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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)
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©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.)
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©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)
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©Karen Baker, M.S. Pharm, 02/10/14