Inorganic Pharmacy-II

Dental Products

Md. Abdul Muhit, PhD

Associate Professor
Department of Clinical Pharmacy and Pharmacology
University of Dhaka, Bangladesh
 Introduction
The inorganic compounds and their formulations which are used in
maintaining the oral and dental hygiene are known as dental products.

Dental products include anticaries agents , polishing agents, and

desensitizing agents.

Anticaries agents: These are the agents which help in prevention of

dental decay. e.g. Sodium fluoride, stannous fluoride, sodium
monofluorophosphate

Cleaning agents (Dentifrices/ Polishing agents): Dentifrices are agents

used along with a toothbrush to clean and polish natural teeth. They must
be abrasive to some degree to remove the stains from the teeth. They are
supplied in paste, powder, gel or liquid form. e.g. Calcium carbonate,
Dibasic calcium phosphate, calcium phosphate, sodium metaphosphate

Desensitizing Agents: These reduce sensitivity of teeth to heat and cold.

Examples include strontium chloride and zinc chloride.
 Dental caries
Dental caries, or tooth decay, involves a gradual demineralization
(softening) of the enamel and dentin. If it is not treated then
microorganisms may invade the pulp, causing inflammation and infection.

Dental caries (tooth decay) is infectious disease, also called as dental

plaque, in which acid formed by the action of oral microbial flora on
carbohydrates.

Dental plaque is a biofilm or mass of bacteria that grows on surfaces within

the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it
is often brown or pale yellow. It is characterized by decalcification of tooth
accompanied by foul smell.
 Dental caries
The microbial flora (primarily streptococcus mutans and lactobacillaceae)
present in the mouth act on carbohydrates (taken in tea and food) and
produce acids, especially lactic acid.
Calcium salts are dissolved in acidic media, remaining organic matrix is
easily digested by the proteolytic enzymes and cavities are formed.
Dental caries can be prevented and oral and dental hygiene can be
maintained with the help of dentifrices. Dentifrices are the products that
enhance the removal of stain and dental plaque by the toothbrush. The
most accepted approach to prevent caries includes flossing and
brushing accompanied by administration of fluoride either internally or
topically to the teeth.
 Fluorides-Mechanism
The deposited fluorides on the surface
of teeth prevent the action of acids or
enzymes in producing cavities.
Fluoride is anticariogenic as it replaces
the hydroxyl ion in hydroxyapatite with
the fluoride ion to form fluorapatite in
the outer surface of the enamel.
Fluorapatite hardens the enamel and
makes it more acid resistant. It is also
possible that fluorides may possess
some antibacterial activity and help in
remineralization of enamel.
A trace of amount of fluoride in drinking
water is enough to prevent dental
caries. Fluorapatite has also shown
antibacterial activity.
 Fluorides-Mechanism
Fluoride can be administered by orally and topically. Fluoride can be
administered orally as sodium fluoride tablets or drops added in water or
fruit juice. Addition of fluoride to the municipal water supply, known as
fluoridation
Fluoride when administered internally, is readily absorbed from the
gastrointestinal tract, partially deposited in the bone or developing teeth
and the remainder gets excreted by the kidneys.
A small quantity (0.5 -1 PPM) of fluoride thus becomes necessary to
prevent caries. However, if more quantity of fluoride (more than 2-3 PPM)
is ingested it is carried to bones and teeth and gives rise to mottled enamel
known as dental fluorosis.
Slow continued ingestion of fluoride may cause mottling of teeth, increased
density of bones, gastric disturbances, muscular weakness, convulsions
and even heart failure.
Topical fluoride solution, mouthwashes and gels are less effective than
orally administered fluoride. Sodium fluoride tablets or solution of sodium
fluoride in a dose 2.2 mg/day is generally.
 Sodium Fluoride (NaF)
Properties: A white powder or colourless crystals. Soluble in water
practically, insoluble in ethanol (95 %)
Preparation: It may be prepared by neutralizing hydrofluoric acid with
sodium carbonate.
2HF + Na2CO3 2NaF + H2O + CO2
Another method includes the double decomposition of calcium fluoride with
sodium carbonate wherein insoluble calcium carbonate can be removed by
filtration
Uses: Sodium fluoride due to its fluoride ion is an important agent in dental
practice for retarding or preventing dental caries. Fluoridised teeth have
been resistant to microorganisms causing dental caries. It also decreases
microbial acid production.
Sodium fluoride in 2 % aqueous solution is widely used topically;
occasionally the solution is applied to the surface of dry teeth periodically
over several times in a year.
Application: 1.5 to 3 ppm (equivalent to 0.7 to 1.3 ppm of fluoride ion) in
drinking water; topically as a 2% solution to the teeth.
Sodium Fluoride (NaF)
 Stannous Fluoride (SnF2)
Properties: A white powder or colourless crystals, bitter and salty taste,
freely soluble in water and is practically insoluble in alcohol.
Advantages: Stannous fluoride is a valuable adjunct in the prevention of
caries and is considered to be superior to sodium fluoride for two reasons
i) simplified application ii) greater effectiveness.
The first advantage is supported by the fact that single application of 8 %
aqueous solution to the tooth surface is enough for every 6 months to 1
year, while, a 2 % sodium fluoride is applied 4 times during a 10 days
period.
The second advantage derives from the fact that the stannous ion
increases the anticariogenic action of fluoride ion so that both ions
contribute towards clinical effectiveness.
Uses: A freshly prepared 8 % solution of stannous fluoride is applied to the
cleaned teeth. A single application has been reported to be sufficient for six
to 12 months. Aqueous solution of stannous fluoride deteriorates rapidly on
standing because of oxidation of stannous cation to stannic form causing
turbidity. Thus stannous fluoride solution must be freshly made.
Stannous Fluoride (SnF2)
 Mouthwash
Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is
held in the mouth passively or swilled around the mouth by contraction of
the perioral muscles and/or movement of the head, and may be gargled.

Usually mouthwashes are antiseptic solutions intended to reduce the

microbial load in the oral cavity, although other mouthwashes might be
given for other reasons such as for their analgesic, anti-
inflammatory or anti-fungal action.

Additionally, some rinses act as saliva substitutes to neutralize acid and

keep the mouth moist in xerostomia (dry mouth).

Common use involves rinsing the mouth with about 20-50 ml of

mouthwash.

Generally it is given as antiseptic and anti-plaque mouth rinse to kill

the bacterial plaque that causes cavities, gingivitis, and bad breath. It is,
however, generally agreed that the use of mouthwash does not eliminate
the need for both brushing and flossing.
 Mouthwash
Common Ingredients:

1. Alcohol: Alcohol is added to mouthwash not to destroy bacteria but to

act as a carrier agent for essential active ingredients such as menthol,
eucalyptol and thymol which help to penetrate plaque.
2. Benzydamine/Difflam (analgesics)
3. Cetylpyridinium chloride
4. Benzoic acid: As buffer
5. Betamethasone: To reduce inflammation
6. Chlorhexidine digluconate and Hexetidine (antiseptic):
Chlorhexidine digluconate is a chemical antiseptic and is used in a
0.12–0.2% solution as a mouthwash. However, chlorhexidine binds
to tannins, meaning that prolonged use in persons who consume
coffee, tea or red wine is associated with extrinsic staining of teeth.
7. Essential oils: Phenolic compounds and
monoterpenes include essential oil constituents that have some
antibacterial properties (eucalyptol, eugenol, hinokitiol, menthol,
phenol, or thymol). Mouthwashes based on essential oils could be
more effective than traditional mouthcare - for anti-gingival treatments
 Mouthwash
Common Ingredients:

8. Fluorides: Anti-cavity mouth rinses use stannous fluoride to protect

against tooth decay.
9. Flavoring agents and Xylitol: Flavoring agents include sweeteners
such as sorbitol, sucralose, sodium saccharin, and xylitol, which
stimulate salivary function due to their sweetness and taste and helps
restore the mouth to a neutral level of acidity.
10. Hydrogen peroxide: Hydrogen peroxide can be used as an oxidizing
mouthwash (e.g. Peroxyl, 1.5%)
11. Lactoperoxidase (saliva substitute): Enzymes and proteins such
as Lactoperoxidase, Lysozyme, Lactoferrin have been used in
mouthrinses (e.g. Biotene) to reduce oral bacteria and hence the acid
produced by bacteria
12. Lidocaine/xylocaine: Oral lidocaine is useful for the treatment
of mucositis symptoms (inflammation of mucous membranes) that is
induced by radiation or chemotherapy
 Dentifrices
Dentifrices contain agents for cleaning tooth surfaces and providing
polishing effect on the cleaned teeth.

These agents are abrasive in nature. They are responsible for physically
removing plaque and debris. The overall effect provides whiteness to the
teeth.

Dentifrices are applied as powders or pastes. Examples include dicalcium

phosphate, sodium metaphosphate, pumice, calcium pyrophosphate,
calcium carbonate and calcium monohydrogen phosphate.

The main drawback is that it will not be able to clean surfaces inside
cavities and crevices between teeth, even if the material reaches them
during application.

The cleaning action is dependent upon abrasive property and the rubbing
force used. Pumice is too abrasive for daily use in a dentifrice.
Dentifrices
 Toothpaste
Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and
maintain the aesthetics and health of teeth. Toothpaste is used to
promote oral hygiene: it is an abrasive that aids in removing dental
plaque and food from the teeth and delivers active ingredients (most
commonly fluoride) to help prevent tooth decay (dental caries) and gum
disease (gingivitis).

Common Ingredients:

1. Abrasives: Abrasives constitute at least 50% of a typical toothpaste.

These insoluble particles are designed to help remove plaque from the
teeth. Ex. Calcium carbonate, calcium hydrogen phosphates, silica.

2. Fluorides: Sodium fluoride (NaF) is the most common source of

fluoride, but stannous fluoride (SnF2), olaflur (an organic salt of fluoride),
and sodium monofluorophosphate (Na2PO3F) are also used. Stannous
fluoride has been shown to be more effective than sodium fluoride in
reducing the incidence of dental caries
 Toothpaste
3. Surfactants: Toothpastes contain sodium lauryl sulfate (SLS) or
related surfactants (detergents). SLS is found in many other personal
care products as well, such as shampoo, and is mainly a foaming agent,
which enables uniform distribution, improving cleansing power.
4. Antibacterial agents: Triclosan, an antibacterial agent, is a common
toothpaste. Triclosan or zinc chloride prevent gingivitis and, according to
the American Dental Association, helps reduce tartar and bad breath.
5. Flavorants: Toothpaste comes in a variety of colors and flavors,
intended to encourage use of the product. The three most common
flavorants are peppermint, spearmint, and wintergreen.
6. Remineralizers: Hydroxyapatite nanocrystals and a variety of calcium
phosphates are included in formulations for remineralization, i.e. the
reformation of enamel.
7. Humectants: To suppress the tendency of toothpaste to dry into a
powder. Such as glycerol, sorbitol, or xylitol, or related derivatives, such
as 1,2-propylene glycol and polyethyleneglycol.
 Fluoride Toothpaste-1

Agents Amount
Stannous Fluoride 0.4%
Stannous pyrophosphate 1%
Calcium pyrophosphate 39%
Glycerin 10%
Sorbitol (70%) 20%
Water 29.6%
 Fluoride Toothpaste-2

Agents Amount
Sodium monofluorophosphate 0.76%
Insoluble sodium metaphosphate 41.85%
Anhydrous dicalcium phosphate 5%
Sorbitol 11.9%
Glycerol 9.9%
Sodium N-Lauroyl sarcosinate 2%
Water 24.4%
Miscellaneous formulating agents 4.2%
Toothpaste
 Abrasivity of dentifrices

Brand name Index

Listerine 26
Pepsodent 26
Colgate 51
Close-up 87
Crest 95
White plus 110
Sensodyne 157
Iodent 174
 Desensitizing agents
Desensitizing agents reduce the pain in sensitive teeth caused by cold,
heat or touch.

These products should be non-abrasive and should not be used on a

regular basis unless directed by a dentist. Examples include strontium
chloride (Sensodyne) and zinc chloride (Listerine).

The exact mechanism of action of desensiting agents is not known with

certainty. However they act probably like local anaesthetic.

Zinc chloride is very deliquescent. It is soluble in water or in alcohol, topical

to the teeth as 10% solution, to the skin and mucous membranes as 0.5 –
2.0%

Zinc-Eugenol cement is also used. It contains powder and liquid parts.

Such as Zinc acetate (0.5 g), Zinc stearate (1 g), Zinc oxide (70 g), Rosin
(28.5 g) should be added and Eugenol (85 ml) and cottonseed oil (15 ml)