MouthFx (www.mouthfx.com)
97% effective in 41 countries
Nutribiotic Dental Gel
Supports teeth and gums, No
(www.nutribiotic.com/dentalgel)
fluoride which is toxic
Parodontax-F (www.parodontax.de) GSK Soothing herbs/mineral plus FlPeelu (Peelu Products)
Miswak/Siwak chewing stick
Propolis TP (Beehive Botanicals)
Protects hive, benefits mankind
Tea Tree Oil TP (Desert Essence)
Especially good for gingivitis/perio
Tea Tree TP (Thursday Plantation)
Healthy gums, decrease tartar
The Dirt Natural Toothpowder
Paleo friendly and xylitol free
Tom’s of Maine (Colgate)
No dyes, preservatives, sweetners
Tooth and Gum Paste (DHC)
No SLS, “natural F source” ( tea)
“Active Ingredients”
Neem, Peelu, 24 herbal extracts
Melaleuca, propolis, myrrh
Echinacea, rosemary, essential oils
BS, tartaric acid, CaCo3, myrrh
Sage, vitamin C, Calcium Carrot Pwd.
MFP, aloe vera, echinacea, goldenseal,
calendula,propolis,grapefruit seed extr.
Calendula, plantain, horseradish, witchhazel
CoQ10, Aloe Vera, Sea Salt, Melaleuca,
Perilla Seed Extract
NaMFP,aloe vera,micronized silica
Coconut oil, bentonite clay, theobromin
100% natural essential oils
Grapefruit Seed Extract, Zinc Citrate,
sanguinaria, aloe vera, stevia
Rhatany, chamomile,myrrh,fluoride
Peelu fiber, natural sorbo fruit juice
Propolis, xylitol, flavoring oils
Melaleuca, propolis, ginger
0.4% melaleuca, chlorophyllin-copper
Bentonite clay,baking soda, myrrh gum
Some with F-, xylitol, many formulas
Echinacea, green tea, essential oils
PATIENT POINTS: 1. Non-Fl: Dabur, Denticare, Dentaforce, Propolis, , Tea Tree Toothpaste
2. Fl:
Denticare, Healthy Teeth&Gums , Jason Healthy,Tom’s of Maine Fl-, Tooth&Gum Paste
f. TARTAR CONTROL DENTIFRICES
Product
FCleaning+ RDA* Other Ingredients
Aim TC (Church&Dwight)
.80 MFP
108
Zinc citrate 0.5%
Aquafresh TC (GSK)
.24 NaF
(4)
124
Tetra NA pyrophosphate 3.3%
A & H TC Toothpaste (Church&Dwight)
.24 NaF
34
Napyrophosphate, Naphosphate
A&H TC Gel (Church&Dwight)
.24 NaF
71
Napyrophosphates
Close-Up TC Paste (Church&Dwight)
.76 MFP
62
98
Zinc citrate 0.5%
Close-Up TC Gel (Church&Dwight)
.76 MFP
63
NaCl, zinc citrate 0.5%
Colgate TC Gel (CP)
.24 NaF
74
87
3.3% tetraNapyrophosphate, PVM/MA
Colgate TC Paste (CP)
.24 NaF
62
165
3.3% tetraNapyrophosphate, PVM/MA
Colgate TC Gel/Paste MCF (CP)
.24 NaF
87/113 3.3% tetraNapyrophosphate, PVM/MA
Colgate TC Micro Cleansing (CP)
.24 NaF
(4)
112
3.3% tetraNapyrophosphate, PVM/MA
Kiss My Face TC with Zinc Citrate
Zinc citrate, aloe vera, lemon flavored
Listerine EC TC Gel/Paste (J&J)
.76 MFP
(4)
90
Zinc citrate trihydrate, essential oils
Natural White TC (Natural White)
.24 NaF
113
TetraK pyrophosphate
Pepsodent Complete Care(Ch&Dwight)
.76MFP
Zinc citrate, silica
Rembrandt TC Paste (J&J)
.80 MFP
55
"Citroxain" = alumina, papain, citric acid
Sensodyne TC/Plus Whitening (GSK)
.24 NaF
100
KNO3, tetra Kpyrophosphate, silica
Tom’s of Maine TC&Whitening (Colgate
90
Zinc citrate, xylitol, hydrated silica
Ultra-Brite All in One (C-P)
.24 NaF
Pyrophosphates, no alumina
PATIENT POINTS: 1. Pyrophosphates are associated with dentinal sensitivity and soft tissue lesions.
2. Sodium Hexametaphosphate produces adverse effects equivalent to standard pyrophosphates.
3. Switch to zinc salts to get calculus reduction without sensitivity and soft tissue lesions.
12
©Karen Baker, M.S. Pharm, 06/01/17
g. DESENSITIZING DENTIFRICES
Product
AquaFresh Sensitive (GSK)*
A&H Dental Care Sensitive Formula
Biotene Sensitive Toothpaste (Laclede)
ClinPro 5000 1.1% NaF Dentifrice with Calcium and Phosphate
Colgate Enamel Health Sensitivity Relief (CP)
Colgate Sensitive Pro Relief 1500ppm (CP)
Crest Pro-Health (P&G)
Crest Sensi Relief (P&G)
Crest Sensi Repair and Prevent (P&G)
Denclude Desensitizing Dental Cream with Sensistat (Ortek)
Dr. Collins Restore with Novamin
Enamelon Preventive Treatment Gel (Premier)
Kiss My Face Sensitive Fluoride-Free with Aloe (KMF)
Level OralCare Sensitivity Herbal with Xylitol (Level Oral Care)
Orajel Sensitive (Del)*
Prevident Sensitive (P&G)
Sensodyne Baking Soda (GSK)
Sensodyne Cavity Prevention (GSK)*
Sensodyne Complete Protection (GSK)
Sensodyne Fresh Mint* (GSK)
Sensodyne Cool Gel (GSK)
Sensodyne Original Flavor (GSK)
Sensodyne Pronamel (GSK)
Sensodyne Repair and Protect (GSK)
Tom’s of Maine Sensitive Teeth Natural Toothpaste (Colgate)
Topol Plus Sensitive Teeth (Dep)
FNaF
NaF
MFP
NaF
NaF
NaF
SnF
NaF
SnF
.45SnF
.76MFP
1%MFP
NaF
NaF
MFP
SnF
MFP
NaF
MFP
NaF
SnF
MFP
Densensitizer
5% KNO3
5% KNO3
5% KNO3
Ca and Phos
5% KNO3
5% KNO3
SnF
5% KNO3
SnF
Sensistat
Novamin
Ca and Phos
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
5% KNO3
Cleaning+
(3)
50/(2)
(3)
(3)
(3)
80
-
RDA++
91
54
55
68
62
100
107
39
90
55
89
89
92
100
39
68
-
PATIENT POINTS: 1. Potassium Nitrate and SnF are most effective for OTC twice daily use.
2. Patient should consult dentist after 4 weeks of twice daily use with no positive effects.
3. Abrasivity should be selected at an RDA of 120 or below
h.
WHITENING” DENTIFRICES (# ADA Accepted for Extrinsic Stain Removal )
Cleaning
Abrasion+
Product
FRDA
“Whitening Ingredients”
NaF
Aquafresh Whitening TC (GSK) #
(4)
M
113
Na tripolyphosphate
NaF
Aquafresh Iso-active Whitening
Na tripolyphosphate, Isopentane
NaF
A&H Dental Care Adv. Whitening
(3)
L
106
TetraNapyrophos,BS Napercarbamate
A&H Truly Radiant Enamel Strength NaF
BS, silica, cal sulfate, cal peroxide
MFP
110/80
Close-Up Paste/Gel (Church&Dw)
85/72(4)
H
Silica, titanium dioxide in Clear
Colgate Fresh Confidence Whitening NaF
75
M
124
TetraNa pyrophosphate,Ultra mint
SnF
Colgate Sensitive Plus Whitening
51
120
Micronized Silica
MFP
Colgate Optic White Anticavity
Hydrogen Peroxide,pyrophosphates
NaF
Colgate Pro-Clinical Daily Cleaning
Silica, 2 pyrophosphates
MFP
Colgate Pro-Clinical Daily Renewal
Silica, 1 pyrophosphate,PVM/MA
NaF
Colgate Pro-Clinical Whitening
Silica, 2 pyrophosphates
MFP
Colgate Sparkling White BS, Per
Silica, BS, pentaNa triphos, pyropho
NaF
Colgate Sparkling White TC #
69
190
Silica, pentaNa triphosphate, pyropho
NaF
Colgate Total Adv Cleaning Plus
H
210
Triclosan, Gantrez, silica
Whitening #
NaF
Colgate Total Advanced Whitening
H
180
Triclosan, Gantrez,
MFP
Colgate Whitening BS, Per, TC
(5)
M
145
BS, alumoxide, pyrophos, td, Caperox
NaF
Crest Extra Whitening (P&G)
M
130
Silica,
NaF
Crest Multicare Whitening (P&G) #
62
M
144
Silica 31%, BS 1.5%, pyrophosphate
SnF
Crest Pro-Health Whitening (P&G)
155
Silica,sodium hexametaphosphate
SnF
Crest Pro-Health HD 2 step (P&G)
SnF followed by hydrogen peroxide
13
©Karen Baker, M.S. Pharm, 06/01/17
Crest 3D White Vivid (P&G)
Crest Whitening Plus Scope (P&G)
Gleem (P&G)
Luster Premium Deep Stain Eraser
Natural White (Natural White)
Pearl Drops BS Paste (C&D)
Pearl DropsPaste (C&D)
Pearl Drops Toothpolish (C&D)
Pepsodent F- (Church&Dwight)
Plus White (CCA)
Rembrandt Plus # (J&J)
NaF
NaF
NaF
NaF
NaF
NaF
NaF
MFP
MFP
MFP
52
79
74
(4)
58
53(3)
M
M
M
H
M
M
L
205
125
118++
101++
195
227++
150
94++
55++
Rembrandt Plus Premium Whit. Gel
with Peroxide (J&J)
Rembrandt Whitening Cankersore
Rembrandt Intense Stain Removal
Sensodyne Extra Whitening (Block)
Supersmile (Robell Research)
Topol Plus BS (Topol-Dep)
Topol Smoker’s Fluoride Gel (Dep)
Topol Smoker’s Toothpaste/Fl- (Dep)
MFP
-
L
70+
NaF
NaF
MFP
MFP
MFP
MFP
MFP
82
76
L
L
H
H
55++
94
150
62+
207++
227++
Silica, disodium pyrophosphate
Scope MW ingredients,pyrophosphate
Silica, triNaphosphate, titanium diox
Silica, Urea peroxide, corn starch
Silica, glycerin, titanium dioxide
TetraK&Na pyrophosphates, BS, td
Silica
Silica, AlHydroxide, triNaphosphate
Silica
TriNaphosphate, monoNaphosphate
Citroxain(papin, alumina,
NaCitrate)Carbamide peroxide
Carbamide peroxide < 3% citroxain
Citroxain, hydrated silica
Dicalcium phosphate,silica,alumina
KNO3, calcium peroxide
Calcium peroxide, titanium diox, BS
Silica, BS, diNaphosphate, titan diox
Silica, Zirconium silicate, titandiox
Silica, Zirc. silicate, titan. diox., tetra
NaPyrophosphate
TetraNaPyro,SLS,xylitol,ITALIAN
Silica, BS, alumina, titanium dioxide
Silica, BS, prop glycol, Caperoxide
Silica, alumina, titan. dioxide, pyro
MFP
Marvis Whitening Toothpaste
MFP
Ultra-Brite BS (C-P)
M
MFP
Ultra-Brite BS &Peroxide (C-P)
(3)
M
MFP
Ultra-Brite Paste/Gel (C-P)
86/72(5)
M/M
133++
MFP
Ultra-Brite Advanced Whitening
M
260
*Consumer Reports 9/92 or 8/98 Journal of Dentistry 20:283-286, 1992, +Reported by the manufacturer 5/95 (L=low,
M=moderate, H=high), ++Oral Health Research Institute, Indiana University, RDA 92-69, # = ADA ACCEPTED FOR
REMOVAL OF SURFACE STAIN
PATIENT POINTS:
1. Toothpastes cannot effectively bleach teeth and can only remove extrinsic stain.
2. Cleaning ability does not necessarily correspond to abrasivity.
3. Chronic exposure to peroxides should be avoided in tobacco users.
4.
FDA recommends RDA limit of 200 while ADA recommends limit of 250.
5.
FDA recommends RDA limit of 200 while ADA recommends limit of 250.
a. Options for Whitening is Based on Patient Preference and Tolerance
 Least effective are whitening toothpastes because they only polish off stained pellicle
 Next most effective is OTC Whitestrips with the most effective being Crest“Advanced”
 At-Home or In-Office Bleaching Using Custom Trays are Equally Effective
 At-Home Bleaching leads to longer shade maintenance than In-Office Bleaching
b. Patient-Specific Whitening Product Recommendations
1. Pellicle stain/ no exposed roots/ no canker sores
 Colgate Whitening BS, Per, TC/ / Crest Multicare Whitening/Ultra-Brite Paste
2. Pellicle stain/ exposed roots/ no canker sores
 Aquafresh Whitening// Gleem/
3. Pellicle stain/ exposed roots/ canker sores or BMMP or LP
 No pyrophosphates, SLS, CMPB or high detergent content
 Tom’s of Maine Botanically Bright, Squigle Enamel Saver,
14
©Karen Baker, M.S. Pharm, 06/01/17
3.
Smokers or Chewing Tobacco Users
 Avoid, Colgate Whitening/ Rembrandt / Stay White/ Supersmile/ Ultra Brite BS &
Peroxide/ White Step (any toothpaste with peroxides)
V. CREST WHITESTRIPS: WHAT ARE THEY CALLED NOW??
A. Retail Purchase:
1. Crest Whitestrips Classic is now Crest 3D White Whitestrips Vivid
10% HP in 20 strips for 10 days of once daily use –No Advanced Seal but cheapest
2. Crest Whitestrips Premium is now Crest 3D White Whitestrips Advanced Vivid
– 9.5% HP in 28 strips for 14 days of once daily use. Contains Advanced Seal
3. Crest Whitestrips Pro Effects is now 3D White Whitestrips Professional Effects
– 10% HP in 40 strips for 20 days of once daily use. Contains Advanced Seal
4. Crest Whitestrips Advanced Seal is now Crest 3D White Whitestrips Advanced Vivid
- 10% HP in 28 strips for 14 days of once daily use as listed above
5. Crest Daily Whitening Multicare is now Crest 3D White Whitestrips Stain Away
- 6.0% HP plus 2% pyrophosphate in 28 treatments for 5minutes once daily use
6. New Crest 3D White Whitestrips Gentle Routine – 6% HP for 5minute per day
-28 treatments to be used for 5 minutes daily. Use for four weeks.
B. Dental Office Dispensed:
1. Crest Whitestrips Professional – 6.5% HP in 84 strips for 21 days of twice daily use
-has been discontinued
2. Crest Whitestrips Supreme – 14% HP in 84 strips for 21 days of twice daily use
C. Effectiveness
1.
Original Whitestrips – overall color improvement 2.96 in 14 days
2.
Whitestrips Premium – overall color improvement 3.2 in 7 days
3.
Professional Whitestrips – overall color improvement 4.20 in 21 days-discontinued??
4.
Supreme Whitestrips – overall color improvement 40% better than Professional in 21 days
D. Adverse Events
1. Localized
a. Tooth sensitivity – a little higher with Supreme Whitestrips
b. Gingival irritation-lowest with Supreme Whitestrips
c. Resolution in 24-48 hours without treatment is typical
VI. SALIVA ENHANCERS
A. NeutraSal (OraPharma) and SalivaMax (Forward Science) –supersaturated calcium
phosphate as a powder packet for immediate rinsing.
B. Novamin (calcium sodium phosphosilicate) by NovaMin Technology Inc. of Alachua, FL.
Calcium Sodium-phosphosilicate ( Novamin)
A synthetic mineral composed of calcium, sodium, phosphorous and silica, all elements naturally occurring in the body.
Silica (glass) containing Ca and PO is the driving mechanism that binds to the tooth surface
15
©Karen Baker, M.S. Pharm, 06/01/17
1. Omnii Oravive Tooth Revitalizing Paste (Oravive)
2. DenShield Tooth Sensitivity Therapy (Novamin)
3. Butler NuCare Tooth Root Conditioner (Butler)
4.
5.
6.
SootheRx Sensitivity Therapy (Omnii)
Dr. Collins Restore Toothpaste for Home Use
Topex Renew by Sultan is Novamin plus NaF 5000ppm
C. Tri-Calcium Phosphate – ClinPro with NaF 5000ppm – 3M Espe
D. Recaldent (casein phosphopeptide-amorphous calcium phosphate)
Casein phosphopeptide and amorphous calcium phosphate (CPP-ACP)
Casein phosphopeptide is a milk protein peptide that is bound to amorphous calcium phosphate
The milk derived peptide containing amorphous Ca and PO is the driving mechanism that binds to the tooth surface.
5.
Sugarless gum – Trident White and Trident for Kids Berry
6.
MI paste and MI PastePlus with 5:3:1 mineralization ratio by GC America
E. Soluble Calcium Sulfate
7. Arm & Hammer Enamel Care Toothpaste (Church and Dwight)
F. Amorphous Calcium Phosphate (ACP)
ACP is inorganic amorphous calcium phosphate, made by combining soluble salts of calcium and phosphorous
1. Relief ACP Oral Care Gel by Discus Dental
-NaF 0.22%
-Potassium Nitrate 5%
- Amorphous Calcium Phosphate 0.375%
G. Arginine Bicarbonate and Calcium Carbonate (Sensistat) – Now Pro-Argin (Colgate)
Arginine bicarbonate is an amino acid complex found in saliva that is bound to calcium carbonate
1. Proclude (Ortek)
2. Denclude (Ortek) 3. Tom’s of Maine Rapid Relief Sensitive Toothpaste
VII.
BLEACHING OF VITAL TEETH
A.
Mechanism
1. Hydrogen peroxide is an oxidizing agent which produces free oxygen radicals (unpaired electron).
2. Free oxygen radicals are unstable and electrophilic. They can react with most unsaturated bonds,
resulting in disruption of electron conjugation and a change in the absorption energy of the organic
molecules in tooth enamel. Simpler molecules that reflect less light are formed which causes whitening
3. Saturation point is reached when only hydrophilic colorless structures exist. Bleaching then results
in breakdown of enamel with subsequent tooth brittleness and increased porosity.
B. Chemicals Used for Bleaching
1. Hydrogen peroxide 1 .5% - 10% (pH of 3% hydrogen peroxide is 2.7)
2. Carbamide peroxide 10% - 40% (10% CP = 3.6% hydrogen peroxide and 16% CP = 5.76% H 2O2
-a.k.a. urea peroxide, perhydrol urea, carbamide, carbamide urea
3. Carbamide peroxide products contain either a carbopol, glycerin base, or propylene glycol base.
16
©Karen Baker, M.S. Pharm, 06/01/17
C. Factors that Affect Bleaching Effectiveness
1.
2.
3.
4.
5.
6.
Surface debridement
Hydrogen peroxide concentration - highest is 50%
Temperature - an increase of 10 degrees centigrade doubles rate of oxidation reaction
The pH - slightly acidic pH is ideal for shipping. storage but best oxidation is at pH 9.5 – 10.8
Time period - Longer exposure results in greater shade changes
Seated environment - increases efficiency of the bleaching process
D. Contraindications for Bleaching Vital Teeth
1. Extremely large pulps which cause sensitivity
2. Hypersensitivity - exposed root surfaces or transient hyperemia due to orthodontic treatment
3. Severe enamel Loss
4. Extensive Restorations - greatest damage to glass ionomers and least to porcelain
5. Pregnancy, lactation, peroxide allergy, latex allergy with power bleaching
6. Transient hypersensitivity with prolonged application of home use get
7. Hypersensitive reactions or allergic reactions caused by extended exposure to chemicals and
appliances such as burning sensation, sore throat, nausea, irritation, or edema.
8. Lack of compliance- either through inability or unwillingness to wear the necessary time
E. Predictors of Bleaching Success
1.
2.
3.
4.
5.
6.
Discoloration is fairly light, evenly distributed, and on the surface, not in dentin.
Teeth are yellowed as a consequence of aging.
Matching large amalgams or crowns is not required.
Enamel is fairly heavy and even with no pits, fissures, or grooves.
There is no need to change tooth structure.
How Long Does it Last?


VIII.
At 1.5y – 74% are satisfied, at 3y – 64% are satisfied with shade lightening
Minimum “lock out” period of 6 months is recommended for pulp health
CHARACTERISTICS OF IN-OFFICE AND AT-HOME BLEACHING PRODUCTS
NEW BLEACHING MATERIALS
PRODUCT
OTHER ACTIVE
INGREDIENTS
Assisted Bleaches (light or heat)
Biolase Tech Laser and HP 38%
Den-Mat LUMIBrite HP 35%
Den-Mat LUMIBrite Bleach Free
Discus Dental Zoom Advanced Power
Plus Lamp HP 25%
GC America GC TiON 3% HP mixed
with 30% CP = 20% HP
LumaLite w LumaCool System HP 35%
Chairside Unassisted Bleaches
Dentsply NUPRO White Gold HP 36%
Life-Like In-Office HP 35%
Premier Perfection White HP 35%
SDI Pola Office+ HP 37.5%
TREATMENT
TIME
# SESSIONS
TO
COMPLETION
20 min
60 min
35min
3 x 15min
2
1
1
1
MI Paste
60 min
3 x 20min
Optional
No
No
Yes, before and after
treatment
Optional
nothing
3 x 8min
1 x 24min
Yes, afterward
Nothing
Nothing
Nothing
KNO3
15-45 min
40 min
1 hour
3 x 8 min
1
4 x 10min
1
1 x 24 min
No
Yes, included
Yes, afterward
No but optional
KNO3
NaF/KNO3
NaF
Relief ACP
Home Tx Rec Before
or After
TREATMENT
17
©Karen Baker, M.S. Pharm, 06/01/17
SDI Pola Zing CP 35%
Ultradent Opalescence Boost HP 38%
At-Home Carbamide Peroxide
3M ESPE White&Brite CP 10,16,22%
DenMat LUMIBrite 16%, 22%, 32%
GC America GC TiON CP 15%
Heraeus Kul Natural Elegance CP 16,22
Life-Like CP 10%,15%,20%,30%
Nuvora White CP 17%
SDI Pola Night CP 10%,16%, 22%
SDI Pola Paint CP 8%
Ultradent Opalescence PF CP 10%,
15%, 20%, 35%
At-Home Hydrogen Peroxide
Discus Dental Zoom Weekend HP6%
Premier Perfecta Bravo HP 9%
Premier Perfecta REV HP 14%
SDI Pola Day HP 3%,7.5%,9.5%
WOW SPRAYWHITE PRO HP 17.5,35
At-Home HP/CP Combination
Dentsply Nupro White gold HP 15%,
CP 15% or 10%
Discus Dental NightWhite ACP and
DayWhite ACP HP 6-9.5%, CP 10-38%
Na and KNO3
NaF and KNO3
Carbopol
Carbomer
NaF/KNO3
NaF/KNO3
Nothing
Cellulose Polymer
NaF/KNO3
NaF/KNO3
NaF/KNO3
30 min
15 min
1 but home tx
3-4 x 15 min
Yes, afterward
Yes, afterward
1.5-2h
2h/1h/3min
2-4h, max 10h
22%-1hperday
20-60min
1-2h
1-8h
30min 2x daily
30min for 35%,
others 4-8 h
7-14days
14 days
14 days
10-14days
10-14 days
10-14days
10-14 days
Up to 14 days
10-14 days
TouchUp Avail
TouchUp Avail
TouchUp Avail
TouchUp Avail
TouchUp Avail
TouchUp Avail
TouchUp Avail
It Is a TouchUp
TouchUp Avail
4-8 h
30 minutes
15 minutes
30-90 min
1-90 sec
2-3 days
10-14 days
7-14 days
7-14 days
1-7 days
Yes, included
TouchUp Avail
TouchUp Avail
TouchUp Avail
TouchUp Avail
15minovernight
Night-8hmax
Day 15-30min
1-2x daily
7-14 days
TouchUp Avail
7-14 days
TouchUp Avail
NaF/KNO3
Carbomer
Carbomer
NaF/KNO3
KNO3
NaF/carbopol
NaF/KNO3
IX. ADA Professional Product Review of 6 Chairside Whitening Systems






BIOLASE LaseSmile System
BriteSmile Whitening System
Den-Mat Sapphire System
Discus Dental Zoom2
Life-Like 35% HP System
UltraDent Opalescence Extra Boost
X. MOUTHWASHES USED FOR COSMETIC AND THERAPEUTIC EFFECTS
A. PROPERTIES OF SELECTED OVER-THE-COUNTER MOUTHWASHES
Product (Manufacturer)
Alcohol (%) PH Active Ingredients
Advance Breath Care (Arm&Hammer)
15
9.1 Baking Soda, Zince Citrate, Cetylpyridinium Cl
Biotene (Laclede)
0
6.5 Glucose oxidase, lactoperoxidase, lysozyme
Cepacol (SKB)+++
14.5
6.0 Cetylpyridinium chloride 0.05%
Colgate Dry Mouth Relief (Colgate)
0
6.0 NaF -.048%, Glycerin, PG, CPC, Sorbitol once daily
Crest Pro-Health Complete (P&G)
0
6.0 NaF-.0219%, CPC for twice daily use
Crest Pro-Health Mouthrinse (P&G)
0
4.7 Cetylpyridinium chloride 0.07%
Crest Pro-Health Enamel Shield (P&G)
0
6.4 Sodium Fluoride 0.02% for 10ml twice daily use
Crest 3D White Multicare Whitening Rinse
0
5.4 H2O2, sodium hexametaphosphate
Lavoris Crystal Fresh (Dep)
5
6.0 Citric acid, zinc oxide, sodium hydroxide, zantrate
Listerine Antiseptic Mouthrinse (J&J)
21.6
4.2 Four essential oils in a hydroalcoholic rinse
Listerine Total Care Anticavity Rinse(J&J)
21.6
3.2 NaF 0.0221% for 10ml 2x daily use, NO EOs
Listerine Total Care Mouthrinse (J&J)
21.6
6.0 NaF 0.0221% for 10ml 2x daily use, SLS,No EOs
Listerine Whitening Pre-Brushing (J&J)
8
5.8 Hydrogen Peroxide 2%, castor oil, No EOs
Listerine Whitening Plus Restoring Fluoride
10.5
4.0 NaF 0.0221% for 10ml 2x daily use,H2O2,castor oil
Listerine Zero Less Intense (J&J)
0
4.3 Sodium lauryl sulfate, benzoic acid,sorbitol
Listermint Arctic Mint (Pfizer)
0
5.8 Sodium lauryl sulfate, zinc chloride
18
©Karen Baker, M.S. Pharm, 06/01/17
Natural Dentist Anti-Gingivitis
Natural Dentist Anti-Cavity
Natural Dentist Whitening/Gingivitis
Oral-B Anti-Plaque Rinse
Oral Max Oral Rinse (Novus Natural )
Peroxyl (Colgate)
Plaque HD Remineralizing (TJA)
Rembrandt Premium Whitening Plus (J&J)
Rembrandt Whitening with Fluoride (J%J)
Scope Outlast Long Lasting (P&G)
Scope with Baking Soda (P&G)
Scope Sparkle Mouthrinse (P&G)
Signal (Chesebrough-Ponds)
SuperSmile (Robell Res)
Targon (Block)
Therasol (Oratec)
Tom’s of Maine Wicked Fresh (Colgate)
Tom’s of Maine Natural Cleansing(Colgate)
Tooth and Gum Tonic (Dental Herb Co.)
0
0
0
0/6.6
0
0
0
0
0
13
9.9
0
14.5
0
6
8
0
0
0
3.3
7.0
6.0
7.0
3.0
3.7
8.4
4.0
6.4
6.0
8.4
5.0
6.8
8.2
5.5
5.5
3.1
2.7
4.7
Peppermint,sage,aloe vera, xylitol
Sodium Fluoride 0.05%, aloe vera, xylitol
Peppermint,sage,citric acid,betaine
Cetylpyridinium chloride 0.05%
Natural tannins from plant polyphenols
Hydrogen peroxide 1.5%
BS,,zinc citrate,,xylitol,,melaleuca, aloe vera
.05% NaF, H2O2, castor oil, glycerin for once daily
0.02% NaF, H2O2, Castor oil for twice daily
Concentrated flavoring oils, CPC, benzoic acid
Baking Soda, cetylpyridium chloride, domiphen br
Hydrogen Peroxide, sodium hexametaphosphate
Sodium lauryl sulfate, sodium chloride
NaMFP, BS, pyrophosphates, calcium peroxide
Castor oil, detergents
0.3% C31G, NaF 0.02%, glycerin
Vitamin C, aloe vera, glycerin, witch hazel
Oils of peppermint,red thyme,cinnamon,eucalyptus
PATIENT POINTS: 1. Listerine must say “Antiseptic” on the yellow banner in order to significantly reduce gingivitis.
2. Mouthwash containing peroxide cannot significantly whiten vital teeth.
3. Breath freshening effects of high concentration flavoring oils last about 1 hour.
4. Effective oral malodor agents are zinc salts, chlorine dioxide & antimicrobial essential oils.
5. Many fluoride rinses now contain 0.02% NaF to be used twice daily instead of 0.05% once daily.
B. PROPERTIES OF “THERAPEUTIC” MOUTHWASH PRODUCTS
Product
Plaque Reduction Toxicity
Alcohol
Chlorhexidine (Peridex, Periogard, generics))
High
Low
11.6%
Delmopinol (PerioShield,ButlerGUM.)
Moderate
Low
0%
Phenolics (Listerine gold/blue or green, TC)
Moderate
Low
26.9%/21.6%
Sanguinarine (Viadent Original)
Low-moderate
Low
11.5%
Quat. Ammon. Comp.++ (Scope/Cepacol,
Low
Low
18%/14%
Viadent Advanced Care, Crest Pro Health)
Low-moderate
Low
0%
Oxygenating Agents (H2O2/chlorine dioxide)
Low
Unsure
0%
Pre-brushing (Plax/New Plax)
Low
low
7.5%8.5%
PH
5.6
5.7
4.4
4.5
6.5/6.0
6.0
2.7/8.4
8.2
Substantivity
High
Mod
Low
Low
Low
Low-Mod
Low
Low
C. THERAPEUTIC MOUTHRINSE: FLUORIDE
TOPICAL/HOME-USE RINSES
Nonprescription
Prescription
Generally 0.05% NaF designed for 10ml once daily use
Generally 0.2% NaF designed for 10ml once weekly use
which exposes teeth to 2.23mg F- per day
which exposes teeth to about 9mg F- per day
Act Restoring-11% alcohol in icy cool mint, cinnamon,
NaFrinse Acidulated Oral Rinse and Systemic Supplement,
vanilla mint, icy spearmint by Chattem
Orachem Pharmaceuticals
Act for Kids Fluoride Anti-Cavity Treatment for Kids-BB
NaFrinse, 0.05%,, Orachem Pharmaceuticals
Act Anti-Cavity ETOH-free mint or cinnamon for adults
Fluorigard Anti-Cavity Dental Rinse, Colgate-Palmolive
NaFrinse, 0.2%, Medical Products Laboratories, Oral
Co.
Pharmaceuticals Div.
Oral-B Rinse Therapy Anti-Cavity Treatment, Oral-B Lab
Phos-Flur® Oral Rinse Supplement, Cherry, Cinnamon,
Fluorinse by Oral-B
Grape, Wintergreen, Colgate-Hoyt Laboratories, Div. Of
Colgate-Palmolive Co.
NaFrinse Acidulated Oral Rinse 0.05%, Colgate Oral
PreviDent Dental Rinse, 0.2% Colgate Oral Pharmaceuticals
Pharmaceuticals
NaFrinse Neutral Rinse, 0.05%, colgate Oral
Pro- Dentx 0.02% Neutral Sodium Fluoride Rinse (ProPharmaceuticals
Dentec)
19
©Karen Baker, M.S. Pharm, 06/01/17
COCHRANE LIBRARY REVIEW 2012
“Fluoride mouthrinses for preventing dental caries in children and adolescents”
Regular supervised use of fluoride mouthrinses by children would reduce their tooth decay, even if they
drink fluoridated water and use fluoridated toothpaste.
Fluoride is a mineral that prevents tooth decay (dental caries). Since widespread use of fluoride toothpastes
and water fluoridation, the value of additional fluoride has been questioned. Fluoride mouthrinse is a
concentrated solution that needs to be used regularly to have an effect. The review of trials found that
regular use of fluoride mouthrinse reduces tooth decay in children, regardless of other fluoride sources. One
in two children with high levels of tooth decay (and one in 16 with the lowest levels) would have less decay.
However, more research is needed on adverse effects and acceptability of mouthrinses.
D. Therapeutic Mouthrinses: Anti-Plaque/Anti-Gingivitis
i. Efficacy of Crest ProHealth Mouthrinse for Gingivitis Reduction
ii. Oxyfresh (Oxyfresh USA) – toothpaste and mouthwash for halitosis
CloSys II mouthrinse and Closys II toothpaste (Rowpar Pharmaceuticals)
ProxiPure (Dentist Preferred Inc., 1.800.997.7694) – contains chlorophyll
Ingredients: stabilized chlorine dioxide (Purogene)< pH = 8.4-9.2
Smart Mouth Advanced Clinical Formula contains CPC 0.05% and is promoted for
Maximum Plaque and Gingivitis Protection along with breath odor reduction.
Smart Mouth Original Formula contains sodium chlorite and zinc chloride.
iii. Listerine Mouthrinses (J&J) – Only those that say “ANTISEPTIC” on the yellow
banner areADA/CDA accepted for plaque and gingivitis reduction: Cool Mint,
Freshburst, Naturals, Original, Soft Mint and UltraClean are all effective in
reducing gingivitis by 25-36% in addition to toothbrushing.Don’t dilute!!
Directions: Rinse with 20ml twice daily for 30 seconds, pH = 4.2
LISTERINE WHITENING PLUS RESTORING – 2% H2O2, alcohol 10.5%, and
0.0221% NaF designed for 10ml 2x daily use. Contains NO anti-gingivitis (EO)
ingredients
LISTERINE AGENT COOl BLUE – alcohol free disclosing rinse for use prior to
brushing twice daily. FD&C Dye No. 1 is the disclosing agent.
LISTERINE TOTAL CARE – has 21.6% alcohol and 0.0221% Fl for 10ml 2x/day
iv. Chlorhexidine 0.12% [Peridex (Omnii)], [Periogard (CP)], [Chlorhexidine 0.12% rinse
(Teva or Barre)] – ADA/CDA accepted anti-plaque and gingivitis
The standard for comparison for plaque and gingivitis reduction.
Ingredients:
Chlorhexidine gluconate 0.12%, 11.6% ETOH, pH =5.6
Directions:
Rinse with 15ml twice daily. Foaming agents inactivate chlorhexidine.
Advantages:
Substantivity, lack of toxicity, broad spectrum of antimicrobial activity
Disadvantages: Staining, increased calculus formation, alcohol content, taste, unstable
in toothpaste due to inactivation by anionic surfactants such as SLS
Chlorhexidine 0.12% alcohol free and therapeutically equivalent (Sunstar
America) and pH is 5.1
20
©Karen Baker, M.S. Pharm, 06/01/17
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