Oral Health Products For Home Use: An Update For

Transcript

ORAL HEALTH PRODUCTS FOR HOME USE: AN UPDATE FOR THE DENTAL CLINICIAN 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 Websites  www.dentalproductshopper.com  www.dentalcompare.com  www.dentalcare.com; www.colgateprofessional.com;  www.drugstore.com D. Professional Newsletters  "Biological Therapies in Dentistry" published by BCdecker.com  edited by Dr. Sebastian Ciancio and published 6 times per year  to order call 800.568.7281 (US and Canada). Cost is $53.75US/$79CAN/year  "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: [email protected]  www.foodnews.org; www.ific.org, www.quackwatch.org  www.consumerlab.com, www.mskcc.org/mskcc/html/11570.cfm  www,supplement-geek.com, www.science-based medicine.org III. 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 Bisbiquanides Halogens Heavy 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 Sodium Lauryl Sulfate Pre-brushing rinses, almost all toothpastes Chlorhexidine * Alexidine* Peridex, Periogard, ProSoL PerioChip, generics European products only Chloramine-T Chlorine Dioxide Fluoride Iodine/Iodophors* Oxychlorosene Povidone-iodine Zinc Citrate* or Zinc Chloride* Tin* Chlorazene Oxyfresh Rinse/Paste, Clos-Sys IIRinse/Paste, etc. MFP= 14% F-, NaF= 45% F-, SnF2= 24% F-, Ora-5 Kasdenol Betadine, Perimed TC (Aim, Close-Up,Tom’s of Maine)Lavoris, Listermnt, 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* Domiphen Bromide Delmopinol* Simethicone, dimethicone Confident Paste and Rinse, Tea Tree Products, etc. Many “natural” oral health products Gly-Oxide, Proxigel, Many Office Preparations Amosan Ortho-Fluor, Perimed, Peroxyl, Crest Whitening Rinse S.T. 37 Many generic formulations also available Cepastat, Chloraseptic, Carmex Lip Balm Mentadent-P (zinc citrate, NaF), Crest Gum Health/Ultra(5% pyrophosphate, NaF), Colgate Gum Protection (2% copoLymer,NaF) Colgate Total (2% copolymer, NaF) Scope, Crest Toothpaste with Scope Cepacol, Crest Pro Health Viadent Rinse,BreathRx 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 $1.9 Billion spent in 2013] 1. ANTI-CAVITY KID'S MOUTHWASH Types ANTI-GINGIVITIS DESENSITIZING ANTI-CALCULUS DEODORIZING BAKING SODA WHITENING "NATURAL" PROTECT ENAMEL 2 ©Karen Baker, M.S. Pharm, 02/10/14 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 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 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 a 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 Ingredients ClinPro 5000 1.1% NaF (3M ESPE) 1.1% NaF 5% Novamin Control Rx (Omnii)# 1.1% NaF Dimethicone (Microdent) Cypress SF 5000 Plus (Cypress) 1.1% NaF - . Denta 5000 Plus (Rising) Fluoridex (Discus)# Prevident 5000 Plus (CP)# Prevident Dry Mouth (CP)# Prevident Booster (CP)# Prevident Sensitive (CP)# Pro-Dentx (Pro-Dentec)# Topex Renew (Sultan Healthcare)# *Consumer Reports, 9/1992 or 8/1998 #Available Rx only, not ADA accepted RDA+ 68 80 - 1.1% NaF Available as 2-pack 1.1% NaF May have KNO3 1.1% NaF 80 1.1% NaF No SLS 110 1.1% NaF Penetrating Formula 110 1.1% NaF 5% KNO3 90 1.1% NaF 90 1.1% NaF 5% Novamin +ADA Council on Dental Therapeutics, May 1993 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 3 ©Karen Baker, M.S. Pharm, 02/10/14 c. ANTI-PLAQUE AND GINGIVITIS DENTIFRICES (*Two are ADA Accepted for Plaque/Gingivitis) Product* Cleaning FRDA Other Ingredients 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 Biotene PBF paste (GSK) MFP 78 Calcium lactate, mucinase, dextranase Blend-A-Med (Blendex) MFP Allantoin, urea 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 ProHealth Night (P&G) SnF 139 Stannous Fluorite, Sodium hexametaphosphate,zinc Listerine EC paste/gel (J&J) 60/(4) MFP 85 Essential oil ingredients as in the rinse Oral Defense (BioGlobe Tech) NaF Cetylpyridiumium Cl, no SLS Oxyfresh (Oxyfresh USA) 45 Stabilized chloride dioxide Tom’s of Maine Antigingivitis 68 Zinc citrate 2%, xylitol, baking soda Viadent Adv. Care (C-P) MFP Zinc citrate 2%, no sanguinaria (bloodroot) * 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. 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) 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 - F NaF MFP NaF NaF NaF MFP MFP 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) 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 combination. 4 ©Karen Baker, M.S. Pharm, 02/10/14 e. “NATURAL” OR HERBAL DENTIFRICES Product/Manufacturer Claims Auromere (www.auromere.com) Invigorates/purifies Burt’s Bees(www.burtsbees.com) Multicare,Whiten,Kids Dabur (Nature Care) Astringent/cleaning 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 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 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 Cranberry,calciumphosphosilicate,FTulsi, Loturbark, essential oils 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 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 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 FAim TC (Church&Dwight) .80 MFP Aquafresh TC (GSK)** +++ .24 NaF A & H TC Toothpaste (Church&Dwight) .24 NaF A&H TC Gel (Church&Dwight) .24 NaF Close-Up TC Paste (Church&Dwight) .76 MFP Close-Up TC Gel (Church&Dwight) .76 MFP Colgate TC Gel (CP)** +++ .24 NaF Colgate TC Paste (CP)** +++ .24 NaF Colgate TC Gel/Paste MCF (CP)** +++ .24 NaF Colgate TC Micro Cleansing (CP)** +++ .24 NaF Kiss My Face TC with Zinc Citrate Listerine EC TC Gel/Paste (J&J) .76 MFP Natural White TC (Natural White) .24 NaF Pepsodent TC (Church&Dwight) .76MFP Rembrandt TC Paste (J&J) .80 MFP Sensodyne TC/Plus Whitening (GSK) .24 NaF Tom’s of Maine TC&Whitening (Colgate Ultra-Brite All in One (C-P) .24 NaF *ADA CDT, May 1993, **ADA Accepted, +Consumer Reports 1992, 1998 Cleaning+ (4) 62 63 74 62 (4) RDA* 108 124 34 71 98 87 165 87/113 112 (4) - 90 113 55 100 90 - Other Ingredients Zinc citrate 0.5% Tetra NA pyrophosphate 3.3% Napyrophosphate, Naphosphate Napyrophosphates Zinc citrate 0.5% NaCl, zinc citrate 0.5% 3.3% tetraNapyrophosphate, PVM/MA 3.3% tetraNapyrophosphate, PVM/MA 3.3% tetraNapyrophosphate, PVM/MA 3.3% tetraNapyrophosphate, PVM/MA Zinc citrate, aloe vera, lemon flavored Zinc citrate trihydrate, essential oils TetraK pyrophosphate Zinc citrate, silica "Citroxain" = alumina, papain, citric acid KNO3, tetra Kpyrophosphate, silica Zinc citrate, xylitol, hydrated silica 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. 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 Sensitive (CP) Crest Pro-Health (P&G) Crest Sensitivity Protection (P&G)* +++ Denclude Desensitizing Dental Cream with Sensistat (Ortek) Dr. Collins Restore with Novamin Orajel Sensitive (Del)* Prevident Sensitive (P&G) Sensodyne Baking Soda (GSK) Sensodyne Cavity Prevention (GSK)* +++ Sensodyne Fresh Mint* (GSK) Sensodyne Cool Gel (GSK) Sensodyne Iso-Active Gel (GSK) Sensodyne Original Flavor (GSK) Sensodyne Pronamel (GSK) Sensodyne Pronamel for Children (GSK) Tom’s of Maine Sensitive Teeth Natural Toothpaste (Colgate) Topol Plus Sensitive Teeth (Dep) FNaF NaF MFP NaF SnF SnF NaF 1%MFP NaF NaF MFP MFP NaF Naf MFP NaF Densensitizer 5% KNO3 5% KNO3 5% KNO3 Ca and Phos 5% KNO3 SnF 5% KNO3 Sensistat Novamin 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 90 55 89 89 92 92 100 39 NaF MFP 5% KNO3 5% KNO3 - 39 68 - PATIENT POINTS: 1. Potassium Nitrate is the most effective OTC desensitizer. 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 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) Silica,sodium hexametaphosphate NaF Crest 3D White Vivid (P&G) Silica, disodium pyrophosphate NaF Crest Whitening Plus Scope (P&G) 52 M 125 Scope MW ingredients,pyrophosphate NaF Gleem (P&G) 79 M 118++ Silica, triNaphosphate, titanium diox Natural White (Natural White) M 101++ Silica, glycerin, titanium dioxide NaF Pearl Drops BS Paste (C&D) TetraK&Na pyrophosphates, BS, td NaF Pearl DropsPaste (C&D) 74 Silica 6 ©Karen Baker, M.S. Pharm, 02/10/14 Pearl Drops Toothpolish (C&D) Pepsodent F- (Church&Dwight) Plus White (CCA) NaF MFP MFP (4) 58 - H M M 227++ 150 94++ Silica, AlHydroxide, triNaphosphate Silica TriNaphosphate, monoNaphosphate Rembrandt Deeply White (J&J) Rembrandt Plus # (J&J) MFP MFP 53(3) M L 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 94 L 94+ Urea Peroxide,hydrated silica Citroxain(papin, alumina, NaCitrate)Carbamide peroxide Carbamide peroxide < 3% citroxain NaF NaF MFP MFP MFP MFP MFP 82 76 L L H H 55++ 94 134 62+ 207++ 227++ 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 MFP Ultra-Brite BS (C-P) M Silica, BS, alumina, titanium dioxide MFP Ultra-Brite BS &Peroxide (C-P) (3) M Silica, BS, prop glycol, Caperoxide MFP Ultra-Brite Paste/Gel (C-P) 86/72(5) M/M 133++ Silica, alumina, titan. dioxide, pyro MFP Ultra-Brite Advanced Whitening M 145 Silica, tetrasodium pyrophosphate *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. 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, or high detergent content  Tom’s of Maine Clean & Gentle, SquigleEnamelSaver, Burt’s Bees,Biotene 3. Smokers or Chewing Tobacco Users  Avoid, Colgate Whitening/ Rembrandt / Stay White/ Supersmile/ Ultra Brite BS & Peroxide/ White Step (any toothpaste with peroxides) 7 ©Karen Baker, M.S. Pharm, 02/10/14 IV. CREST WHITESTRIPS: THE NAMES JUST KEEP CHANGING 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. C. Effectiveness 1. Crest Whitestrips Supreme – 14% HP in 84 strips for 21 days of twice daily use 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 V. J&J Rembrandt Whitening Strips A. Home Use -Noticeably whiter teeth in 5 days with once a day 30 minute wear time -8% Hydrogen Peroxide vs. 10% HP for Whitestrips Premium -Longer strip and less slippage than Crest Whitestrips -Patented dry gel formula keeps peroxide at the treatment site B. Consumer Reports Evaluation of Home Whitening August 2009 1. Compared Crest Whitestrips to Aquafresh, Rembrandt and others 2. Conclusion was that Crest Whitestrips was the most effective product and the Crest Product was the only one to receive a CR recommendation. 8 ©Karen Baker, M.S. Pharm, 02/10/14 VI. SALIVA ENHANCERS A. 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 1. Omnii Oravive Tooth Revitalizing Paste (Oravive) 2. DenShield Tooth Sensitivity Therapy (Novamin) 3. Butler NuCare Tooth Root Conditioner (Butler) 4. SootheRx Sensitivity Therapy (Omnii) 5. Dr. Collins Restore Toothpaste for Home Use Calcium Sodium-phosphosilicate PLUS NaF 5000ppm 1. ClinPro – 3M Espe 2. Topex Renew - Sultan B. 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. 1. Sugarless gum – Trident White and Trident for Kids Berry 2. MI paste and plus by GC America – “Comparison of Recaldent Technology” sheet C. Soluble Calcium Sulfate 1. Arm & Hammer Enamel Care Toothpaste (Church and Dwight) D. 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% E. 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) 9 ©Karen Baker, M.S. Pharm, 02/10/14 VII. MOUTHWASHES A. PROPERTIES OF SELECTED OVER-THE-COUNTER MOUTHWASHES Product (Manufacturer) Alcohol (%) PH Active Ingredients Act Anticavity Mouthrinse (Chattem) 0 6.4 0.05% NaF for 10ml once daily rinsing (Mint,Cinnamon,Bubblegum,Oceanberry, Scooby Doo Watermelon) Act Braces Care Anti-Cavity Fluoride Mouthwash with Xylitol Act Dry Mouth Rinse (Chattem) 0 6.6 0.02% Naf, Xylitol, aloe vera 0 6.8 Act Restoring Mouthwash (Chattem) Act Restoring Anti-cavity Mouthwash Act Sensitive Care Anti-cavity Rinse 11 11 0 6.4 6.4 6.6 Act Total Care Rinse (Chattem) 0 6.6 0.02% NaF for twice daily rinsing, glycerin, sorbitol, xylitol, propylene glycol, CPC 0.02% NaF for twice daily rinsing, sorbitol, CPC 0.05% NaF for once daily rinsing, sorbitol,CPC 0.02% NaF for twice daily rinsing, glycerin,sorbitol,xylitol, natural plant extracts 0.02% NaF, sorbitol, CPC Act Total Care Sensitive Formula 0 6.6 0.02% NaF, glycerin, sorbitol, xylitol, CPC Advance Breath Care (Arm&Hammer) Biotene (Laclede) Cepacol (SKB)+++ Colgate Dry Mouth Relief (Colgate) Crest Pro-Health Complete (P&G) Crest Pro-Health Mouthrinse (P&G) Crest Pro-Health Enamel Shield (P&G) Crest 3D White Multicare Whitening Rinse Diabeta Rinse Lavoris Crystal Fresh (Dep) Listerine Restoring Anticavity Rinse(J&J) Listerine Total Care Mouthrinse (J&J) Listerine Whitening Pre-Brushing (J&J) Listerine Whitening Plus Restoring Fluoride Listerine Zero Less Intense (J&J) Listermint Arctic Mint (Pfizer) Natural Dentist Anti-Gingivitis Natural Dentist Anti-Cavity Natural Dentist Whitening/Gingivitis Oral-B Anti-Plaque Rinse Peroxyl (Colgate) Rembrandt Premium Whitening Plus (J&J) Rembrandt Deeply White with Fluoride (J%J) Scope with Baking Soda (P&G) Scope White Mouthrinse (P&G) Signal (Chesebrough-Ponds) SuperSmile (Robell Res) Targon (Block) Therasol (Oratec) 15 0 14.5 0 0 0 0 0 0 5 21.6 21.6 8 10.5 0 0 0 0 0 0/6.6 0 0 0 7.0 3.7 4.0 6.4 Baking Soda, Zince Citrate, Cetylpyridinium Cl Glucose oxidase, lactoperoxidase, lysozyme Cetylpyridinium chloride 0.05% NaF -.048%, Glycerin, PG, CPC, Sorbitol once daily NaF-.0219%, CPC for twice daily use Cetylpyridinium chloride 0.07% Sodium Fluoride 0.02% for 10ml twice daily use H2O2, sodium hexametaphosphate Aloe vera, echinacea, tea tree oil, chamomille Citric acid, zinc oxide, sodium hydroxide, zantrate NaF 0.0221% for 10ml 2x daily use, NO EOs NaF 0.0221% for 10ml 2x daily use, SLS,No EOs Hydrogen Peroxide 2%, castor oil, No EOs NaF 0.0221% for 10ml 2x daily use,H2O2,castor oil Sodium lauryl sulfate, benzoic acid,sorbitol Sodium lauryl sulfate, zinc chloride Peppermint,sage,aloe vera, xylitol Sodium Fluoride 0.05%, aloe vera, xylitol Peppermint,sage,citric acid,betaine Cetylpyridinium chloride 0.05% Hydrogen peroxide 1.5% .05% NaF, H2O2, castor oil, glycerin for once daily 0.02% NaF, H2O2, Castor oil for twice daily 14.5 0 6 8 8.4 5.0 5.5 - 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 Tom’s of Maine Dry Mouth Anti-Cavity Tom’s of Maine Natural Cleansing(Colgate) 0 0 6.8 2.7 0.44% NaF, xylitol, aloe vera, Vitamin C, aloe vera, glycerin, witch hazel 4.7 Oils of peppermint,red thyme,cinnamon,eucalyptus 6.0 6.0 6.0 6.0 6.4 5.0 6.0 6.0 3.2 6.0 5.6 4.0 7.0 5.8 9.9 Tooth and Gum Tonic (Dental Herb Co.) 10 ©Karen Baker, M.S. Pharm, 02/10/14 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 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) D. Therapeutic Mouthrinse: Anti-Plaque 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 iii. Listerine Antiseptic (J&J) – ADA/CDA accepted plaque and gingivitis reduction Ingredients: menthol, methyl salicylate, eucalyptol, thymol, 21.6% ETOH, TC contains ZnCl 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 daily use 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 will 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 (Sunstar Americas – now available from pharmacies by prescription only) 11 ©Karen Baker, M.S. Pharm, 02/10/14